Policing doctors in Ghana

Friday Jun 21, 2013 -

This week I ask a lot of questions: how do we police doctors? How do we identify the bad doctors, sanction them or prevent them from continuing to hurt innocent patients?

Recently, there have been two dramatic media reports of doctors, ostensibly, doing “bad” things to patients who had sought their professional services.

Without prejudging the culpability of these doctors (the one who reportedly had sex with patients who had gone to him for abortions and the one who performed liposuction with complications), these stories seem to give the impression that there are some pretty bad doctors out there.

Again, the questions: how big is this problem of doctors doing bad things? Who and where are these doctors? How does a wronged patient or family member bring his/her complaints to the institutions that can investigate these reports of malfeasance? Is the method of contacting these public institutions enough to be easily accessed by all? How are these investigations done? What sanctions are applied? How are the sanctions communicated to the reporting patient or family and to the general population? Are the sanctions effective enough to protect the population from further harm at the hands of those found guilty?

The single overriding question is this: do we have a system in place in this country that allows a patient to easily (and the word here is “easily”) report medical negligence?

I personally believe that there should be a clear, public, easily accessible method of reporting bad doctoring to the appropriate institutions. The appropriate institutions should be clearly identified in the media for all to know who they are and what they do.

The results of the investigation of egregious activities of doctors after they are fully investigated, sanctioned, gone through appeal processes and confirmed must be made public. The publication will not only reassure the public, but will be a deterrent.

There have been calls for patients to sue doctors for malpractice. Inasmuch that seems like a good thing to do, it is impractical and not the best way to approach medical negligence. First, it is expensive and will further overburden an already overburdened judiciary system, thus making it a laboriously ineffective option.

Most patients will not have the resources or the time to pursue that option. What we need are clearly identifiable institutions (the Ghana Medical and Dental Council and the Ethics Committee of the Ghana Medical Association) which are easily reachable and will aggressively respond to complaints, but will also be fair to the reported doctor. We also need a robust coroner’s inquest process that will investigate deaths resulting from medical malpractice.

These two, I suspect, will help us to answer most if not all the questions.

What do you think?

Dr. Joseph Boateng

About Dr. Joseph Boateng

Dr. Joseph Boateng is a Physician Specialist. He has practiced medicine for over 31 years. He has extensive medical management and leadership experience as Medical Director or Deputy Medical Director for several hospitals in the US, Ghana and Nigeria, and as the managing partner of a medical practice he founded in the US.

57 comments on “Policing doctors in Ghana

  1. Good write…but what happens to the Medical Officer who cancelled an Upper Respiratory Track infection diagnosed by a Medical Assistant and replaced it with Malaria on the folder?
    What happens when on admission, the eight month old patient could not swallow a bit for all the food and drugs given to “return”?
    What happens to that Officer when the poor girl lost her life on the third day on admission?
    Really, there are some bad ones in the pack and one is only “lucky” to encounter them.

    • Misdiagnosis do happen peharps not intentionally. if an officer finds out the prevoius diahnosis was wrong he ha the obligation to investigate based on presenting symptom and rediagnose the patient properly.Remember, its not the Dr.’s repetation we are defending, its the patients life.

  2. I know many people who have made countless complaints about botched surgeries in Ghana and nothing has ever been done. I stayed at Bomso Clinic Kumasiwith my mother for 2 weeks and while i was there (August 2004) at least 4 people died from botched surgery including my mother. The doctor removed her colon without attaching a pouch known as ileostomy, which is a surgically created opening in the abdominal wall through which stool can pass, or an ileoanal pouch anal anastomosis (IPAA), the creation of an internal pouch that’s connected to the anus, allowing stool to pass through the natural opening. Now tell me something how can a qualified doctor not know that once the colon is removed something needs to be done to ensure that stools collected passed out. My mother died because Ghana’s many arrogant doctors. I am not a doctor but I did ask the doctor why he felt that removing the colon was the best option as I knew Ghanaian doctors were not yet trained to perform ileoanal and did not think a young person like my mother would be comfortable with a pouch attached to her person. The doctor categorically discounted me as if he knew better and his better was to just simply remove the colon,nothing else. it would have been better if he had just strangled her to death.

