The old man who inspired this article (
head bowed )
Two days ago, I attended a funeral of a friend’s father. After several
hours at the funeral, it was time to leave, so our grateful friend, a Ghanaian
Doctor based in the United States, accompanied us out of the funeral grounds.
At the car park, as the seven of us indulged in some pre departure small talk,
we heard a loud thud. We turned towards the source of the thud and saw an old
man, clad in funeral attire, lying prone in the dust beside a bench he had
obviously fallen off.
Within one tenths of a second, my brain had processed the entire scene and
come to the conclusion that the man must have been drunk. I turned away from
the scene to continue the conversation. But not the Doctor. He took one look at
the scene and walked over to the man lying in the dust. Shamed into action, I
followed him. As I got to the scene, the Doctor was struggling to lift the old
man into an upright position. I joined him and we seated the gentleman back on
the bench. The Doctor started asking questions . . .”Are you alright?”, “ Do
you have a headache?”, “Has this happened to you before”, “Are you on
medication?”. For a split second, I thought I was participating in a real life
episode of Grey’s Anatomy. The old man initially dazed did not answer but when
he did, a gust of “fuse” burst out of his mouth and into our nostrils. As if to
confirm what our noses had already told us, he declared that he was only drunk
and that there was nothing to worry about. With that we wiped the dust off his
face and clothes and with obvious reluctance the Doctor walked away, followed
by myself.
The entire episode did not take more than five minutes but those five
minutes highlighted and underlined the glaring difference in Medical Care,
Medical ethics and patients rights between Ghana and the United States. Most
Ghanaians have stories to tell about the lack of compassion and
professionalism, exhibited by Ghanaian Health Professionals towards their
clients, i.e patients. Many a Ghanaian has a story to tell of friends,
relatives and loved ones who have died avoidable deaths in Ghanaian hospitals. In
most of these situations, a slight dose of professionalism and compassion would
have saved Ghanaian lives.
Ghana trains many Doctors, some of whom stay in the country to work, others
who emigrate to other countries to practice their medicine? I have always
wondered why, the same Ghanaian Doctors, excel out there and are more
compassionate and in many cases, more professional than the colleagues they
left behind in Ghana? My Doctor friend had been trained in Ghana by those, and
together with those who currently man our health system. He left for the United
States 10 years ago and obviously had entered a system that had
institutionalized compassion and care. By working within the American Medical
system and doing what the “Romans” did, professionalism and compassion had been
imbued in him. It was second nature, almost reflex for him to react the way he
did, irrespective of geographical location. The saddest aspect for me was the
fact that if he came back to Ghana to work in our health care system, this work
ethic would slowly evaporate and he would become as ______________ as the
health care professionals here in Ghana. I leave you, the reader to fill the
blanks as you see fit.
My hypothesis is that the framework that exists out there, has
institutionalized compassion and respect for patients rights in a manner that
simply does not exist here in Ghana. We need to replicate this framework here.
What is this framework? Basically United States Congressional law protects
and ensures the right to quality medical care and the right to informed
consent. These laws essentially provide patients with rights and enjoins Health
care providers to guarantee those rights. The first Hospital Patients Bill of
rights was drafted in 1973 and must be posted in the corridors of accredited
hospitals in the US. It includes 12 basic rights, namely:
1. A patient has the right to considerate and respectful care.
2. A patient has the right to receive complete information from a physician
about a patient's diagnosis, treatment plan, and prognosis.
3. A patient has the right to obtain information about the specific nature
of a proposed treatment or procedure, a disclosure of the risks involved, and
information about medical alternatives.
4. A patient has the right to refuse treatment and to be informed of the
medical consequences.
5. A patient has the right to privacy during discussion of one's medical
condition and while undergoing medical care.
6. A patient has the right to expect all records related to medical care
will be kept confidential.
7. A patient has the right to expect that reasonable efforts will be made
to respond to the patient's request for services, and that the patient will not
be transferred to another medical facility without advising the patient of the
need to be transferred and without ensuring that the new facility will accept
transfer of the patient.
8. A patient has the right to obtain information about the relationships
amongst care providers in the hospital and related medical and educational
institutions. This is designed to protect patients from conflicting interests
that might affect quality of care.
9. A patient has the right to obtain information about human
experimentation and research that might affect treatment or care, and to refuse
to take part in such experimentation and research.
10. A patient has the right to expect reasonable continuity of care. This
is meant to assure the patient that, for example, diagnoses will be followed up
with continued treatment.
11. A patient has the right to examine and receive an explanation of the
hospital bill.
12. A patient has the right to be informed of hospital rules and
regulations that apply to patient conduct.
These rights, combined with:
• The Hippocratic Oath
• American Medical Association Principles of Ethics
• American Nurses Association Code
• Federal Emergency Medical Treatment and Active Labor act 1989
• Patient Self Determination Act
• Medical Malpractice Precedents established in courts
have combined to ensure that the highest standard of medical care is given
to each and every patient in the United States. Basically US Law and Medical
ethics require a Health Professional to provide comprehensive treatment to a
patient who is presented at a medical facility and/ or find another medical
professional who can. Anything less than that and you could be open to a
Negligence or Medical Malpractice lawsuit. I submit that there is nothing like
this to inculcate professionalism and compassion into any Health Professional.
If Ghana could replicate to an appreciable extent, the above framework,
customized to our peculiar context, we could create the foundation for a total
revamp of our health care system. Recognition by health professionals, that
patients have rights, can transform the Doctor-Patient relationship from an
authoritative and paternalistic one to one where the quality of medical care is
enhanced and both sides form a partnership to achieve the goal of universal
health care.
To the average Ghanaian Health Professional, all this will be scoffed at
and regarded as being too "book long", inapplicable and unnecessary.
But this framework, with enforcement, provides benefits to both patients and
hospitals. It guarantees the patient quality and appropriate health care and
ensures that in the long term, with enforcement, the health profession and
professionals deliver on their objectives as well as the Hippocratic Oath.
It is my hope, that somehow,the Executive and Parliament of Ghana will
establish a legal framework emanating from our Law of Tort, to create the
necessary foundation from which to build a healthy Ghana. We owe it to our
friends, relatives and loved ones, who died avoidable deaths.
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