The Epidemic of Road Traffic Accidents in Ghana

 During my first couple of weeks in Ghana, a health disparity that immediately caught my attention was the high prevalence of motor vehicle accidents. When our group first arrived in Accra, we sat down for dinner at a nearby outdoor restaurant. While enjoying our food, we heard a deafening bang followed by silence. Jeanette explained that the noise came from a motor vehicle accident and that they are common in Ghana. That moment served as my introduction to the health crisis of road injuries in Ghana and its detrimental impact on the healthcare system.  

Over time, I began to recognize road safety challenges in Ghana. In Ghana, motorcycles are a major form of transportation and, often, people operate them unsafely. For example, many people do not wear helmets on motorcycles, potentially due to their inability to afford the cost of one. More unsafe behaviours I have witnessed include young children operating motorcycles and women on motorcycles with infants strapped to their back. Those who drive motor vehicles often speed, crowd in lanes, and fail to stop for pedestrians and oncoming traffic. Additionally, road design in Ghana leads to heavy traffic congestion in the city, further increasing the likelihood of motor vehicle accidents. As a result of these contributing factors, a health crisis emerges.

The prevalence of motor vehicle accidents weighs heavy on Ghana's healthcare system. My time spent working in Accident and Emergency gave me a full picture of the detrimental effects of motor vehicle accidents in Ghana. Every day, people are rushed into Accident and Emergency with road injuries, most commonly polytraumas, multiple fractures, and skin abrasions. Some Ghanains practice traditional medicine and attempt to treat fractures locally, which can lead to severe conditions such as infection and gangrene. In A&E, fractures are stabilized in various, innovative ways, such as by securing sand filled water bottles to each side of the affected limb. This example demonstrates how incredibly well the Ghanain nurses problem solve with their limited resources.

When examining the high incidence of motor vehicle accidents in Ghana, I often reflect on the root causes of the issue. As reported by the World Health Organization, in Ghana, road injury is the 7th leading cause of death in males and results in 39.8 deaths per 100,000. Moreover, 92% of deaths caused by road injury occur in low and middle income countries, demonstrating the disproportionate impact of the issue. Although Ghana has road regulations and drivers licensing requirements, there is a failure to enforce them. When considering Ghana's socioeconomic status, which was heavily weakened by colonization, I recognize the financial challenges in reducing road injuries. Many solutions to the crisis require major financial investments, such as hiring and properly paying law enforcement, investing in road infrastructure, and revising road policies. A multifaceted approach that allocates Ghana's existing resources to road safety is necessary to mitigate the epidemic of road injuries in Ghana and reduce the burden on Ghana’s healthcare system.

- Brianna, Year 4 BSN

Tamale Teaching Hospital - Accident & Emergency

3 days in the Accident & Emergency unit at Tamale Teaching Hospital provided the perspective I have only yet been able to read about. It could be expected that sitting in a global health lecture, no matter how informative, would undoubtedly not compare. Without the connection, you cannot feel the realness of the experiences of these people. Suffering is right in front of you, it’s not hidden like it is in Canada. The wards are open, with beds a foot apart from each other, and seldom curtains to pull. Anyone can see the sickness, anyone can see the death. 

I was told that when Ghanaian people go to the hospital they expect to face pain. The same degree cannot be said in Canada. Family members bustle around doing everything they can to take care of the patients. They are the ones bringing food, water, and fan their loved ones from the heat. 

I consider myself lucky to have met several wonderful nurses and doctors during my days here. These types of people are so purely genuine, and their souls stick with you long after your interactions. They were so well educated and competent, and I truthfully learned a lot from them that I will bring forwards in my practice. They make the best of the circumstances even though the system doesn’t set up them for success or positive patient outcomes. They are realistic and logical, but not defeated and angry. There isn’t the same capacity to avoid preventable deaths. There are aspects of cultural differences when it comes to relational practices, but when the system doesn’t support you, how are you expected to support the patients. Many continue to show up without pay. 

These days at TTH were more for personal learning rather than to make a difference on their health system. A system level change is multifaceted requiring analysis of their culture, the country’s power, ability to allocate resources, and ultimately spending their government chooses to place towards healthcare. The power imbalances in spending abilities and resources distribution between Global North and Global South can also be considered when considering the difficulty Ghana encounters procuring necessary resources. 

Many medication and vaccine shortages persist. Money, stigma, distance, and healthcare staff to patient ratios are huge barriers to accessing healthcare. It became a familiar act to watch the priority be placed on the transactional requirement before medications are administered or treatments are done. In several patient’s charts, the doctor’s orders were tagged with - if the patients family can afford. If they can’t, it won’t happen. 

There is no pause button for the patients as they wait for their pain to be managed, their wound to be dressed, their open fracture to be casted, or their medication the urgently require, but there is for the staff. No payment, no treatment. Here, healthcare is not guaranteed.

Blog written by Kyra - 4th year BSN Student

Shekhinah Clinic - A Place of Love and Compassion

The Main Entrance

Working our first day at the Shekhinah clinic was quite unexpected. The minute you step onto the property, you feel how peaceful it is. Shekhinah is a free clinic catering to the poor and destitute (see vision and mission statement). 

