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Opinions of Friday, 1 August 2014

Columnist: Atiyire, Carl Woni

Ghana Standard’s Authority, a mere window dressing

By Carl Woni Atiyire (carlatiyire@yahoo.com)

Even the president of the highest order of nations could not convince us that, together as a nation, we have failed. President Barack Hussein Obama upon assuming the reigns of governance in the United States, barely 6 months in office, made a historical stop -over to Ghana in July , 2009 and rehashed in our parliament unequivocally and forcefully, in his usual demeanor for speeches what we all know to be true “LET YOUR INSTITUTIONS WORK!!!”. I hope this declaration still rings in our ears fresh like yesterday. As I say all the time, even if we do not give priority to institutional workability, we can’t treat health matters with kid’s gloves; it is a sensitive area as it concerns lives.
This article extolls the health worker and yet exposes the risk involved therein, since health workers in Ghana provide quality health unquestionably even when the right systems are not put in place to check infection transfer, as they give care.

For the first time as a clinical nurse, i remember using a surgical glove for wound care, and to my utter amazement, there were stains of blood on the tip of my fingers, it is no mere occasion of happenstance as I tell you this, since I have to grapple with it on several occasions. A nurse in-charge also opened a supposedly new sterile glove, but lo and behold, the index and middle finger tips were quelled together like an aura of heat blazing brazenly piecemeal on a thick Brazilian hair, it was no surprise to everyone present anyway! Others have seen strands of hair or dead matter on the inner surface of these supposed surgical gloves after they are qualified and certified by the standards authority as user- worthy, bringing the quality of our gloves to consisting questioning. How can we trust these “Standard” crosiers?

The topic about the quality of our medical gloves is an issue most clinical workers do not want to delve into because of the perceived ephemeral benefits, the tediousness and the time saddling nature of the job. But be it as it may, deep down in their hearts, they have a bazillion unanswered questions to the Standards Authority. They know something amiss is going wrong, where do they begin even if the wish to? How many of them even know the Standards Authority regulates consumables like glove? Who will grant them audience even if the wish to ask? They fear to join the bureaucracy bandwagon of asking ad infinitum questions without response. Perhaps is the reason for the lack of interest in initiating a regime of questions to confront the issue head-on.

We are actually doing ourselves great disservice operating on patients and surreptitiously observing sterile procedures, while we care less to undertake post-mortem research analysis of immediate post-surgery infections. And for this reason, surgeons are quick to apportion blame, attributing most post-surgery infections and mortalities wholly on nursing inadequacies rather than the possible infection outcome during surgery. I tell you what? Because we cannot blame the problem on mere “RUBBER”. It’s this same glove hand that cuts the skin and peritoneum, opens the abdomen, explores the bowl, the stomach, the liver, kidneys , suture back the fissure and the skin and yet we refuse to reason the patently veritable evidence of any infection outcome should the glove be of low grade or infection riddled. Methinks the bigger blame should be on the Ministry of Health and the Ghana Health service whose overall onus is to ensure glove quality before brought into the hospital facility.

It is not uncommon to find nurses and doctors picking nosocomial infections from the ward as a result of glove usage and later use retirement benefits to nurse their ailments acquired during their active clinical periods. We have witnessed quit a number of Doctors and nurses getting infected with the HIV,Hepatitis B and tuberculosis from these same glove usage and have to spend the rest of their life nursing the psychological drilling. Am not saying normative praxis are not been adhered too, but what makes it normal any longer, when even the gloves we use on our patients are not of standard? For instance, disposable and surgical gloves are often imported from foreign countries and virtually nothing is done to check or counter check their quality. Aside Ghana Standards Authority which is the sole veritable entity for hospital consumables. I will advocate for a more counter check system approach to ascertain the quality of our gloves even after the Ghana Standards Authority has done their “CONNIVAL” studies, to ensure complete worker safety, because these guys are simply not to be trusted.Huh!!
In so doing , we will be equipping our hospital’s Central Sterile Supply Department with the mandate to counter check their quality. This should be the last in the series of checks to ensure full worker satisfaction for posterity sake.

