Ambulance service is a critical component of any emergency relief services. The ability to offer on-the-spot first response to a health emergency is a decisive element in the avoidance of life loss from emergencies, especially during childbirth or accidents.
The Ghanaian National Ambulance Service (GNAS) was born following the May 9, 2001 stadium soccer disaster in the capital city of Accra. The incident resulted in 123 fatalities and brought to light pot-holes within Ghana’s emergency medical services and care.
With a limited coverage area of regional capitals and few districts as of 2009, Ghana’s medical emergency system consisted of 49 government ambulances and a fleet of various private hospital ambulances.
Since 2009, there has been no organization or proper guidelines for private sector ambulances. Consequently, private ambulances have many uses other than patient care. Also, there is no standard training required for ambulance drivers in the private sector and many private sector ambulance drivers only receive in-house training or what is popularly termed on-the-job-training. Until the National Ambulance Service (NAS) Bill is passed private ambulances cannot be considered to function as Emergency Medical Services (EMS) as they do not meet the standard of an ambulance.
Despite the quality of services provided by private ambulances, over 90% of people arriving at emergency care facilities are brought in by private ambulances or taxi.
As far as my mind’s eyes can see, the number of hearses (a funerary vehicle used to carry a coffin from a church or funeral home to a cemetery) in Ghana is more than the number of active ambulances to convey emergency cases like pregnant women in labour to hospitals. Likewise, “51% of maternity hospitals in Ghana do not have a general ambulance which can transport women in case of obstetric emergencies”[according to the Ministry of Foreign Affairs].
Unfortunately it appears Ghanaians value the dead more than the living. What is the number to call for an ambulance in Ghana? The general service codes including Ambulance 193, fire 192, and police 191, do they work? If they do, how many Ghanaians know about their services and how promptly do they respond when called? To some people, calling isn’t the problem. Being there in time or worst of all, on time to serve as its job demands is the biggest challenge to NAS.
Hard to reach communities like Bomkpa in the East Gonja District, Ghana, needs an air-ambulance service. Why do I say so? It is one of the most isolated villages in Northern Ghana. You can hardly find it on the map. The village is also unique because the people have never seen a doctor, professional midwife or even a health assistant in the village. The nearest hospital is at Salaga, several hours away by motorbike. That is, if you can cross the river. The make-shift bridge over the river is broken. Though every baby is headline news, in Bomkpa for example, every house has a maternal death experience to share.
How about the people of Old Nzulezu? The Nzulezu Stilt Village is an amazing village built entirely on stilts of central wood, as the villagers call it. The ‘streets’ are woven rafia walkways which attracts thousands of tourists from all over the world in a year. It is situated about 150km west of Takoradi, in the middle of Lake Amansuri. My interaction with them reveals that community settlement started over 500 years ago.
Nearly everything in this village built on stilts takes place on or just above the water, including health care. Whenever a new baby is born, it is baptized in the lake, which is believed to be a protection against drowning.
Though the village has no modern health centre, it has a herbalist who solves both physical and spiritual needs of the people. When a pregnant woman is in labour, she is taken to a resident traditional birth attendant for delivery. But if there are complications, the pregnant woman is transferred by a canoe, which takes about two hours, to the nearest health centre in the near-by town for safe delivery. During the dry season when the lake is not up to its full level, pregnant women in labour are indigenously assisted in an improvised cloth-made palanquin after traveling in a dugout canoe for one hour to the nearby feeder road for further transportation to hospital.
According to them, it is only during polio vaccination periods that one sees teachers (not trained health workers) administering ‘foreign’ drugs to them. There are currently no trained health professionals visiting or stationed at Nzulezo.
Apart from few towns and cities that make daily news headlines, several communities are situated in the deepest interior of rural Ghana. Places most travelers may describe as “the middle of nowhere”. Villages such as Bodada and Kute-Buem on the Ghana-Togo Border are remote villages in the Volta Region where telecom signals barely reach and the broken, dirt roads lead to more broken dirt roads. Maternal Health Channel Television and Radio Series produced documentaries on them (Click here and Here).
