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Opinions of Tuesday, 25 August 2020

Columnist: M.A.Y Kulewosi

When the doctors cast the first stone

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To go around propagating that Physician Assistants in Ghana are not well trained for which reason they must be supervised by doctors is an insult to any rational thinking person. I have heard rumours and read articles to the effect that medical doctors in Ghana, at least their lobbyists, are scheming to make the physician assistant program as useless as they can. I encountered a form signed by Dr, Patrick Kuma-Aboagye, the Director-General at the Ghana health service, where he endorsed that enrolled nurses and community health nurses (many of whom do not even have a diploma) can now go on study leave to read BSc. Physician assistantship.

There is nothing wrong with allowing health professional to advance in their professional fields. My problem, however, is that I encountered a study leave form where a Senior Physician Assistant who had one of these same doctors as his district director of health denying him the opportunity to also advance to become a medical doctor. What is the difference between a physician assistant’s work and the work of a medical doctor? Maybe I am yet to find out but the comment I read concerning why the senior physician assistant couldn’t progress to take the medical course was simply because the director in his wisdom was of the view that the two courses were unrelated.

Physician Assistants attend to patients independently at their various places of work, be it at a health centre, clinic or the hospital, and the patients they attend to are not dead. They are rational just like a banker, a policeman or even a Judge and can see, investigate, assess and refer cases to where they can be adequately solved. This is the same even at teaching hospitals where professors abound and M.Os struggle to find their feet during ward rounds. So I wonder why anyone so reasonable would think that because P.As mainly serve in the villages their service is not compatible with what is done by doctors and so cannot be granted study leave to read medicine.

When Ghanaian medical doctors begin to whisper about other healthcare professionals whom they think are not well trained, what are they actually referring to? Are they talking about a student who did not enter an institution from SHS with at least 6As 2Bs or they simply mean a person who read Physician Assistantship in any accredited university be it in Ghana or outside Ghana and has returned to practice in Ghana?
Let us face it. I am a physician Assistant simply because I am not interested in being a medical doctor. I think the doctors instead of saving lives are more interested in being greedy, self-centred and above all hypocritical than they want to save lives.

Even whilst in training, I could see that many Ghanaian doctors do not have that minimum level of intelligence that grants them the ability to think as scientists. Let me tell you a few stories of doctors I have encountered whilst still a student on clinical. I will tell you about a foreign-trained Ghanaian doctor, a Ghanaian trained doctor on housemanship and then a Ghanaian trained doctor who is a Medical officer.

Sometime 2014 whilst I was still under training, I had the opportunity to be mentored by a Snr Ghanaian doctor. He was an Obstetrics and Gynecology specialist and he had two of us to mentor, a fourth-year medical student from Ukraine and then myself a second-year Physician Assistant student. This snr doctor mentored us for a while on how he was attending to patients. How he took the complaints examined and gave medications to suit the diagnoses. Whilst in the midst of it, there was an emergency (from I gathered from the phone call he received) so he quickly finished with his last patient and left us in the office to attend to whoever comes but to call on him where we are not sure.

Looking at it rationally, the medical student was senior to me so I gave him the main seat and took the side seat. In no time a child was rushed in. Mother complained that the child was usually itchy at night and showed us some rashes that we examined. I saw a heat rash, the tiny bumps surrounded by red skin on the child’s back and around the neck. In order not make it seem like we were two learners, I observed throughout. But even without him asking what I also thought should be our intervention he quickly scribbled Whitfield’s ointment and signed off. I later asked him what he diagnosed and he said miliaria. I didn’t know what it was then but as soon as possible I reached for my smartphone and realized that miliaria was the same as the heat rash but Whitfield’s was not the right medication. The patient might have already taken her medication by the time I realized it so I didn’t want to make a case of it. After all, he was training to be a medical doctor in Ukraine, maybe their textbooks differ.

The next experience I had was at no other place than at the Tema General Hospital. This was a place where many house officers came to do their house job. I won’t talk about how petty they could get when it comes to their usual free lunch so let me just talk about the makeup doctor I, sorry let me say we encountered there. This lady was a graduate from KNUST medical school. Anytime I saw her she was always on her smartphone shopping online for makeups, dresses and shoes but whenever she sees student PAs then she begins to act up. One day during ward rounds at the emergency unit at the same facility she was asked by the senior medical officer to clerk an unconscious or was it a semi-unconscious patient that was rushed in. I didn’t have a look at the folder or what she might have written in there but just when she seem to have finished writing whatever she wanted to write at the patient’s bedside, she walked coyly to my friend who was also a P.A student, to ask him what she should score the unconscious patient on the Glasgow Coma Scale. We were both shocked at that point because to score anyone you just don’t look at them from afar and score them, you would have to let them respond to a number of stimuli and then score them accordingly. A few years ago, after I had finished the program, I saw her on one of our prime television channels giving a health talk to the public. At the time I knew her she couldn’t even organize a presentation. I guess from even such a terrible beginning she has now gathered the needed confidence to do a health talk.

