The cost of congestion in Ghanaian health facilities

Some have said a clean mind resides in a clean body. Though this may be true, a few things I have observed around outpatient health facilities in Ghana make me wonder what sort of minds we leave health facilities with. A few days ago, a friend of mine wrote on social media how she felt when confronted with significant body odour whilst seeking healthcare. My initial reaction was to burst into fits of laughter. I did laugh because I have long been aware of the debilitating effects of body odour on human thinking. To put it mildly even the hardened amongst us could have their thinking sequence significantly altered when confronted with pungent human fragrances. Having managed to get myself back to concentrate on my research I realised that her experience related to what I was thinking of writing about.

The fact is our outpatients’ departments are on most occasions heaving with humans. I have always believed that for some working in healthcare this is the biggest indicator that business is thriving. However, from a business standpoint, I have argued that this is a misrepresentation. I say so because an ordered waiting area would yield more patients, improve efficiency and ensure a better working environment. Sadly, irrespective of the opening of new health facilities and the training of new health human resource the situation seems to be entrenched in our health seeking culture.

This brings me to the subject of hygiene and sanitation in our hospitals. Truth is, as a society we never take sanitation seriously. However, unsanitary conditions at health facilities carry serious repercussions.  Firstly, many who come to these facilities are quite unwell and could carry a disease condition that could be transmitted to others through a number of ways. Many respiratory tract infections can be transferred through the air. Airborne infection transmission happens when bacteria, fungi or viruses travel on dust particles or on small respiratory droplets as aerosols when people sneeze, cough, laugh or exhale. Thus, having a large number of people in close proximity of each other with some having serious chest infection results in a high probability that those around the infected will become infected too. Diseases that are transmitted by this route include anthrax, chickenpox, Influenza, measles and tuberculosis.

As if this is not enough, many of these facilities have poor places of convenience, another area where infections can be picked rapidly. To make matters worse most are consistent without running water making simple tasks like flushing the loo, washing hands and cleaning of these public spaces by janitors virtually impossible. Accessories like soap, liquid sanitizers and disposable hand drying facilities are just wishful thinking. Consequentially such areas have also become avenues where patients share their gems unwittingly; living by the phrase, “sharing is caring.”

In some of these facilities, patients come into close proximity with each other transmitting all sort of infections by direct body contact. In other cases, contact with materials such as files, tables and benches become the medium through which infection is transmitted. Research has shown that furniture in health facilities are able to house and culture microorganisms for a considerable period of time without proper cleaning procedures. Thus, patients deposit blood, excreta or any other bodily fluid on these without proper cleaning and disinfection leave in their wake a health risk for others. Is this not a regular occurrence? Have we ever paused to think about the consequence? If this is not living in oblivion, I wonder what this is.

I can go on indefinitely about other sources of potential infection that can be acquired through visiting a health facility for a routine outpatient appointment, including health workers who attend to patients, the clothes they wear, the equipment they use like statoscopes and thermometers etc through to vendors of refreshments and other foods. However, I want to at this point look at why as a society we have refused to acknowledge these risks and move to do something about it.

As a health professional, I cringe at the thought that many of us who trained to keep society healthy and to prevent loss of life may be putting ourselves at risk, whilst risking the health of our patients too. Data on hospital-acquired infections in Ghana is extremely scanty. In fact, there is little documentation even on health workers who have become infected as a result of occupational hazards. However, some researchers have studied microbial contamination across our health facilities. One such study by researchers from the University of Cape Coast found twenty-four different microorganisms predominating as contaminants in peri-urban polyclinics in Ghana.

It is clear therefore that many of us may be going into hospitals to seek healthcare but leaving with more than we wished for. My view is that this is a situation that needs addressing. Having said that I struggle to see a way out – I do because there are significant cultural barriers that need to be confronted to ensure that this happens. To start with, the human congestion in these areas will have to be dealt with. This will require an introduction of an appointment system for seeking healthcare and a jettisoning of the current jumble sale approach that encourages queuing. It will also involve discouraging the sale of water, food and drinks in such areas, ensuring that there is constant running water, sanitisers are available and used equipment is sanitised and hand washing is practised rigorously.

In a nutshell, to minimise the risk of outpatient acquired infections we would need to be disciplined and stay disciplined. This is one area where we cannot pay lip service and expect results. It will require collaboration among health administrators, health workers, auxiliary staff and patients to get results. This is why I do not believe we will be dealing with this problem anytime soon and why I would advise my friend to be bothered less about the pungent smells that disturb the orifices of her nose but bother more about what accompanies her home. The real threats we encounter when present in health facilities are not what we can see, feel and smell but what is hidden in plain sight.

By Kwame Sarpong Asiedu

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