HEALTH OF AFRICANS – PART 1
By Charlotte Ahmadu
From the Project Leader,
Life is such a fragile entity- here one moment, gone the next; seemingly just another teeny-tiny part of an unending cycle of birth and death. But let’s not linger in philosophy, this is a pharmacy blog post. What I’d like you to wonder with me in the coming months as you join us in the unveiling of our six-month project is: what happens between birth and death? Not necessarily the events… remember, quality is always more imperative than quantity. No, I want you to ask- what is the quality of life well lived?
I can presume to think of what your answer is- health. What other state affects the whole being of man but his/her health status? As a pharmacist turned economist, my first thoughts when health comes to mind are always- how much does it cost to stay healthy? Who pays for it? And so I ask you, dear reader, how much does it cost you… how much does it cost your patient… and most importantly (since economists are interested in normative conclusions)- how much should it cost a human being to have good health? And who should pay?
This project is our torch- our attempt to give you the tools you need to answer that question factually (not based on your own idiosyncratic experience). We asked ourselves- how much does it cost for an African to stay healthy? We didn’t look to statistics and numbers… as pharmacists first and foremost, with patient care forever ingrained into our cerebrum, we answered that question subjectively by gathering data (qualitatively) from the African patient experience.
We (not I) thank you and hope that you will understand and show support to our project- Healthcare of Africans (HoA).
Story 1: Interviewing Mr S:
Background: Mr S is a Ghanaian pharmacist.
- What are some of the most memorable illnesses that you’ve had? And what interventions were made?
Ans: There are two memorable illnesses I have experienced.
The first one was in April 2013. I was in my final year of high school preparing for WASSCE examinations in May. I had pain crises which affected my two legs and made walking a difficult task for me. I went home (being a boarding student) for medical intervention but the doctor did not admit me as an inpatient so I received home care. I was on analgesics and was given about three to four infusions of Ringer’s lactate daily. Thermal treatment using hot water was given to my limbs to ease the pain.
I recovered slightly, being just well enough to return to boarding school and prepare for my exams. My health deteriorated, but I stayed to write my O’ level exams.
The second memorable illness was in October 2016 (my final year pharmacy school). It was the beginning of the first semester of level 400. I was diagnosed with malaria and given a full malaria treatment but my symptoms did not abate. I went to another healthcare facility and was once again diagnosed with malaria, was given artesunate injection together with full-course malaria treatment. But things only seemed to get worse and so I had to return home. I saw another doctor who diagnosed me with gastroenteritis, malaria and I was treated for all of them. The pain only seemed to get worse, eventually leading me to be admitted to the hospital. Investigations showed that I had developed severe malaria and also splenomegaly. But after being given Infusions of Ringer’s lactate and normal saline, diclofenac injection and Artemether injection, I was discharged. Under the care of my mum, I eventually bounced back to good health.
- Do you have any chronic illnesses? And if so, what are they?
Ans: The word chronic does make me uncomfortable but yes. I do. I have the sickle cell condition.
How do you stay healthy?
Ans: I do a lot of things. To tell you the truth, I forget to keep up every day but I try to take folic acid tabs on daily basis, drink a lot of water, protect myself from weather extremities and eat fruits and vegetables. But I do not go on regular check-ups.
How do you plan for your future health? E.g. A pregnant woman plans by packing a hospital bag and keeping it close by.
Ans: I always carry analgesics and folic acid. If I feel pain and it starts getting stronger I take an analgesic to manage it. I have heat balms and ointments with me all the time to use for my limb pain crises. I have bandages, but I don’t carry them everywhere. And once I feel that things are getting bad, I go straight to a clinic for medical attention.
Do you have health insurance? And if so, what does it cover?
Ans: Yes, I do have health insurance. My health insurance is government sponsored. It is under the National Health Insurance Scheme run by the Ghana government. It basically covers my medications, laboratory tests and, hospital admissions, but not everything is covered.
- What is the burden of your medical bills like e.g. give a round about the amount of yearly expenses in USD?
Ans: I am unable to tell the expenses of my medical bills since I do not always have severe pain crises that require expenses. Also with my health insurance, most of my bills are taken care of and my parents pay for what my insurance doesn’t cover.
- Do you ever worry about your health one day becoming unaffordable?
Ans: Yes, I do. The Ghanaian health insurance scheme through effective has been having challenges. Sometimes I fear the scheme might collapse and I would have to revert to out-of-pocket payments for my health. I do have this fear that this could drain me of all my money.
- What does having health insurance mean to you?
