The impact of the COVID-19 pandemic on Ghana’s Health System: “It makes me feel like quitting”. A personal reflection of a doctor at the maternity unit of a rural health facility in Ghana.

Author: Hannah Tiwaa Banor
One can be ready and prepared enough for a guest who announces the time of their arrival and is easily recognizable. But could any country really be ready for a respiratory virus with high transmissibility, dynamic in nature, whose symptoms are non-specific, and its nature is not entirely understood by the scientific community? The answers to these questions remain a mystery to be unraveled.
At the beginning of 2020, I was full of excitement and expectation as a new medical officer starting her career at the maternity department of the Catholic Hospital in Battor, of the Volta Region of Ghana. This hospital has a renowned obstetrics and gynecology unit and attracts patients across the country. This was my first time of moving out of the city to reside and work in a rural area. Despite being anxious about this move, my desire to serve was enough driving force for me to be excited about my new posting and work. I was welcomed nicely into the system, there were abundance of personal protective equipment to work with and work was moving on smoothly though the hospital has its own setbacks. However, these were all short lived as the advent of the COVID-19 changed everything.

Source:https://www.ghwedey.com/battor-royal-ladies-gentlemen-donate-ppes-worth-%C2%A212000-to-battor-catholic-hospital/

The novel coronavirus, subsequently named SARS-CoV-2 was first reported by officials in Wuhan City, China, in December 2019 (Global & Alert, 2020). On 13th of March, the WHO declared the coronavirus a global emergency as the death toll in China jumped to 170. To most stressed health systems with inequitable distribution of medical personnel and supplies, the spread of COVID-19 was a wakeup call to how vulnerable their health systems are. The first two cases of COVID-19 were reported in Ghana in March 2020. They created a lot of panic and anxiety amongst health workers but less so in the rural areas.
Yet, it quickly became obvious that health workers and their facilities across all levels were not prepared in the fight against COVID-19 pandemic. The default attitude is to do our best and leave the rest to God. Africans are incredibly religious; it is therefore not surprising that the attitude of most health workers is to resort to prayers and hope that God will protect us from the ‘cold hands’ of the novel virus which seems to have no regard for colour, race, ethnicity, money, power or social status.
A lot of questions were going through my mind when Ghana recorded its first case. I wasn’t sure our facility was ready to handle any case, but I consoled myself with the fact that the virus was far away from us. However, one fateful day whilst I was seeing a patient in my consulting room without any form of protective clothing, it became apparent that we were not prepared as we had quickly run out of PPEs following the outbreak of COVID-19 in the country. The patient I was caring for had symptoms that fit the case definition of COVID-19, and later confirmed as our facility’s first suspected case. The patient was 34 weeks pregnant, lived in a nearby town, had travelled to Nigeria two (2) weeks before reporting, and had also gone to Accra via a public transport 2 days before reporting at the facility.
The patient started coughing ten (10) days after her travel, with high grade fever, nasal congestion, sore throat and flu like system. After my assessment, the public health unit was contacted to look for isolation room for her whilst we took a sample for testing. This was when our unpreparedness was brought to the fore. We had no isolation center or units, no PPE, no trained laboratory personnel to take the sample and there was also no swab stick to even take the sample. We were forced to send the patient home, back to her community, and counselled her to return the next day for the sample to be taken. I left the consulting room for the first time with a troubled heart and numerous unanswered questions on my mind. Some of these were:
“What if this suspected case is a positive case for Covid 19?”
“What about those in the community she might have contact with or going to have contact with?”
“What about me, will I test positive too as I did not have any PPE on during the examination?”
“Is it safe to continue working without the appropriate personal protective equipment (PPE)?”
“What if I quit working? Will the vulnerable pregnant women from these villages who report mostly in emergency situations be neglected?”
“If I lose my life in the course of providing care to patients, what will happen to my family who had spent so much money in my training and are depending on me?”
“Why can’t the hospital provide us with basic PPE like face masks to work with?”
“What happened to the various PPE donations given to the hospital and announced at the national level to be under distribution?” “Is the administration hoarding it and for what?”
The more I pondered on the reality in the facility and questions raised as a health worker and community member, the further away the answers seemed. The weakness in our health facility and disregard for the severity of COVID-19 made me want to quit my job.