How do people in such isolated villages access ambulance services in times of emergency? How can residents make a call to National Ambulance Service (NAS) when the signal on their phones indicates Togo Network? Does this not pose a great challenge to NAS in reaching these communities in time?
My observation is that a number of harrowing deaths recorded in Ghana could have, to some extent, been avoided if there were reachable ambulances. Losing life in the process of giving another in a dramatic and painful way has become a norm.
According to tradition, once a woman is pregnant and about to deliver, she must leave the village to give birth somewhere else. Compounding this is the fact that there is no ambulance in Mafi-Dove and surrounding villages. In villages of this nature, there must be a stand-by ambulance to assist during emergency services. That is to say, some cultural beliefs impede health delivery.
For the purposes of discursive decency I believe we cannot allow culture to deteriorate. We have for long suffered from impositions of beliefs and practices which our forefathers have socialized our generations with. But wearing my maternal health lenses and situating this peculiar belief within a health discourse, and without disregarding, the wisdom of its initiators, certain cultural practices must be discarded. Yes! Culture is a way of life. This does not mean we must hold on to certain practices that is taking us nowhere. But as a nation, we must ensure that what’s right is done. I am not saying culture must be thrown away. Our scant knowledge on culture dynamics has exposed us to many challenges that are affecting us as a country.
Ghanaians, for that matter Africans, have been described as notoriously religious. Just imagine the various ways in which we parade hearses during funerals, and yet it’s a different scenario in emergency cases that require the services of an ambulance. I strongly believe Ghanaians treasure the dead more than the living.
Almost all the various tribes in Ghana have a certain amount of beliefs with regard to a dead person. The dead person becomes a messenger, conveying messages from the land of man to the spiritual world. These emanated from the pervasive existence of illiteracy and superstitious beliefs. This has affected the nation and the whole of Africa in such a way that, we place death rites among all other things. We must be ready to do away with beliefs and practices that hinder progress in a country.
The “poli-tricks” in Ghana is killing us.
In a Ghana News Agency article posted by Spyghana.com (http://vibeghana.com/2012/04/20/government-to-decentralise-the-ambulance-service/) titled “Government to decentralise the Ambulance service” on April 20th, 2012, the then Vice President John Dramani Mahama announced that government would give meaning to the ambulance decentralisation programme by procuring a minimum of 600 ambulance vehicles in the next two years (2012-2013).
Vice President Mahama announced this when he presented 50 of the ambulances to the Ministry of Health to be distributed to some districts. I ask, is this feasible or one of many unfulfilled promises? Ghanaians on a daily basis pray for the materialization of this promise.
In response to recent blames leveled against the Ministry of Health over shortages of ambulances published by Daily Guide on June 29, 2012 (http://www.dailyguideghana.com/?p=53728), the then Minister of Health, Mr. Bagbin said, “The fact that the emergency medical service system in Korle-Bu failed and somebody died doesn’t mean we should just pick them from the harbor…We are all up to our task, nobody is sleeping and let’s be sensitive to each other’s feelings,”.
In what seems to be a revealing situation to me, majority of residents in Sogakope, a renowned town in the Volta Region of Ghana, before May 2013 do not know the number to call for an ambulance. This came to light during Maternal Health Channel Television Series’ (MHC) Community Video Screening in the town. By popular demand from the attendees, the District Health Director made the number available but with a caution “do not abuse it. Don’t call when you’re experiencing headaches etc”. The number was subsequently projected on screen for public utilization.
Victus K. Sabutey is the Research & Productions Co-ordinator, Maternal Health Channel Television Series, +233(0)24911432. Watch the Maternal Health Channel Thurs. GTV 8 pm & Fri. TV3 8:30 pm.