Ans: It means everything to me. That I get to have access to good health care and medical expenses are not as much as I would have had to spend without any help. With the economy of the nation being so unstable, having health insurance is the best security for me.
- What aspects of health care coverage would you like to see be made better for Ghanaians?
Ans: All aspects of health care really, but especially those pertaining to medication and care for chronic and lifetime conditions. Most Ghanaians with chronic and lifetime health conditions, in my opinion, need the health insurance coverage and not forgetting people with emergency conditions like accidents, delivery and surgery.
- Would access to better healthcare be one of the top 5 reasons you would choose to live outside Africa?
Ans: Yes. It would. Improved and rapid healthcare delivery is very important to me.
Story 2: Interviewing Mrs B
Background: Mrs B is a 77-year-old mother of 6.
Que: Tell us about your health? What brought you to the pharmacy today?
Ans: I’ve recently been diagnosed with pneumonia. It was a surprise- it only started with me feeling quite cold and having chills. I had a bad fever too.
Que: Have you had any other illnesses?
Not really… just dimmed eyes, the age you know. Headaches, body pains… things like that.
Que: What sort of healthcare you have received?
The doctor prescribed some medications for me, I’ve started my drug therapy already.
Que: How have you been keeping up with your healthcare expenses?
My husband pays for all my medications. He doesn’t complain, he says it’s not expensive, so it’s okay.
Que: Has healthcare expenses affected your finances?
No, as I said, my husband doesn’t complain and I hardly ever fall sick. So we’re alright.
Que: How do you stay healthy?
I always exercise and eat well.
Story 3: Interviewing Mrs A
Background: Mrs A. is 59 years old, she has 3 children. She is a petty trader and doesn’t have health insurance.
1. What is your health story?
Ans: I was diagnosed with tuberculosis. It started with a cough that became very persistent. I was very concerned and so I did a lot of tests but nothing came out as the cause. I was put on a lot of medications, but nothing changed. Finally, I went to the military hospital and my lab results came out positive for tuberculosis.
- Have you faced any other illnesses? Chronic? Acute?
Ans: Thankfully, just this TB and usual malaria. I have diarrhoea and fever sometimes, but never anything to take me into the hospital.
- You don’t have health insurance, has your treatment caused a strain on your finances?
Thanks to God my treatment hasn’t been very expensive and I’ve never fallen ill (with the exception to this TB).
- How do you stay healthy?
I regularly take medications, I eat fruits and exercise.
Story 4: Witness account of a pregnancy that went wrong
Background: Mrs Itohowo’s pregnancy was a difficult one which ruined her life.
Mrs I was a firm believer in health insurance but she found herself living in the rural area (antenatal care for pregnant women is not given, the traditional way is still so closely followed in ignorance). She never had a scan, never visited the nurse’s ward, never had tests… she only waited in hope until her baby was ready to be delivered.
When she went into labour, her problems began. The baby was too big and there was no conventional medical care available. Her baby was delivered in the traditional way and her uterus was badly handled by medically untrained midwives. She was damaged so badly that her urogenital muscles lost tenacity. The medical term for her current dilemma is urogenital fistulae.
Obstetric fistulas are abnormal communications between the genital tract and the urinary tract (urogenital fistula) or the gastrointestinal tract (most commonly, rectovaginal fistula). These fistulas result in urinary or faecal incontinence. Obstetric fistula is uncommon in countries in which the healthcare infrastructure is well developed… In sub-Saharan Africa, vesicovaginal fistulas are much more common… Obstetric trauma from prolonged, obstructed labour is the cause of the majority of vesicovaginal fistulas in these settings (Wall, L.L, 2013).
Ever since the birth of her baby, nothing has been the same. She’s become isolated from her family and from society. Her finances are all spent on medications to manage her condition. She tries to stay positive and healthy, even in her current situation, she continues to live as well as she can.
From the Project Leader;
Humans beings are naturally optimistic. We think tragedy won’t happen to us- almost like our very existence is behind a door whose panels are painted with blood… so that when the angel of tragedy comes, he will pass over us. But life is full of ups and downs- sorrows and happiness- blessings and tragedies. Health is too fragile for optimistic obliviousness.
Insurance is protection against probability. And with health, the probability is never 0 or 1. If there is a chance, slight or great, then rationality begs for action. Am I too much an economist and too little a pharmacist to think this way? What are your thoughts… that’s what we want to know.
This project is about catastrophic health expenditure. Perhaps as you read on, you will know more. My colleagues- Jen, Miss. M, Mash, SD and Emma; all worked superbly hard to bring these stories to you. I was lacking in many ways as project leader, but where I stopped, they started.