Source: https://coverghana.com.gh/north-tongu-dce-donates-covid-19-medical-items-to-battor-catholic-hospital/

Source: Source:https://www.ghwedey.com/battor-royal-ladies-gentlemen-donate-ppes-worth-%C2%A212000-to-battor-catholic-hospital/

Later that week, the parliamentary member for the constituency made a huge PPE donation to the hospital (coverghana.com, 2020). The members of the Battor Royal Ladies and Gentlemen for Unity, Peace, and Development also donated PPEs to enable the fight against the pandemic (Ghwedey, 2020). Yet, health workers could still not get the PPEs to work with. It was later noticed that some of the staff were taking the items home for their personal use, leaving the actual frontline workers nothing to work with.
Source: https://www.ghwedey.com/battor-royal-ladies-gentlemen-donate-ppes-worth-%C2%A212000-to-battor-catholic-hospital/
The result from the suspected case was reported to be negative, which was a huge relief for me and the entire health workers at the facility. Four (4) months down the line, we have still not recorded a confirmed case. But we have learnt lessons to strengthen our preparedness for the pandemic. We can now boast of an isolation center, a rapid response COVID19 team, trained personnel to take samples of suspected cases as well as a stock of PPEs to support staff and patients. There are still times when we have work without facemasks due to shortage, but this is being addressed. Clearly, despite all those gains, there is still room for improvement, but half a loaf they say is better than none.
The COVID-19 has revealed the vulnerability in our hospital management systems particularly in PPE supplies as well as their preparedness for epidemics. Health workers are still anxious and the realities of a lack of adequate PPEs and other WASH facilities facing frontline workers is real. COVID-19 seems to be here to stay and this is putting pressure on our already scarce human and material resources in our health facilities. We pray each day for Gods protection as we continue to see patients, knowing very well we are at risk of contracting the novel corona virus ourselves.
Despite the realization of vulnerability in our health system, we continue to work despite the possibility of contracting the virus. We hope this pandemic has exposed the vulnerability in our health care system to enable us to put effective measures in place to combat future occurrences. The fight continues each day and the dilemma to work or not to work is still a thought provoking not just me but probably a few health workers as the virus and disease burden increases. Humanity is witnessing moments of extreme uncertainty and an unprecedented global health crisis. Although it is impossible to foresee where this pandemic is heading, it is evident that a new chapter in infections, epidemics and pandemic management has been made in history and for infectious diseases this has just begun (Balkhair, 2020).
Looking forward, equipping health facility with the needed resources will enable them to render their services without unnecessarily putting their lives at risk. This must be the focus of all health managers and leaders in supporting the wellbeing of their staff and clients. The country’s health system should be more proactive in dealing with such epidemics so it remains resilient despite all the challenges. This can be achieved by establishing efficient and effective infectious disease control units and teams in all hospitals. These teams must be competent to deal with infectious diseases as well as building capacity for the entire hospital. Lastly, efficient and well equipped laboratories with the right human resource must be established in the various district assemblies to provide real-time results for quick decision making and service provision. On a personal level, this experience also calls us to reflect on our individual roles in fighting the pandemic irrespective of our position.
References
Balkhair, A. A. (2020). COVID-19 Pandemic: A New Chapter in the History of Infectious Diseases. 35(2), 2–3. https://doi.org/10.5001/omj.2020.41
Global, T., & Alert, O. (2020). Coronavirus disease 2019 ( COVID-19 ). 2019(April).
Coverghana.com. (2020, September 11). North Tongu DCE donates Covid-19 medical items to Battor Catholic Hospital . Retrieved from Coverghana.com: https://coverghana.com.gh/north-tongu-dce-donates-covid-19-medical-items-to-battor-catholic-hospital/
Ghwedey. (2020, September 11). Battor Royal Ladies and Gentlemen donate PPEs. Retrieved from ghwedey.com: https://www.ghwedey.com/battor-royal-ladies-gentlemen-donate-ppes-worth-%C2%A212000-to-battor-catholic-hospital/

The Centre for Health Systems and Policy Research (CHESPOR) at GIMPA:
This Blog Series is compiled and edited by Dr. Gina Teddy, Coordinator at the Centre for Health Systems and Policy Research (CHESPOR). It is part of a Special COVID-19 Edition to explore issues of health systems vulnerabilities and resilience compiled by the Centre for Health Systems and Policy Research (CHESPOR). The COVID-19 Edition is a series from the GIMPA MPH 2019/2020 Cohort working as frontline workers in various sectors of the health system to enable them to share their experiences and perspectives on the impact of COVID-19 Pandemic on Ghana’s Health System. However, the views expressed herein are those of the author and do not necessarily reflect those of CHESPOR or the Ghana Institute of Management and Public Administration (GIMPA).