Tag Archives: health care

Unavailable and underfunded: mental healthcare in Ghana

The Accra Psychiatric Hospital only has a capacity for 600-800 patients, but currently houses many more.

Like much of the developing world, mental healthcare is lacking in Ghana. Mental illnesses are deeply stigmatized and widely misunderstood, and access to mental health professionals and infrastructure is limited. Although the recent passing of the innovative Mental Health Bill lays the legal framework for the required changes, steep challenges remain.

Ghana spends 2.58 per cent of an already small health budget on mental health. Accordingly, Ghana has only three publically-funded mental health hospitals. The hospitals are all old, overcrowded, and located in the southern part of the country. Consequently, they fail to provide adequate care for the estimated 250,000 people that need treatment in the country.

Pantang Hospital, the newest in the country, was built in 1975 and is located just outside Accra. Ankaful Hospital was built in 1965 and is located in Cape Coast, 150 km outside Accra. The largest hospital, the Accra Psychiatric Hospital, was built in 1906 and is located in the centre of the capital. It only has a capacity for 600-800 patients, but currently houses close to 1,000. It’s a condition that “compromises the comfort and general well-being of patients and constitutes an appreciable strain on [the hospital’s] resources, staff and funds,” according to the hospital’s website.

There are also only twelve psychiatrists working within the government system, many of which perform only administrative duties. There are fewer than 500 psychiatric nurses, more than half of which are located in the mental hospitals, leaving the rest of Ghana wanting.

The result of the widely unavailable care is that many rely on traditional healers, especially in the more rural and impoverished northern parts of the country. Their methods vary from prayers to exorcisms to human rights abuses.

“We’ve seen people who have cuts on their bodies that have festered into sores… It’s all under the guise of treatment,” said Peter Yaro, the Executive Director of BasicNeeds Ghana, an NGO that seeks to “ensure people with mental illnesses and their families live and work successfully in their communities,” according to Yaro.

“We have seen people who are shackled and left in the open, rain or shine for days. We’ve seen people who have been locked in rooms for days, months, and years. They ease themselves there, they eat there, and they sleep there. And nobody bothers to do anything about it until it’s reported to us,” he added.

The garden inside the Accra Psychiatric Hospital.

BasicNeeds has been operating in Ghana since 2002 and has since expanded to six out of Ghana’s ten regions. It strives to improve access to appropriate treatment, teach people with mental health conditions to support themselves, give people suffering from mental illness a political voice, and address the fiend that exacerbates all mental health problems in Ghana – the monstrous social stigma that surrounds the issue.

In Ghana, people with mental health issues are widely misunderstood and mistreated. People view mental illness as anything from a deserved consequence of a spiritual transgression to a contagious condition that will infect anyone who works in the field. As a result, they are discriminated against and marginalized, Yaro explained.

“The moment you are seen as mentally ill you are seen to be less human.… People think you can’t even feel,” he said. There is also little understanding of, or interest in, proper treatment.

“For those who know about the hospitals, they come and dump you there. For those who don’t know about the hospitals, they dump you at the traditional healer so they can move on with their life,” Yaro said.

The social stigma also affects the professionals who work in the field. Unlike other medical specialties, psychiatry is not prestigious. “It’s not attractive. It has no status, socially,” said Yaro. Because of this, and the fact that many people still think mental illness is contagious, few choose careers in the field.

The Mental Health Bill – the government’s plan to address these pressing issues – was finally passed on March 2, 2012. Originally drafted with help from the World Health Organization, the Bill meandered through parliament for eight years.

It emphasizes community based treatment over institutionalization. This is very important because up until the Bill was passed, the legislation that guided Ghana’s mental health service plan had changed little since the colonial Lunatic Asylum Ordinance made in 1888, explained Yaro.

“The national health policy under which mental health services are provided is not only arcane, but very bad,” he said. “We’ve come a long way towards understanding what mental health issues are and the law needs to be retrofitted.”

