It's off to work I go

I'm going to talk shop for a bit so you may switch off if you wish but I have been asked what it is I am actually doing out here. Last Tuesday I began my 6 week placement in Hohoe hospital, which has 600 beds (can't confirm how many of these are actually in a ward) and 3 doctors (!), and where I am scheduled to work in the mornings, Monday to Friday. Officially it is on an observational basis but unofficially who knows?

First I met with John, the hospital director who informed me that considering my interests and background, I would be based for the 1st 4 weeks in the physiotherapy department, for the 5th week in the emergency ward (A+E I think that means) and for the last week in the children's ward. So, a good start I thought. Then I was given a brief tour of the children's ward and A+E before being introduced and deposited in the physiotherapy department.

Physiotherapy, by all accounts, is the nicest and best equipped department in the hospital. It has a large gym area with a couple of treatment beds, parallel bars and weights machines, exercise bikes and stepper. It also has a separate area with cubicles and some electrotherapy equipment and a large waiting area. Much better in many ways than I expected. And there are even fans to keep the temperature down.

The department suffers from the same problem as everywhere else however - transient running water. I eventually discovered some soap (shampoo!) in the kitchen but it took me longer to track down the water - collected in buckets - to wash with. Might need to modify my finely tuned and practised hand washing technique then.

The beds (plinths) are nicely presented with a sheet, the purpose of which is lost on me. Normally as I understand it, a sheet protects a bed so that it can be used by more than one person as only the sheet needs changing in between. The thing is that while these beds are properly wipeable, the sheet is not. And is changed only once a week.

The hierarchy within the hospital runs with the doctor at the top and the patient quite firmly at the bottom. This appears to be the case in the physiotherapy department also to a degree. I was shown around the department on my first day where there were patients being treated in most of the cubicles - in varying degrees of undress. We wandered in and out of the cubicles and for once I was disappointed (and embarrassed) to find that my anonymity, to the patients at least, remained intact. It was also the first time I have known a physiotherapist show less than the usual basic courtesy to a fellow human being. Almost as schools are run here (kids are regularly disciplined by way of the cane), obedience and conformity are attained (by one therapist, certainly not all of them) through fear. Patients do not always understand the treatment they are given or the goals they are being steered towards.

Healthcare in Ghana works on a pay as you go system: All treatments must be paid for although people can buy insurance which will cover some treatments but not all. Just over half of the population, probably, have insurance. The patients seen in the physio department that have insurance are given a patient number. If they don't have insurance but pay for their treatment they have a different type of patient number, though still a unique identifier. If the patient has neither insurance nor means to pay, they are treated but not given a number. They are not recorded in hospital data and they remain invisible to audit!