Healthcare Insurance in Ghana, Herbalists, and a Taste of Ghanian TV- June 7

 

Wed June 7

I woke up pretty tired and had a mango yogurt that we'd bought at ShopRite that tasted really similar to sweet American yogurts. We took a Bolt to the hospital and arrived around 8:40. Today in physiotherapy there were a couple new patients who met with the doctor in the screened-off office area but the rest seemed to be returners with various conditions, I’m not sure why they came today and not the other specific days but we didn’t get a chance to ask. 

There were some younger toddlers and babies, one with Down syndrome who practiced walking along handhold bars. There were some older kids, maybe 6-7 years old, who the doctor assessed by watching them stand independently for a while. Then he practiced walking with them and worked on motor skills like putting toys in a bin. It was pretty similar to the previous days. 

There is a photo of one of the standing braces that the children with cerebral palsy spend some time in. They are put in the slimmer section facing forwards towards the left side of the photo and a wrap goes behind their back and sometimes foam in between their legs to practice standing. The black bars on the right are the hand-holding bars that can be spread apart for kids to walk in.

Breastfeeding is more normalized here than in the US and the mothers will feed the babies with others around. I haven't seen them breastfeed a child older than maybe 1 or 2 so I'm not sure what the common weaning age is. I've also seen the kids eat porridge, Milo (chocolate drink), and water in sippy cups.

Something new was that there were two dads here whereas in the previous days, it was just mothers and the doctor talked about how dads tend to not be as involved with disabled kids. These dads were very involved, one dad was here alone and one came with the mother and younger sibling, too.

In the middle of the shift, we stepped out to exchange currency outside the hospital with a guy that our coordinator knew. So far the only time I exchanged money at a Forex bureau was at the airport; the few other times it's felt a bit shadier with meeting a guy in the back of a shop or on a street corner.

Things winded down in the ward and when there was just one patient left in the standing brace, everyone in the room (the doctors, nurses, the 2 mothers still there, and my peer and I) watched a drama show on the main local channel, Top TV, about a husband and wife both caught cheating on each other at the same time. Right before it got to the dramatic reveal, the visual went black and the nurses said it was a problem with the station. We then watched some of the news and the news we saw was the new president being elected in Nigeria and a new law in Uganda banning the stealing of human organs. 

Something I noticed was that there were ads running along the bottom of the tv and most were for herbalists promising cures for infertility or other conditions. I did see "fertility tea" being sold in the complex that ShopRite was in. I haven’t had a chance yet to learn much about traditional medicine here, but I have noticed some signs for traditional healers. Today I saw a sign with a number for a “100%” cure for asthma. The doctor in the physiotherapy unit did say that sometimes the parents might get discouraged that their kids can’t be cured and quit coming and instead go to spiritual or traditional healers because they see it as more of a spiritual problem than a physical one (such as thinking their child is possessed).

We got lunch at the hospital (chicken and rice) then took a bolt home. I showered and did a quick bodyweight workout on our floor (there are gyms a bit of a ride away but apparently they’re pretty hot and crowded and I haven’t ventured into that yet). 

Then, I took a nap then we had a lecture from Dr. Christian, a house officer. He talked about healthcare financing in Ghana. 

The Ghanaian healthcare system has been through a lot of changes, but the most notable one is when National Health Insurance was introduced in 2003. The Ministry of Health is the top authority and runs the National Health Insurance Scheme (NHIS). Some people do have to pay a bit for this, but it makes services free for children, pregnant women, people with disabilities or mental disorders, the elderly, etc. 

This has been a great improvement but there are still some challenges. One of the main ones is that there is often delay for hospitals or clinics being reimbursed- he said that sometime after a year of services, a hospital might be only reimbursed for the first 3 months by the NHIS. So, some private hospitals opt out of accepting NHIS patients and funding. This can lead to people not enrolling in NHIS because they have the perception that it won’t even cover what they need; and this along with other reasons has led to a low active membership in NHIS. 

The Ministry of Health does have several goals to achieve in health by 2030 and a lot include bettering preventive care services instead of relying on emergency care (this is similar to the US where we don’t focus on preventive care and rely on emergency care) and improving access.

We had dinner delivered (a chicken wrap from Starbites, a pretty reliable restaurant with both Ghanaian food and American style food). We watched some of the Accra Medic tv show which was more drama than medicine then hung out and went to bed.

 

One of our peers who has been here for longer is actually observing in the psych ward in the Korle-Bu Teaching Hospital, one of the main hospitals in Accra that is on our way to the Children’s Hospital. The psych ward is new and the President of Ghana was at its opening! But apparently, the President does have some relation to the main doctor there. 

One of my roommates went on a school visit today with the doctor from the family planning unit and other students/nurses. She said they walked about 15 minutes to the school and saw 4-7-year-olds. They lined up and one person checked their skin, another checked their ears and eyes, and another checked their heart and lung sounds. They would point the student to the doctor if there was a problem but almost all the kids seemed very healthy except for slight anemia in some and a few with bad lung sounds (but had a cough) or eczema. 

Then, they gave them vitamin A drops from a vitamin capsule. In a previous visit with nursing students, they gave them some vaccines, and it seems like this is a somewhat often occurrence where a group from the hospital goes into schools.

Here's a photo of a street food cart I saw ("Sarah's Kitchen"):

It was rainy again today but not as much as yesterday and we were thankful for the clouds blocking the direct sun.