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Opinions of Tuesday, 7 February 2017

Columnist: Dr. Elikem Tamaklo

Ghanaians don’t trust Ghana’s healthcare system - It’s time to have a conversation about why

By: Dr. Elikem Tamaklo, MD, Nyaho Medical Centre

Nine months is a long time. From the confirmation of pregnancy to delivery, each moment is an array of numerous possibilities and a multitude of potential consequences. It is hard not to be overwhelmed by the thought of what could go wrong, despite all assurances that everything is okay.

Would you trust the Ghanaian healthcare system to deliver your child if you had a choice?

That was my experience when I found out that my wife was pregnant with our first child. The responses I received when I informed friends that my wife was going to give birth in Ghana, at Nyaho Medical Centre, was a mixture of “Why would you give birth in Ghana when you have the choice?” and “Don’t you know the statistics?!” Some even remarked, “Wow, that’s brave!” as though we were doing something extraordinary instead of something as natural, and as celebratory, as bringing a life into the world. I had reviewed the maternity service in the hospital with the clinical staff, and my wife and I made the decision feeling confident that all would be well.

Initially, I thought that these responses were due to the fact that we had recently moved back to Ghana from the UK, and that my wife was British. But as this continued on, doubt started to set in. Had we made the right decision? How would we cope if there was a complication and something bad happened... especially under my watch? How would I live with myself?

While these questions didn’t stop during the course of my wife’s pregnancy, with each antenatal visit, and with each new interaction with the doctors and midwives, my wife and I built trust. We questioned how the potential risks would be mitigated and we received good answers. Additionally, the knowledge that every day there was a baby born at Nyaho, and that two generations of women had given birth to their babies there, left us with a quiet sense of assurance that all would be well.

My medical knowledge and my understanding of the process were thrown to the side when the time came and I became the stereotypical soon-to-be father. I was frantic and helpless with the understanding that I could do nothing except hold my wife’s hands and encourage her. I was not in control, and I had to trust the doctors and the midwives with the life of my wife and our unborn child.

Eleven hours and an emergency caesarian section later, my wife gave birth to a beautiful baby girl. I was deeply humbled in that moment and tremendously grateful for the service provided to my family.

Fundamentally, the underlying issue is one of trust. It is an extremely vulnerable act to go to a hospital at a time of need and entrust relative strangers with your life or even the life of a loved one. And frankly, there’s a crisis of trust amongst the Ghanaian public concerning the ability of Ghana’s healthcare system to provide quality health outcomes. The issue of mistrust is systemic in all facets of life and came as a result of broken promises and empty words. In healthcare systems across the world, we were led to believe that doctors knew it all and nurses were perfect beings. Perhaps we also chose to believe this image of doctors as demi-gods because deep down, we could not accept the inevitability of death. Yet time and time again, we saw this illusion break down with repeated acts of negligence, and the ultimate effect was the chipping away of the trust that we placed in the healthcare system. We failed to see that doctors and nurses, were indeed human, and despite the skill and expertise that have been honed over many years, were prone to mistakes like all human beings.

So where did this leave us? For those who could afford it and could travel abroad, healthcare expertise was sought in countries that had developed ecosystems that ensured accountability. It wasn’t acceptable for clinical professionals to just show up to work or for hospitals to promise the best. They had to deliver on the effectiveness of their clinical practice, ensuring patient safety and ensuring that patients felt cared for because ultimately, they would be held accountable for the trust placed in them, either by the establishments they worked for or by the patients and their families through the legal system.

In Ghana, the story sometimes appears bleak because we do not speak about the success stories. Sensationalised stories fill the media and people, hurt by the system that failed them so terribly, retell their experiences over and over again… because inevitably, once trust is lost, it is extremely difficult to build back up again.

Despite this, there is still hope! There are hospitals and organisations who have embarked on the quality agenda, seeking to develop systems that build and maintain trust and who ensure, through vigorous risk assessment and risk mitigation, that repeated actions have the same positive results of clinical effectiveness, patient safety and positive patient experiences.

The conversation about quality healthcare in Ghana demands an introspective view on building and maintaining trust between healthcare providers and the Ghanaian public, if we are to see the kind of transformation required to bring equity into healthcare. The conversation should not be about where you were born or your ability to travel to another country, but rather about how health professionals in Ghana can consistently deliver world class care, even as we’re faced with challenges as varied as erratic power supply, scarce talent, and a punishing forex situation. We need to put aside preconceived ideas and look at healthcare with new eyes. Whilst the challenges are significant, we have to remind ourselves that once it has been done before, it is still possible.

Nyaho Medical Centre

At Nyaho Medical Centre, my team and I have been thinking deeply about this question of trust. For nearly half a century, Nyaho has helped many generations of Ghanaians attain their desired health outcomes, and in 2017, we’re embarking on a series of organization-wide changes to better position us to provide world class specialist care in Ghana to all.

We will be announcing the first of many initiatives next week, and I invite you to subscribe to the Nyaho Medical Centre email list to be amongst the first to hear what we’ve been working on over the last few months.

Similarly, if you have ideas about how Ghana’s healthcare community can collectively level up and do more, please feel free to reply in the comments.

My team eagerly looks forward to sharing our plans with you, and working with you to elevate the standard of healthcare in Ghana, as well as the West African sub-region as a whole.

Dr. Elikem Tamaklo, MD, Nyaho Medical Centre

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