The Bill also introduces regulations for both public and private care providers need to adhere to, legally protecting patients’ rights. It also calls for a decentralization of care centers and and seeks to battle the stigma through public education campaigns.

It is estimated that more than 250,000 people in Ghana need psychiatric treatment.

The passing of the Bill marked the ratification of the UN Convention on the Rights of Persons with Disabilities. Ghana was one of the original 80 countries to sign the convention in 2007 and activists and mental health care professionals eagerly awaited its ratification since.

“I don’t know how to express my joy. Eight years of anxiety, apprehension and patience- that is how I can describe my feeling now. If we knew that the bill would be passed today, we would have come here with buses full of people and thereafter paraded through the streets of Accra to exhibit our joy and appreciation,” said Dr Akwasi Osei, the Chief Psychiatrist of the Ghana Health Service, at the time of the Bill’s passing.

“The way the Bill is drafted means a revolution,” said Yaro. Although the Bill received Presidential Assent on June 8 and became law, the revolution is still coming.

The massive investment required for the full implementation of what is in the Bill seems unlikely in the near future. Ghana is a Lower-Middle Income country and its economy is largely dependent on foreign aid, which makes up 11.7 per cent of the country’s GDP, according to the Organization for Economic Co-operation and Development. Its public health care system battles both corruption and a “chronic shortage of funding,” according to a 2008 Austrian Centre for Country of Origin and Asylum Research and Documentation (ACCORD) report.

“We have to be optimistic, however one should not lose sight of the [challenges],” said Yaro. In the meantime he is happy with the progress made so far and will continue working with BasicNeeds as Ghana moves forward with its mental healthcare policy.

Malawi’s vaccines controversy

Women pass by Queen Elizabeth Central Hospital in Blantyre. Photo by Nina Lex.

The topic of immunization is often controversial – but in Malawi, it can be deadly as parents refuse their children access to vaccines.

Two months ago, the online publication, Malawi Voice, reported that 131 children from Nsanje, Malawi’s most southern district were vaccinated at gunpoint.

These families had originally fled to Mozambique to “protect” their children from the anti-measles vaccination, but when they returned home, medical officials and police tracked down the children and forcefully vaccinated them.

It was reported that the Bill and Melinda Gates Foundation was behind the involuntary vaccinations. The foundation has been launching extensive campaigns to make sure all children are vaccinated against deadly diseases. When it comes to vaccines, Melinda Gates called Malawi one of the few countries “on track to reach the UN Millennium Development Goals.”

When contacted the Gates Foundation and its partners in Malawi were unavailable for an  interview.

In Malawi, The United Nations, NGOs and the Malawian Ministry of Health work together to ensure that all children are given shots for tuberculosis, polio, hepatitis and measles, as well as vitamins. The Health Ministry is currently carrying out a mass vaccination campaign, targeting six million vulnerable children under the age of 15 across Malawi.

“It is a requirement that all children are vaccinated, but it’s difficult to trace to see if a child has been vaccinated,” says David Chimwaza, a clinical officer at Queen Elizabeth Central Hospital in Blantyre.

Measles is the most common disease outbreak in Malawi.

Worldwide 164,000 people, mostly children under the age of 5, die from measles. Even though effective immunization costs less than $1US and has been available for 40 years. Furthermore, each year more than 1.7 million children die of vaccine preventable diseases, according to the WHO.

“During an outbreak everyone has to be vaccinated,” explains Chimwaza. “Officials will go into homes to inspect children to check if they were vaccinated.”

However, in rural communities this can prove difficult without proper record keeping and lack of resources.

Similarly, vaccinations can be controversial in Canada, but for different reasons.

Some Canadian parents believe that the measles, mumps, rubella (MMR) vaccine can be linked to autism or sudden infant death syndrome (SIDS).  Although, most doctors and scientists agree the benefits of immunizations that protect against infectious diseases outweigh the rare side effects of vaccines.