    The same doctor decided to operate on a 17yr old girl with a very mild form of goitre which could have been easily treated with iodine tablets and she also died. the lady with appendicitis also died on the operation table and in the mean while he was demanding 100s of millions cedis before releasing his victims bodies. All this happened in Ghana because operating generates more money and these doctors sole aim is to make as much money from their patients regardless of their experience. This doctor when questioned claimed he had trained in Manchester UK like it made a difference to his performance. apparently what I saw while i was there for 2 weeks was nothing, one nurse told me that almost 90% of his operations end in death and yet he chooses to operate just the same because there is no regulatory body checking on doctors. Totally appalling.

    • Nana Afia, it is a story such as yours that makes it imperative for us, as a country, to have a reliable, EFFECTIVE system to report, investigate and deal meaningfully with percieved medical malpactice and negligence.

      First, it will protect patients. Two, it will hold doctors accountable, and third it will bring respect to the profession as a whole.

      I am certain that there will be doctors who will think that advocating a system like that is going to hurt them individually, collectively and bring some form of bad light to the profession. I actually think the opposite is the case. The activities of bad doctors bring disrepute to the profession and indeed to ALL doctors.

      Most doctors are good and doing their best. The activities of the bad doctors however make patients suspicious of almost every doctor.

      Again, EVERY doctor should care that patients are not harmed. Whether they are their patients or not. That is the mandate of our profession. So we should be alarmed when any doctor is doing things that hurt, maim, or kill patients negligently.

      The institutions mandated by law to protect patients from harm should be responsive to patients’ reports of negligence; investigate them seriously and expeditiously and let patients, family members and the general population know of the results of their investigations and sanctions, if any, that have been applied. That can and will clear the name of doctors who are wrongly accused but, more importantly, it will bring some form of closure to family members who lose loved ones, warn the public about the guilty ones and be a deterrent for other doctors who are not so responsible.

      From your story it appears that the existing reporting system did not help the people who used it, assuming that they contacted the right persons or institutions. That is not good. Not at all. It is not good for the patients who suffered harm, it is not good for the unsuspecting patients who will be harmed subsequently, it is not good for the medical profession and definitely is not good for the country.

      We cannot hide our heads in the sand like ostriches like the problem of bad doctors does not exist, we cannot be afraid to confront mediocrity, negligence and irresponsibility.

      We must have some compassion and do what is right for patients. We must sanitize the medical profession because it deals with human life!

      I sincerely believe that that will make us better people, a better profession and a better country.

      Nana, my condolences, even though it happened several years ago. Let’s continue to hope for, work for and insist on a more humane medical profession in this country.

      • Arrogance is the name of the game. This is true both in the United States and Ghana. One thing that brings those in the U.S. under check is the malpractice insurance claims brought against these doctors and the hospitals they work. It offers the hospital administrators the unique opportunity to make sure that qualified doctors are hired and also monitor them through a peer review program. I think the laws should allow for doctors to be sued for negligence because it will help bring them from their high horses to the human level.

    • In as much as I sympathize with the loss of lives,we have only heard your side of the story.You didn’t mention why your Mom required surgery,the facilities available in the hospital,etc.
      I don’t know thyroid pathology the second patient had but need to understand that not all thyroid swelling is due to iodine deficiency.
      Even in the best of hands there is some mortality ,albeit small,associated with appendix surgery.So you see you cannot just blame the Dr without giving him the opportunity to present his side of the case.
      You can present your case to the Ghana Medical and Dental Counsel for investigations

  3. This is an important topic, thanks for bring this to an open. Many Ghanaians live or have lived in the western world and are familiar with the systems they have in place – Negligence and Malpractice by some doctors are seriously investigated; we have specific Agencies that deal with this problems.There should have such agencies in Ghana to investigate these problems.