How do we know our gloves are 100% user worthy? Even if its 70%, must we trust the Ghana Standard Authority for a 100% job done? To unkennel the truth, snippets of information made available reveals that the Ministry of Health and the Ghana Health Service buys these gloves from individual importers who intend bid from their cronies at the Standards Authority to make their products contract –worthy by ignoring formalized procedure. These insiders definitely have a stake in the business of the day at the expense of the poor health worker. Health workers bear the brunt of such greed and calumny from these rogues, as the break down earlier than expected in service, with debilitating palliative conditions. The sages in my hometown will say “voro vo yi Oto wo be mo?” To wit, the soothsayer foresees ones death, but he dies without foreseeing his own. So why the Doctor or the nurse becomes afflicted with medical conditions he /she is abreast of the etiology? This further loses confidence in the health system by the view of an unschooled audience.
Medical gloves are a shape covering for the hand that includes five separated sections for the thumb, index, middle finger, ring and the little fingers, used for general and surgical procedures. Gloves are used when there is the high propensity for fluid contact or where strict sterile procedures are observed. It’s the most common consumable Doctors and nurses will easily lay of their tools if stock is not replenished. There are basically two types. The disposable and the surgical glove. The disposable gloves are used for general procedures including removal of wound dressings for inspection, arresting hemorrhage, handling of patients with topical infectious diseases, taking sample for laboratory analysis etc. while the surgical gloves, as said earlier, are used for strict sterile procedures including nasogastric tube passage, setting of intravenous lines, catheter passage and general surgeries. But, they once nicely powdered gloves which reduces friction between the hand and glove and have an added benefit of reducing infection by killing invading bacteria are no more in the system, and that calls into question the quality of the gloves that come into our hospitals in recent times? To be way secured, some Doctors and nurses resort to double protection and I wonder for how long this will continue, giving the dearth of our supplies. Contemporary studies have even proven that double gloving rather creates more tension allowing the wear and tear phenomenon to work faster exposing individual to further bacteria invasion. Now, can you see how losing confidence in the SA leads to?
As I write this article, I do not foresee in the next few years, in this our beloved country, a forensically sustainable and provable research by any researcher of scholarly astuteness on the quality and use of both i-cannot-do-without surgical and disposable gloves in our health facilities. The Medical and Surgical Skills Institute at Korle-bu is also completely defunct in their operations; they have not published enough theses that will help revolutionize modern tropical asepsis as pertained to our side of the world.
It’s time we render health service to our clients from a health perspective. Whilst it’s imperative to note that the Ghana Standards Authority is there for our safety, let them tutor us to the processes these gloves go through bit-by-bit before they are ready for use, because even after all their so called numerous checks the gloves we receive are substandard in nature. We are simply tired of often being lulled into a greater sense of falsehood.
Let’s go back to the sane precepts of the oratory President Obama and parlay it to our advantage, that, indeed we need to strengthen our institutions and our institutions must work for us; that include the Ghana Standard Authority. And if the preceding is true, then, I dare all clinical practitioners within the hospital set-up to demand complete health insurance from the government or demand reparation in pre or post service acquired infections, as government lacklusterners in this regard, continuous to give the Standards Authority the carte blanche, not to work par excellence.
I purposely premised this article on gloves, because it is the only lexicon that binds clinical practitioners with their clients, and as a way of adding my voice on the issue of the questionable integrity of the Ghana Standard Authority. That, in the face of a chronic culture of silence on pertinent health issues, and people within a particular work domain swallows hook line and sinker what is brought before them without objectionable posture. It takes courage to do the Goliath from a David’s singular effort.
We love our profession, we are there to serve humanity, we care a lot about our patients, and we have families to live for, but, we must stay healthy and lively first to put smiles on the faces of others.

Carl Woni Atiyire (0240378034/0208149391)
Staff Nurse
Ridge Regional Hospital
Accra.