Vision and Mission

They depend solely on donations to keep it running. This means that services can be in short supply. It was challenging to experience, coming from such a privileged country and seeing what was able to be done for the 30 people visiting each day. The dispensary (term used for pharmacy) itself was quite bare. I encountered clients coming to the window and not receiving any of the medications they were prescribed that same day. In some instances clients came to the window with two prescriptions, as they didn’t receive all their medications at the last visit. You could see the disappointment and defeat on their faces afterwards. Their only other option is to pay and unfortunately, these people come to the clinic because they do not have the funds in the first place. Knowing how difficult this was for me, after one day, I cannot fathom how it must be for these clients.

I was able to sit in on consults the first day as well. I found it shocking, the level of care I observed. I saw a short assessment followed by a handful of medications being prescribed. This would be an uncommon occurrence in Canada. However, it’s easy to be judgmental coming from a high income country who believes they have all the right answers. It’s not easy to put yourself in their place and realize there’s not much you would do differently. 

OPD

Working with limited supplies and limited volunteer staff, you are left with limited options. It’s impossible to compare our environment in Canada to this one.  Furthermore, I don’t believe you would find this type of clinic in Canada. Based on experience, Canada does not have the sense of community that I have observed here. I cannot imagine a clinic opening for the hungry and mentally ill, offering them a place to stay when they have no where else. If there was, I can’t see it being as successful as this one, now open for over 30 years. You can see the volunteer staff care deeply for those that come. There is never a shortage of clients visiting the clinic, proving that it is needed as well. At the end of the day, this is what’s important.

A group of 4th year students in Kelowna used their Nursing Leadership Capstone project to work with our Kelowna community to gather medical supplies and raise money to support Shekhinah.  We presented the staff and the Director Mariama with these supplies yesterday.  It was a joyous surprise.  We purchased medications to fill their dispensary shelves, and shared many many suitcases of surgical supplies for their operating room.  

Fun fact for everyone: this mango tree was the location where Dr David Abdulai Fuseini (the creator of this clinic) preformed the first surgery for the clinic. It was a hernia surgery, which was a success.

Blog written by Tyler, 4th year  BSN Student.

Elmina Slave Castle

 

On our way up to Tamale, our group explored the oldest slave castle in West Africa, over 500 years old. It is located on the Cape Coast of Ghana. There were bricks, wood panels, prison bars, and more from when the castle was first built. The rooms echoed a hard hitting history that punched you in the gut when you walked in. The rooms where slaves were kept were small and very crowded with little ventilation and no place to use the bathroom. Those who were sick were thought to be weak and when they died their bodies were thrown to sea. Those who survived were thought of as strong enough to go to the new world.  

Slave Dungeon

We saw a prison for freedom fighters that was dark, hot, and marked with a skull to signify that once entering the dungeon, you would not return alive. The only openings to the dungeon were used for the guards to see when someone starved to death so they could drag them out in front of everyone. The prison for the misbehaving European guards however, was ventilated and they were given water and food and released after a few hours of waiting.

Prison

The women faced even more obstacles.  The governor of the castle would select women to come to his chamber and be raped. If they refused to travel to his apartment, they were chained outside without water or food for days until they said yes. This was a spectacle for the other women so they would not also refuse. If the woman fell pregnant, she would get to live with her child for three years before their child would be sent to school. The mother would then stay in the castle and do domestic work. The shocking reality that being raped and bearing a child for a woman may be the better option than going overseas is a horrific reality.

In the room dubbed "No Return", slaves prepared to embark on a tumultuous trip overseas where they would most likely die on the voyage. The room on our tour was filled with blessings from modern day visitors. Expressions of gratitude covered the floor blessing the sacrifices slaves made before the Slave Trade was abolished.  Candles were lit, crosses were decorated, and notes were left for those who were captured, abused, and taken from their home. The air was heavy in this room, and the history was bleak. 

Tributes in the room of "No Return"

This castle proves how far the Ghanaians have come after being treated as savages by their Portuguese, Dutch and then British colonizers.  When they gained their independence, and the British left, they took all their infrastructure with them. This has led to many growing pains for Ghana's development.

Government and healthcare was created from a a model that was not their own. For over 400 years the colonizers pitted Ghanaians against each other, creating tensions across the country and a sense of protecting your people. There are now significant disparities between the South and North. The South houses the capital, Accra, and has more Governmental support. The rural North faces the greatest challenges, as hospitals are far and few between. Many have to travel a long distance by foot to reach healthcare. Ghana is a young country, and a strong country. Its development makes sense when you understand their history. I feel incredibly lucky to be here.

View from the Governor's Window

Blog written by Nadine.

Let the Journey Begin....

We're all packed and ready to go!!  I'm joined by my colleague Muriel, and 14 students.  

The students have all taken a Global Health course, an Advanced Global Health Elective, have spent an intensive week in seminars to prepare them for the local context, and have packed the supplies we'll be bringing with us.  

They're nervous....excited....and most importantly have open hearts and open minds.  We're in this together.  

Packing in the lab

Packing in the lab

Waiting in Calgary airport!

                                   

Let the journey begin....

Jeanette Vinek

Associate Professor of Teaching

School of Nursing

UBC Okanagan