Practice development
The challenge of managing burns in a Ghanaian hospital
Authors: Rebecca Heath, Stuart Enoch
This article discusses some of the challenges faced by healthcare specialists working in Ghana. The author describes her experience working in a hospital in this West African country as part of an elective placement. She describes some of the cases treated at the unit and discusses the country’s health service from a Western perspective.
Page points
1. Burn injuries caused by gas explosions are common in Ghana.
2. The healthcare service in Ghana is a national insurance opt-in system.
Useful links How to accurately assess burn depth
INTRODUCTION Having passed her medical exams, the author spent a two-month elective placement in Ghana, where she faced daily ethical dilemmas, such as, patients being refused treatment if they had not paid the equivalent of £7 for their national insurance to cover medical care and many being unable to afford dressings or intravenous (IV) fluids. She also experienced a very different healthcare service, much less privileged than the UK National Health Service (NHS), for which the author currently works as a foundation doctor. The author worked for one month in Korle Bu — one of the largest teaching hospitals in Africa — in the plastic surgery department, where she encountered a huge variety of cases, including numerous burns. She spent the other month in Kwahu Government Hospital — a small community hospital (about 100 beds and staffed by just three doctors) situated outside of the capital, Accra. Ghana lies on the west coast of Africa, a
few degrees north of the equator and its population of approximately 24.5 million is ranked as a lower-middle income economy by the World Bank with 27% of the population living on less than $1.25 a day. Ghana is best known for its cocoa produce, which it exports all over the world, but it also remains one of the top gold producers in the world. The average life expectancy at birth in Ghana is 64 years of age[1]
. There is a
ratio of 15 physicians per 100,000 and the healthcare system recently benefited from a cash injection of €52m from the European Commission (January 2012) to help reduce maternal mortality. Hopefully, this will not be hampered by corruption, which has been the downfall of previous attempts to improve the country’s health service.
32 Wounds International Vol 3 | Issue 3 | ©Wounds International 2012
HEALTHCARE IN GHANA The healthcare service in Ghana is a national insurance opt-in system that, as previously mentioned, costs individuals approximately £7 per year. However, many people cannot afford what appears to be a negligible cost from a Western perspective. The medical bills incurred for patients without health insurance cover can be astronomical, sometimes amounting to an entire year’s income. Even with healthcare insurance, patients are required to pay for their treatment, although the cost is dramatically reduced. People have to pay for their own dressings and IV fluids, which relatives then bring to the resuscitation area. The longer-term care for wounds and dressings is exorbitant for a Ghanaian and many cannot justify or afford it. However, the plastic surgeons working in
Korle burns unit are highly skilled and do have the expertise to perform many basic burn- related surgeries, such as skin grafts [Fig 1].
BURNS Burns are commonplace in Ghana[1]
. During
Figure 1 – Skin graft being laid onto a wound at Korle Bu, Ghana.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64