27
Thu, Feb

A unit within the newly built Wuhan Hospital. Wuhan is the capital of Hubei province, the source of the 2020 coronavirus outbreak.

Thoughts From Afar
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In that same week, information began to emerge that two people had been hospitalised in Ghana with suspected Coronavirus (2019-nCoV) infections.
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“Sorrow prepares you for joy. It violently sweeps everything out of your house, so that new joy can find space to enter. It shakes the yellow leaves from the bough of your heart so that fresh, green leaves can grow in their place. It pulls up the rotten roots so that new roots hidden beneath have room to grow. Whatever sorrow shakes from your heart, far better things will take their place.”

Towards the end of the week, it emerged that Dr. Li Wenliang, the Chinese doctor who first blew the lid on the 2019 coronavirus outbreak in Wuhan, had succumbed to the disease. Though details about his death are sketchy, the anger that has greeted the announcement in China and across the world is palpable. Many are of the view that his treatment by provincial police and the censoring of his warnings to other medics via WeChat delayed the Chinese and worldwide response to the epidemic by up to three weeks. In this time, many travelled out of the province internally within China and abroad making the province’s lockdown less effective and any chances of contact tracing difficult.

In that same week, information began to emerge that two people had been hospitalised in Ghana with suspected Coronavirus (2019-nCoV) infections. They were allegedly quarantined at the country’s leading health facility Korle Bu Teaching Hospital. Fortunately, tests conducted proved to be negative. Though this is gratifying, several issues surrounding the handling of these two individuals raises some cause for concern. One of the patients with the suspected Coronavirus infection was said to have left the Korle Bu Teaching Hospital isolation ward on the night of their admission only to return the next morning. This was long before the all-clear for both was given. Considering that the mode of transmission and spread of this viral infection is not fully understood, this is a situation that should be well investigated and the lessons shared.

To start with, we must have a clear understanding of how the health team and security at the isolation ward allowed this patient to leave their care. Was it the case that the patients lacked an understanding of the risk they were putting themselves and the entire nation to? Considering that this happened in Korle Bu, should this be an indication that our health system may be ill-prepared to deal with this disease and any similar outbreaks, should a confirmed case occur? Or is it that apart from Ridge and Tema General Hospitals which are the designated Coronavirus case management centres, the health human resources in other areas of our country are not up to speed with the management of this disease?

It will be easy for many to look at the handling of this patient and begin to blame the hospital or its personnel. However, I hold a different view. I do because of the data from the 2019 Global Health Security Index report. With an overall score of 35.5 out of a possible 100, Ghana placed 105th out of the 195 member countries of the World Health Organisation (WHO). More importantly, our score was below the average global score of 40.2, which points to the fact that our health system is functioning well below the global average and may not be providing the securities needed to manage our care safely. Our health system has a lot of catching up to do.

A few other things stand out in this report. One of the categories in the report is that of “Prevention”; which scored a country’s preparedness to prevent the emergency release of pathogens that could constitute an extraordinary public health risk. Ghana’s score was 32.2 and is ranked amongst the least prepared. This means that as a country, we should not be surprised about this incident occurring at Korle Bu and the risk of human-to-human transmission, since we are overall poorly prepared for such eventualities.

The turnaround time of the test results for the two patients however, together with the speed and reliability with which it was communicated to the public could also have been predicted from this report. Ghana’s score on “Detection and Reporting” which measured a country’s ability to detect and report epidemics of potential international concern that can spread beyond national or regional borders was slightly above the global average at 40.5. Our score in this category could have been much higher if our score in health data integration between human, animal and environmental health sectors had not been zero i.e. these sectors ordinarily does not share information in a manner that keeps citizens safe.

However, our lowest score, 23.4 out of 100, was in the category that measured our health system’s ability to sufficiently and robustly treat the sick and protect health workers.

Again, the behaviours expressed when a patient in isolation was allowed to leave for hours, and the fact that health workers abandoned their post when they became aware that there were suspected cases of Novel Coronavirus 2019 should not surprise anyone. That even the Chief Executive Officer of the hospital Dr. Daniel Asare justified the actions of the medical personnel who allegedly fled the scene speaks volumes about our country’s level of preparedness. Hear him out, “the decision by some staff to rather not attend to the patients was just a matter of common-sense application as it’s safer to flee when one has no safety precautions than to contract the deadly disease.”

This is why I think this entire episode should be a wakeup call for all of us. The reality of our health system’s deficiencies is one that we can choose to ignore at our peril. Reading the 2019 Global Health Security Index report has made me wonder yet again how come all this data and information on our health system is available on international portals but our government for the past two years has failed to publish data on the performance of our health system locally.  Is it that they are aware of the gravity of these failings and are keeping us in oblivion under the guise that ignorance is bliss? Whatever the reasons, I find this untenable. The truth is if we don’t know how grave the situation is, as citizens we will ultimately pay the price for our ignorance with our health. We are just fortunate that this test result turned out negative. If the result was positive for Coronavirus infection, the entire nation would have been on tenterhooks since there would have been little chance of effective contact tracing, and we would all have been sitting ducks.

I have thought hard about discussing this breach but concluded that we should not go down the route of suppressing failings that emanate from our health system. Rather, we could learn from these failures. With the benefit of hindsight, we know that many, Li Wenliang included, may have been alive if his concerns had not been swept under the carpet. Whilst his death fills me with sorrow, I hope that it brings in its wake far better things and an understanding that politicisation of healthcare often leads to avoidable consequences.

 

Edited by Winifred Awa.

 

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