    A Ghanaian came to USA from England and worked at a top hospital here in USA, he was hired as Surgeon. During several surgeries, the team realized that he could not perform any basic surgery, so the hospital investigated his back ground.

    Apparently, they could not verify most of the things on his application, that means, he never went to medical school.Many people die just from small surgeries which should not happen. Ghana has trained many doctors who perform so well in USA, so how come some of the doctors in Ghana cannot perform simple surgeries without loosing lives in Ghana? This is very, very sad.

    Ghana is being developed, therefore we should have a health care system that can take care of people that want to invest in Ghana as well as our own.The doctors should be paid well so that they can perform well. Some people even do not go to the doctor when they get sick, they go to pastors for treatment, some what. We should try and implement some of the good things we see in the western world.

    Great discussion.

    • Lady Dee, when a surgical death occurs it is important to find out what actually caused the death. It could be the surgeon’s mistake alright but it could also be other causes such as anesthetic mistakes or poor post operative care due to nursing mistakes. Other complications such as infections which may be due to lack of cleanliness or effective infection control in the institution or lack of antibiotics to treat infections which can be attributable to institutional and even a system problem, may be the cause.

      Unfortunately, a surgical death is, in a lot of cases, blamed on the surgeon. Without holding brief for bad surgeons, I will like to suggest that that may be some (out of many) of the reasons that creates what one may perceive as “more” deaths due to surgeon mistakes in Ghana, as you put it.

      The important thing, I believe, is for us to have a system in place that can investigate complaints concerning surgical deaths in such as way as to find out exactly what caused the death and whether it was preventable. If the death is a direct result of the surgeon’s activity then the appropriate recommendations can be made.

      Such an investigation will unearth underlying issues that can be tackled. The best way to solve any problem is to know and understand what the causes of the problem are then apply the right corrective measures.

      I would want to suggest a special coroner’s inquest process to investigate surgical (and medical) death complaints.

  4. The Medical and Dental Council is the governing body that deals with malpractice, and they seriously follow up all complaints. I have discussed this matter with the Registrar on several occasions. Part of the problem comes because of lack of meaningful audit of surgical cases. But as long as social relationships are more important than the truth, these problems will still occur. But there is also another problem: The sad fact is that there are also remote hospitals in this country in which medical officers struggle heroically to save lives with minimal equipment; yet, if anything goes wrong, these people are supposed to be held to the same standard as if they were at Ridge Hospital with all its facilities. Thus the potential exists for good doctors doing their best with bad equipment and few staff to be erroneously prosecuted along with quacks who are only after easy money.

    • Dr Lamissi, thanks for your contribution. This call for improving malpractice investigation and sanctioning in Ghana includes a call to strengthen the Medical and Dental Council and resource it adequately to do its work. But also important is the need to make the role and the work of the Council known to the ordinary man in the street.

      Last Friday after a lecture, some of my final year students and I were discussing this issue of malpractce reporting. They knew that the Medical and Dental Council investigates reports of medical negligence. I asked them if they knew how to contact the Council and they drew a blank. Some suggested that they would go to the Council offices in Accra to make a complaint.

      That is significant.

      I suspect that most people in Ghana do not know how to contact the Council except “go to their office in Accra”.

      My suggestion is that the Council should make its role publicly known in the Media and how to contact them from anywhere in the country.

      Also if the results of some of the more serious investigations, such as the Medina “sex doctor” and the recent “liposuction doctor” are made public, public confidence in their protective work will be enhanced and will also act as a deterrent to other doctors.

