It was a normal working Thursday in the capital of the Fanteakwa district; precisely Begoro District Hospital. In the middle of a staff durbar I received a frantic call from my wife. “Nii your mum is not well and I think she does not want you to know but me thinks its quite serious and needs urgent care.” Immediately after the call I was deeply disturbed and called my mum. After a few questions I was more disturbed because the medic in me picked up some concerning signs and symptoms. I returned to Accra and arranged with a few colleagues in Korle-Bu for her to be seen at the Emergency unit.
The fear of Korle-Bu
I had to do a lot of convincing to get her to seek care at Korle-bu. The fact that this Tertiary facility has come to be labelled as a “last stop” was enough for her to request I take her to another facility for treatment. What convinced her to go was the lie I told her that she won’t be admitted, she was extremely short of breath but ironically, she was more worried about going to Korle-bu than her clinical symptoms. A lot of public health campaigns would be necessary to disabuse people’s perceptions about this important facility
KORLE-BU ER’s new look
I was astonished when I entered the ER. The place was decongested and things appeared orderly a sharp contrast to my Housemanship days where the place was always crowded akin to a busy market day. Like a properly managed ER she was triaged before eventually seen by the physicians. The physicians queried a pretty serious diagnosis and some investigations where requested. One of this was a CT scan of the chest (CT pulmonary angiography) which was to be done at the department of radiology.
CT SCAN AND DIAGNOSIS
The machine was fully functional and after about 30 mins at the unit the scan was done. The radiologist then comes in to read the results. Whiles he was at it I was carefully studying his demeanor. I noticed he was very disturbed and he then asked again “how are you related to the patient”. She is my mum I responded. After a little hesitation my worst fear was confirmed; doctor your mum has a pulmonary embolism. I was visibly shaken…. Most diagnosis of this nature in our setting are made at post mortem. He was quick to assure me that once the diagnosis was made she will be given appropriate care.
I was thankful because the diagnosis was confirmed and she received the needed care. She is alive and well today.
Role of CT scan and MRI in the health care set up
This cannot be over emphasized any further because it helped save my mother’s life and has saved millions more worldwide. These test not only help at arriving at a diagnosis but also helps direct management.
In the district hospital where I work without the luxury of these machines when a patient presents with a stroke a quick CT scan could tell you the type of stroke and the choice of medication that you need to avoid or prescribe for better outcomes.
In the premier Tertiary facility in Ghana where most referrals are sent there should never be a moment in time when these machines are not available to the populace to access.
Why the recruitment breakdowns
A few people I spoke to concerning the frequent breakdown of these machines have pointed to some of these issues
- Poorly signed contracts on maintenance of these valuable and expensive machines
- Sabotage by workers in the unit as they have privately owned machines that they need to drive market to
- Lack of will to follow planned preventive maintenance (PPM) schedule for the machines
- Inadequate budgetary allocation for maintenance of equipment’s
- Lack of motivation of staff at the unit
- Heavy usage as only one CT and an MRI machine is available for the entire hospital
Over the years successive governments have entered into numerous deals to procure equipment for hospitals to improve quality of care. This equipment’s are sometimes bought for low resource facilities which cannot pay for the cost of maintenance. Worst of all is when the equipment needs reagent to run and per the contract only one company could supply such reagent. Some of these decisions have led to collapse of these machines a few years after being purchased.
Due to the inability of government facilities to properly maintain existing equipment and the huge demand for these services the private sector over the years have come in to rescue patients (who can afford). A few have sprung up both far and near and indeed we are appreciative of the investments they have put in. it is also said they stand to benefit the most by the inefficiency at the government facilities. Rumors have it that some government staffs who work at such private facilities during their free time are responsible for the frequent break downs. If this is true it is rather unfortunate as with the running of Korle-Bu CT there is still room for outside scans.
Most facilities always have a PPM on servicing their machines but due to the high cost of maintenance in low resourced health system most managers usually ignore these schedules and only come in when machines are at the point of breakdown or have broken down. This by and large contributes a lot to why public institutions have their machines breaking down most often.
The Public Financial Management Law entreats all managers of public institutions to budget for expenditure, have it approved before you can actually spend. Most institutions even though will budget for maintenance issues, they are either under budgeted or lack of funds leading to rationing of which maintenance is casualty. But a careful following of the proceedings of the Public Accounts Committee of parliament will tell you where and how we abuse the monies sent to these facilities.
The Korle Bu teaching Hospital has a state of the art CT scan and MRI. The CT scan for example has 640 slides compared to the private facilities with a maximum of 32 slides. Some even have 8 slides. Further checks have revealed that at private facilities the radiographers are paid per case making far in excess to their salary. Front desk workers at the unit also get paid per each case that they refer to these private facilities. At this rate they will be extremely motivated to send cases to these facilities .
My checks at the unit told me that averagely the unit can get 100 requests in a day. From a simplistic calculation the unit can generate averagely 40000 Ghc a day (800000 Ghc a month) for the hospital. With all this amount that is generated by the unit if the management can look into staff motivation it will improve moral at the unit and encourage to give of their best.
The CT Scan and MRI machines are not a luxury in the management of patients it is paramount in health care diagnosis and directing management decisions.
The prices at Korle-Bu teaching hospital too is far cheaper than the private facilities and offers the poor Ghanaian the chance to improved health care.
The management of the hospital should look into procuring a second machine for the premier hospital. This will ease the pressure on the sole machine and there will always be a back up when there is a breakdown
To prevent the possibility of sabotage I urge management of the facility to run CCTV cameras at the unit and especially at sensitive sites where potential saboteurs have access to. Also implement biometric locks to these sensitive places to curb the recurrence of breakdown due to internal sabotage. Anyone found culpable must also be dealt with as the laws of the land permit.
I will once again thank the management of the hospital for fixing the machines. Just like my mum benefited from the machine, thousands of patients will indeed benefit. Its my hope that management will institute proper measures to keep the machines running for most part of the year.
Dr Richard Nii Darku Dodoo
Writer is a medical doctor by profession.
Trained at the Korle-Bu teaching hospital.
Currently a senior medical Officer at District Hospital Begoro
Family Medicine Resident (modular)