In addition to health concerns, some Malawian families are against vaccinations and Western medicine because their religion forbids it, such as the Seventh Day Apostolic Church.  Members of the Seventh Day Apostolic Church who do receive medical care are excommunicated from the church.

A Malawian father, who follows the Seventh Day Apostolic faith, was sentenced to two years in prison after refusing to let his three children receive the measles vaccine due to his religious belief. Police believe that one of his children died from the illness.

In nearby Zimbabwe, the World Health Organization (WHO) issued a bulletin in 2009 stating that the majority of unvaccinated children belong to apostolic faith sects, 45 per cent and 23 per cent belong to the Pentecostal Church.

Muslim fundamentalists are also against immunization programs because vaccines can contain animals that have not been killed in accordance with ritual or can contain alcohol.

In some cases Muslim fundamentalists believe vaccines are used by the West to poison or sterilize followers of Islam.

“Usually because of religion, children do not receive vaccines. They have the idea that if you are sick God will help you – you don’t have to take drugs and medicines,” says Chimwaza.

As for the children who were vaccinated at gunpoint,he explains that both the measles outbreak and the need for its immediate containment were the cause for such an extreme response.

“The police had to vaccinate at gunpoint,” he says.“I think it was the first time that has happened.”

The waiting room

Falling ill in Ghana is often accompanied by fears of contracting malaria, which accounts for one in five childhood deaths in the country

This is a first. I’m sitting in a hospital lab in Accra, being serenaded by Bollywood music on the radio at 9 a.m. I made it four months in Ghana without visiting an emergency room, but the headache and fever that I went to sleep with the night before were there to greet me the next morning. They were accompanied by abdominal pain and two marble-like lumps in my pelvic area, where no lumps had previously been before. I felt dizzy and disoriented, like being all too present in a hot, sweaty, lucid dream.

Like me, my roommate, upon hearing my symptoms and seeing my general state of confusion, seemed to think that malaria could be the bandit behind my missing bill of health. It was with good reason. I stopped taking my anti-malarial meds a few weeks ago. So here I am, at one of Accra’s more reputable hospitals as a male lab tech drew my blood. I clenched my left fist and turned away as he inserted a needle into a welcoming vein. I’m not a fan of needles, and I really dislike the surgical glove stench of hospitals.

“Are you crying?” asked the lab tech.

‘No,” I replied, rather disappointed by his callous bedside manner. “It’s sweat.”

“Oh, ok,” he said. “Go to the waiting room, I’ll call you.”

I paid 19 cedis ($13 CAD) for my consultation with the doctor, 38 cedis ($26.75 CAD) for the lab tests, and would later fork out 65 cedis ($46 CAD) at the pharmacy. It’s no wonder, at these prices, that many Ghanaians cannot seek medical treatment for malaria, a disease which is responsible for one in every five childhood deaths in Ghana. Ghana’s Health Minister, Dr. Ben Kunbuor, has even noted malaria’s strain on the economy. Fighting the disease accounts for one third of the national health budget. Combating malaria, one of the eight UN Millennium Development Goals, is likely to be unmet by the 2015 deadline, according to the United Nations Development Programme, unless more effort is made to focus on preventative care.

Sitting in a waiting room, knowing that the average Ghanaian suffers from two to three bouts of malaria a year, I began wondering about the ailments of the dozen or so people around me. It was somewhat of a relief, around 5 p.m., when a doctor told me that I had a urinary tract infection.

After several days of bed rest, pills and cranberry juice, life continued as usual. Giggling kids in school uniforms ran by me, on my way to work. Familiar faces in the neighbourhood waved as I passed. Even a lone hen added life to the scenery as it clucked its way across the road. That was until a sedan barreled into it. I guess this chicken crossed the road to cross over to the other side.

It was another reminder of why it’s so important to take time to relax and enjoy life, as Ghanaians so often do. Life can be hard, anywhere, really. But I’m always reminded of how meaningful each breath is when I get sick because I realize that it can be taken away so quickly—by a battered old sedan or a mosquito’s stealth sting.