      Concerning the doctors in the less equiped hospitals doing their utmost; I am certain that these challenges will surely come out in a detailed investigation and the appropriate exoneration recommended. First we must realise that some bad doctors may be hiding in the smaller hospitals doing bad things. Second a detailed investigation of rural based doctors will bring out some of the horrendously difficult challenges they face. Hopefully that can help solve some of the problems they face when the effects of some of those problems (preventable patient deaths) become evident.

      This call for improving negligence reporting and santioning is not meant to be a witchhunt or hurt good doctors. It should be absolutely protective of good, innocent, hard-working doctors. It is meant to catch and punish the bad ones and protect the pblic.

      I sincerely believe that a robust, public reporting, warning and sanctioning system will enhance the reputation of the profession.

      • Also, nurse has to be autonomous, they should report to board of nursing and work under their own lic. In ghana, a nurse can not challange a doctor if he is wrong. here in the USA, yes, they do. it serves as checks and balances.

        • Patrick,
          please do not generalize about usa as an example. Nurses in USA do not challenge doctors. They suggest and make their opinion known officially through their Charge Nurse.If you know anyone who claim to do otherwise he or she erred and its not the norm. There are a protocols here and everyone follows them that is why it is an advanced country and most people want to come here.A nurse challenging a doctor is not one of them. Rules are respected and obeyed almost 100% time though not always. This is an issue confronting Ghana. We certainly need to start somewhere and solve it and save patients. The suggestion to improve the reporting and investigation system is is great one. Those in charge should not assume they are wiser and see every suggestion as an affront and confrontational issue to defend. Ghana is not improving because of such attitudes. Please swallow your pride and “big man” attitudes and help change a bad a situation. they should know that it could be them or their relatives one day when they are gone who may face similar situations in a clinic and may need help. And Fellow doctors if you are reading thses comments and you know your knowledge and skill base is a suspect, please find means to update and improve- you have lives to save. Medicine is not a money venture. it could be you one day on the operating table and will wish to have the best skilled and knowledgeable doctor to save you. As a docotr you are not immuned from diseases nor accidents so be careful and improve yourself.Perhps you gotten away with a lot of mistakes and will wish that such improvement never happens and so may be one of those who will fight against changes. Improve yourself and save lives and lets together improve our the system and our country.

          Back to the issue at stake, first please let start with the staff in the office of the Ghana medical and dental council. what is theirr background and work ethics. How much respect do they have for people who show up there. I was there myself and i had a very odd experience on 2 occassions in 2012. I hope things have change. I know the suggestion is for a system that may require or include simple phone call or email or letters without meeting with personel but lets start from there. Employ the right people who know what they are there for and instill in them some work ethics and discipline besides eduation in investigative/reporting abilities and how to process such delecate matters.

          God bless everyone and our country.

      • Dr Boateng,
        I join with other folks to express appreciation for broaching the issue at stake. I will like to assume also that since you are lecturing in a medical school, you have the attention of the “big doctors” who have executive positions to make such suggstions to perhaps at a morning report or Mortality and morbidity conference to really effect a change. In my humble opinion in that way it will not only be a discussion seeking people’s comments but solution wiill be underway since this is not a “big thing” like the salary issue to take too long or needa government immediate intervention but really ” doctors problems” regardless of the auxillary health professionls possible involvemnt. This is an issue docotrs can solve and should be willing to do so.

