HEALTH OF AFRICANS – PART 4
By Charlotte Ahmadu
From Project Team Member
The disease has never proved kind to anyone- not the person diagnosed, nor the ‘family and friends’ who form an emotional and financial network to help that person return to full health. Thus, an unexpected illness is often financially and emotionally traumatic to both parties who had made no preparation for the shock that they have received.
What happens then when both parties cannot afford to absorb this shock? When the hospital/surgery bill is beyond their individual wealth? I am sure you will have an adequate answer to this question because for most of the patients you have read about who have no health insurance, their stories have been sorrowful and disheartening. Many fall into debt because they have borrowed beyond their ability to repay, some give up hope and wait for death to end the painful suffering. But should this be?
Catastrophic health expenditure has left many families in penury-stricken dilemmas. Hard, desperate decisions have had to be made, and many are suffering as you read this.
Catastrophic health expenditure and the unfortunate turn of events that illness often financially exhibits is what gave rise to this project ‘Healthcare of Africans’. It broke our hearts to continually see this cycle of suffering and so we have decided to raise an activist flag. Firstly by bringing your attention to the frequency of this problem with the hope that someone, somewhere will take note and raise an alarm that will resound and resonate across the sub-Saharan.
Story Sixteen: Interview with Mrs Godswill
Background: We interviewed Mrs Godswill five years after her stroke
Que: Tell us about your mobility problems, what happened to you?
In truth, I still find it difficult to understand how this all began. It started in June 2013, I started feeling some strange stiffness in one part of my body. Suddenly, my mobility began to quickly deteriorate. I was rushed to the emergency ward and diagnosed with having a partial stroke.
Sigh, that was where it all began. It hasn’t been easy on me or my family since then. My story has been adrift from good experiences to bad and now, I am no longer my former healthy self.
Que: Have you faced any other illnesses?
I’ve had chronic illnesses- but nothing that can compare to being demobilized by a stroke. I am hypertensive and also diabetic. Now, I have to manage these three conditions.
Que: What interventions have been made so far, concerning your health?
Not many interventions were made, just drug therapies and once-in-a-while physiotherapy, I still find it difficult to walk, and to go on with my normal chores.
Que: You’ve mentioned that you’re not on any health insurance scheme, can I ask how you’ve been able to afford to pay for your healthcare out-of-pocket?
I’m now retired so I have no income coming in. At the onset of my illness, I spent all my savings on my medical bills, but soon it wasn’t enough. Thankfully, my family members stepped in and are now helping to pay for my medication bills. You can see for yourself what effects my ill health has had on my financial life.
Que: Yes, we can. How do you try to stay healthy, despite your ill health?
How do you stay healthy?
I can’t say that I have been healthy since I had my stroke- it sapped a lot of vitality from me and so I can’t say that I am healthy or I can stay healthy, anymore.
I have no income, I’m surviving from hand-to-mouth, depending on the empathy aids from my family members. It feels quite hopeless sometimes.
Que: How often do you access healthcare- from the hospital or pharmacy?
I have bimonthly physiotherapy sessions in the hospital and I come to the pharmacy fortnightly for my drug refill.
She chuckled, just like I visited now.
Story Seventeen: Mental Health Witness
“I grew up seeing my uncle’s mental health worsen with little being done about it. He often has hallucinations and sometimes is very aggressive so living with him has always made me uneasy.
He’s under the health insurance plan but it doesn’t really do anything for him because people in the hospital don’t really care about mental illnesses and so the care is very poor.
My grandmother is always trying to contact her other children to send her money to pay for his healthcare because his drugs are very expensive and often scarce. He has to take them daily and when it’s not available, the situation can be very troubling.
People tend to lock relatives who have such mental health problems indoors because the cost of setting them up in a rehabilitation centre is too high and so little is done to help them.
My view on the Ghanaian health insurance system is that it’s wacky. It doesn’t do much to help and it should consider mental health in addition to physical health.”
Story Eighteen: Biographical
Background: Mrs Rose has been hypertensive for five years now
In 2012, Mrs Rose’s husband died and left his widow behind to become the sole breadwinner for three little children, the oldest being four years old at the time. Her husband’s death left her emotionally broken, traumatised and unable to move on. While struggling to be strong for her children during the day, she spent her nights mourning and weeping. After some times, she began to experience incessant, painful headaches.
“During that period, my blood pressure rose up to 200/110 mmHg”
For a week, her blood pressure was carefully monitored and her physician put her on the sedative-hypnotic drug, lexotan. This helped reduce her blood pressure to 170/90 mmHg. This state persisted only for two weeks until she was admitted into the hospital when her headaches returned in full force and her blood pressure shot up again- she was diagnosed as hypertensive.
“Frankly speaking, I was too young to experience the trauma of losing my husband. I wasn’t able to cope well with everything.”
Her health hasn’t been the same since then. Now hypertensive and struggling to care and provide for her three grown children, the burden has not become lighter. She was put on a strict anti-hypertensive drug regimen (three drugs) for five years.
“Those drugs really helped me stay alive.”