The most recent and final experience that made me give up on trying to determine the difference between a doctor and Physician Assistant was with a child in a ward I had been assigned to. This child was rushed in with loose bloody stool which contained insignificant faecal matter. The child was admitted by a medical officer and the initial diagnoses were dysentery with a differential of gastroenteritis. I had continued managing the child for these conditions with the usual parenteral antibiotics for more than 24 hours but noticed no sign of improvement which was very strange from the little and experience I had derived from practice. I further examined the abdomen of the 3-month-old child and realized that there was more to what we were treating. I approached the medical officer who admitted the child and asked him to visit the ward and possibly re-examine the child. The next day when I went back to the ward he had simply come to change the class of antibiotics to a more potent and expensive one. He wasn’t one of the MOs who could use the ultrasound scan machine so I humbly approached the Medical Superintendent of the hospital to discuss the child. I gave him a brief history and concluded I was suspecting a case of intussusception. He straight away laughed and asked if I knew what I was talking about. Usual of me I smiled and told him I do. He still did not believe me so I pleaded that he go and see the child for himself but he refused and directed me back to the same MO who had admitted the child and came to change just the antibiotics. I told him I had already done that and he has come to see and has not done any changes except in the medication. I became so forceful that he finally asked me to go and bring the child myself for him to examine in the procedure room because he wasn’t going to the ward. It didn’t mean much to me so I discussed it with the mother and she followed me with the child to the procedure room. He observed the child as I laid him on the examination table, toughed his abdomen and as usual of doctors started asking about things I may not possibly have done. “Did you do DRE” I didn’t answer that so he asked me to get him some gloves and gel. Not to bother you with the details the child ended up that night on the theatre bench. He was confirmed to have intussusception and no one aside the child’s relative who thought I was simply a good doctor appreciated my effort. Not even the medical officer who only came to change the antibiotics came to apologize for not doing a thorough investigation when I ask him to.

Bad Medical doctors are everywhere, needless to mention the series of incidents that have been reported in the media lately at the ridge hospital where there are no P.As. And I can continue on this tangent and even tell you about a colleague in SHS who is now a doctor that I have personally hinted on what to write on his paper in our final WASSCE Chemistry exams. Today he is also one of those who think they are superhumans just because they have become doctors. And I am sure almost everyone in Ghana knows a “dumb” person who by virtue of how much they can pay entered the medical school as either fee-paying and went abroad and returned as a doctor and is practising.

But it shouldn’t be so, doctors should not reduce the medical profession to the level where people in the practice would have to be disgracing and bad-mouthing one another as a way to gain superiority and gain monetary advantage from the government. This does not heal the patients that need the services of the health professionals. The medical profession comes in stages. The work of nurse cannot be done by a doctor alone and that is why even nurses progress in various fields, be it eye care, theatre nursing, anaesthetics etc. so that where there are no doctors, these professionals can function to ameliorate the health of patients. The same way, the work of P.A is not that of a doctor. So why are they getting so insecure and want to play a supervisory role? Have they suddenly become so many in the country that they now need more work to do?

I have been a part of a healthcare team that screened the first badge of free Senior High School students of various health conditions in the Keta District. All the prescribers in the team who went to the field to attend to these students were Physician Assistants. We were told not to sign the forms as they will have to be vetted to ensure a thorough work was done. The medical superintendent did not even visit the field once but I was told he would have to sign the forms. After the work was done and Government sent money to the hospital to be used in paying all the health workers who undertook this project, this med sup and those he considered his team shared the money among themselves. As a member of the team who was on the field, I didn’t even receive a dime and when I asked I was told that my name was omitted from the “money list” signed by the medsup and they don’t know why. For many doctors, this is the only reason why they have to be made supervisors of other health professionals. It is not about the job that they so willingly want to do, but it has everything to do with the greed for gain, the insecurity and their unending desire to get paid for work they haven’t done.

We truly must train our health professionals well. The doctors, the physician assistants, the nurses and all, we need to train them well morally and above all professionally. But the question has always been about where to find the angel to train us all.