        Doc, some times i get worried that in our efforts to discuss medical issues confronting the profession, we may stand in public and wash the “dirty clothing” though this issue is not one of the those to hide among us. i worry because some issues are best talked about among as at a our professional conferences if there is any in ghana at all and not on forums like this. In my humble opinoin once again, I may be wrong but I feel this forum under your great leadership should be used toeducate the public about diseases/prevention and not to discuss doctors. Most of the people who read thses are smart but are not necessary medical doctors like you. Any thing s aid about doctors affect you and the many who are not reading it especially if it is coming from you though you may present it as a highly educated point of view properly considered and analysedThe fact that you carry the name doc and say things about “docs” you may be throwing “docs” under the bus though you are one. All doctors lose respect and trust when we bring our professional issues inot the public to discuss. Yes some doctors may be making mistakes and as you and i knnow and you rightly stated there are many reasons a patient may be adversely affected during or after care, most readers may not really understand this. They blame everything on a doctors and i agree with them – who else should they blame? going to a clinic or hospital is the same to many as to going to see a doctor in most people’s mind. The buck starts and stops with a doctor. Not this issue but please lets discuss issues that bring the profession in disrepute at our morning reports and conferences so we do not lose the trust and confidence the public has in all of us carrying the prefix “Doc” before our names.You may be doing everything well in your practice but i bet there are people on this forum who have not seen you or me personally and may get to know this issue first hand from you and may lose some trust for all of us thinking we are doing the same or can do the same ie not because of what is already in the news but for a fellow doc to openly tell them in a more clear terms to think about how to change the system- something perhps only docs and their assocition can change and announce to the public just like you suggested to dr lamisi that gmda should do. Could we have made the suggestion direct to GMDA to send a newsletter to allmembers to attend a conference to see how such issues could be sloved or improved? Or they can only know your thought through this forum? or it will carry more weight if you write it here? I know you have lived, trained and worked for years in USA beofre returning home to make a huge sacrfice and contribution. As you know while here, most issues including this are written in publications such as those from ACP and the medical journals which most doctors subscribe to if its a nation wide problem. The media is kept out as much as posssible to keep the profession respected. With all due repsect to the pastors and religious leaders, we know we are one of the the last resort when people get sick and need help. we need to keep the trust the public has in us.

        this issue is already in public, we may argue, because people know there’re doctors who are so called “sex doctors” etc and that problem need to be solved. I believed direct communication with those who should change the reporting system etc and persistency to see a change silently would have also been one great option.

        One question/suggestion i wish to make is: can a journal or newsletter be started by you and those at home which can be subscribed to by only MDs so that issues like this and others can be discussed there and solution can be found just like in USA and other developed countries? I think Ghana medical and dental council can start or may already have one or great colleagues like you can begin and we all pay and subscribe to so that those in remote clinics can get some educational articles from great doctors and many more like you monthly through the mail instead of this forum. This forum i believe should only be for educating people about baisc diseases eg diabetics, CADs, HTN, Malaria typhoid, Obgyn issue to explanin to people why they need to take care or prevent diseases and effect of their actions beofore they ever need need us.And also answering peoples questions as why doctors do what they do to help them. We owe it to them to educate as you are already doing but lets keep our professional concerns among us to earn and keep their trust and respect.Certainly there are bad nuts among every profession but we can weed and correct ourselves before we publish. In USA as you know you can check the license be it active or not of every doctor in any their start of resident from the state’s medical board website and see if there is any charge or complaint about the doctor- yes that is public but we get the issue discussed in our journals and have numrous CMEs to improve skills and knowledge and behaviours. i know you know this already.We can start with the “inside-profession discussion and weeding out the bad nuts” thru enducation before we add our voices in in public to chastise the profession in the name of seeking comments. They already know thir suggestions will not go anywhere but thye will have ample tool and reasons to deepen their distrust for ALL OF US. Lets send the suggestion to GMDA and follow up to see a change instead of shouting it out in public. You are great doctor and i really respect all that you are doing. Please forgive me if anything i have said has been offensive or not in good taste. i am sorry.
        God bless you

        • Arthur, thank you for your contribution. I am definitely not offended by anything you said in your piece. That is what this forum is all about: to share ideas, disagree with each other, respect other people’s views, all in the hope that we can bring some constructive ideas to a problem that is important.

          I understand your position about “washing our dirty linen in public”. I have also noted the suggestions you make as to how to get these ideas to other doctors and to the GMDC.

          I disagree with you that having these discussions openly through a blog will tarnish the reputation of the medical profession in Ghana. I do not believe that we are saying anything that is either not an open secret to patients or festerng and creating mistrust and angst.