But in 2014, her health condition worsened which almost led to a partial stroke, she was also treated for haemorrhoids. Her blood glucose levels have been on a steep rise and ‘diabetic’ has been added to her patient profile. Affording her medication bills out-of-pocket has become a challenge, as she does not have any insurance coverage. In 2014 when her health condition worsened, her finances also took a nose dive. Working in public service, her salary of just 70,000 naira monthly has barely been able to cover the costs of her children’s education, wellbeing and her healthcare bills.
She abides by her drug regimen religiously, has adjusted her diet to her diabetic profile and tries to get on with her life every day. She seldom goes to the hospital (except when her children are ill) to avoid high medical bills but frequently goes to the pharmacy for medication refills and consultations with the pharmacist.
For Mrs Rose, despite all that has happened to her, life must go on, and she is determined to live each day with her head held up high.
Story Nineteen: Testimonial
“I’m not on the Ghanaian National Health Insurance scheme, though I have filled all the paperwork and obtained the health card. I don’t use any of the services because I believe the quality of the drugs under the program must be substandard. I’d rather buy medications myself.
My uncle has several eye problems that have only worsened as he’s grown older but we bought private health insurance premiums for him and that’s aeons better than the government health insurance.
By the grace of God, my family and I seldom need to access healthcare facilities. The only common problem we have is malaria and when that happens, we go to the pharmacy and buy the drugs we need after consulting with the pharmacist.
I think the Ghanaian government needs to employ more people into the healthcare system. They need to pay them well so that they can take care of us and we’ll have faith in them to patronise the system.”
Story Twenty: Biographical
Background: Mr Ekpedeme was diagnosed with congenital digit fistula as a child. He’s 27 years old and his health condition is both dire and critical.
When Mr Ekpedeme was a child, he was diagnosed with digits fistula. His left arm and fingers were most affected by his condition. He was scheduled for several surgical procedures to correct his birth abnormality but none of those surgeries proved successful. Rather, his situation was compounded with more complications.
Four years ago, he was involved in a ghastly road traffic accident that almost completely damaged his right hand and exacerbated the pains on his left.
“I have experienced pain that is more than grief, itself.”
To regain mobility in his left arm, he was advised to seek medical intervention abroad which would cost him 15 million naira- a sum he had no way of raising. He was in the university studying Law when these unforeseen circumstances happened to him. He had to suspend his education and since then, has been unable to continue.
“I am unfit for society… I always stink.”
Mr Ekpedeme has lived with a swollen arm and fingers since that accident. It’s been five years since then and he is constantly in pain. Bandages must be wrapped around the severe ulcer on his left arm, suspended on his neck while his swollen arm is rested on the abdomen. The pressure caused this has reportedly compressed some of his internal organs.
Some medical interventions were made to ease his condition, but they have all proved useless, instead of exacerbating his illness and delivering devastating blows to his hope that things will get better. I can testify to how severe his condition is and the damage that has been done. To get through the day, he uses self-administered opioids to mollify the intense pains from his ulcers and injuries: up-to 10 ampoules in six hours, up-to 30 ampoules daily, all to stay alive. The silver lining seems to far to see, for Mr Ekpedeme and living has not become merely existing.
“I don’t like this dependence. I tried to stop once, but I thought I would go insane from the pains I was feeling.”
He has no health insurance coverage- all his healthcare bills are paid for by his parents out-of-pocket, there are currently no NGOs or charities that have stepped forward to raise support for an intervention to ease his suffering.
“I would like to do something meaningful with my life again. I think if only I could regain the use of my arms, things would improve. But for now, I’m useless.” He said this while smiling, but his eyes did not smile with his lips.
From Project Team Member
Speaking about mental health is still a taboo in the sub-Saharan, but we shall do so because something must be said about it. ‘Mental Health’ is a level of psychological wellbeing– a state when a person is able to function satisfactorily at a level of emotional and behavioural adjustment to life and day-to-day situations. If an individual is not able to do so, they are then in turn ‘mentally ill’.
There is a myth purported from the Nile to the Congo and the Niger, that people who have mental health issues have either been cursed due to wicked deeds, or possessed by roaming demons. These myths and superstitions have caused centuries of stigma and inconsistent beliefs to be built around any deviation from what is a healthy mental state. Individuals who find themselves in this boat often feel helpless, unable to speak out… isolated.
Being ill- be it mental or physiological, requires specialist care, financial involvement and emotional support for proper rehabilitation and return to a ‘healthy’ status. Sadly in the African continent, inadequate measures have been put in place to cater to the needs of what is a growing percentage of the mentally ill. Health insurance schemes have all but neglected to improve the services offered in this category.
Mental health services and programs would be a worthy investment for any healthcare system to undertake and although rehabilitation programs require huge funding, the net benefit will always outweigh the cost inputs.
Much has been said about the catastrophic financing of health due to physical ailments, but mental illnesses also require a lot of health expenditure as treatment is long and there is often no ‘regimen’ or ‘guideline’ that could be used for every patient that is mentally ill. As mental health has become not only a global but also a continent-wide concern, more significant attention should be given to it when health systems create budgets for services and interventions.