          Indeed part of the reason for even starting this blog was the numerous complaints and negative comments that I heard from patients and family members about doctors and how “bad” they are. Some of these stories are definitely exagerated and embellished, negatively, but they emanate from something we, as a profession, are not doing right.

          The recent doctors’ strike did not help matters, nor did the negative stories in the press. I may be wrong but I think the reputation of the profession needs to be raised a little higher than it is now if we are to restore the level of confidence that is needed for a profession that deals with human life and should engender very high public confidence.

          From your earlier post I take it that you live and work in the US. I will like to suggest that the strict credentialing system and the vigorous investigations of patient complaints of negligence in the US are all to protect the public. But they have, as a corollary, created a very high confidence in the quality of medical care and in the profession because patients know that someone they trust is watching.

          If you study the history of medicine in the US you will find that this current state of affairs was the result of persistent and public patient advocacy by both doctors and non doctors.

          I do not think that public advocacy by members of a profession for improvement in the performance of that profession for the benefit of patients should make the profession less respected. Indeed, I think the opposite is the case. If we can improve the performance of our profession through public fora like this, we will be better served. We cannot hide the failings of our recalcitrant members and hope that nobody will see while we try to reform them.

          Let’s think about it: we have had all the systems in place for years yet we still see and hear of some of these horrendous stories; this arrogance and disrespect for patients.

          How do you even tackle the problem of disrespect for patients by some nurses and doctors? Do you think talking to them through newsletters and journals will do the trick? How do you enforce respect for patients’ rights? Don’t you think that we can have more effect if we educate and empower the patient to refuse to accept that kind of behavior?

          If this empowerment is, hopefully, the result of advocacy as we are doing on this blog, don’t you think that will increase the rsepect of the patient for the profession rather than diminish it?

          The other practical difficulty is that it is a near impossiblity to publish and disseminate a newsletter to all doctors in the country especially the ones in the rural areas.

          I believe that this our effort is an encouraging one. We must guard against fault-finding, personal attacks, and bashing of people and institutions without basis or constructive ideas. That is not always easy to do but we are trying to keep the process civil, constructive and educative. I hope everyone will see this effort in that light and not personalize it.

          Again, thanks for your input. I appreciate it. I really do.

          • Dr Boateng
            Thanks for the explaination. Your are right. We need to have this issue in the open and find solution.

            What do you think about the following: while advocacy group is going on as suggested, can we engage the news media investigative units to report more often some of these doctors, nurses and health personel misbehaviour and mistakes? I feel if a doctor’s name is constantly appearing in a newspaper/tv as disrespectful or coursing more harm to ptients or a nurse not comely to patient in a particular hopspital or clinic be it korle bu or private facility, it will be one additional option to effect a change.I can understand that some of the allegation may not to proven but if a doctor is reported on muerous occasions to the news media and they make it a point to go ask him/her on tv to explain, he will either change or leave the facility be it in a vilage or in a city. Just one little step to effecta change if society deems a particular doctor or nurse to be bad, they will shun him or her.

            Again, thanks for your insights

  5. Doc: doctors policing doctors in as corrupt a country as Ghana is really a high mountain to climb. However, you are to be commended for broaching the subject. Thank you.

    • bathsprins, I know for a fact that there are good, honest and dedicated doctors in Ghana who can be counted upon to protect patients and protect the reputation of the profession.

      I believe that this is an important process so we cannot give up even if the mountain is hard to climb.

      • Perhaps this council should include CID personels, medial and an activist. one of the would stand for the patient.
        Also here in the USA, nurses and Doctors and many more have a two year cycle lic. renewal . those in this category are required by the end of the renewal cycle period to produce a continue education credit, meaning, you have leanr something new such as patient teaching, costomer service,etc.also every wrong or mistake is required by law to be reported daily to the board by the facility underwhich these professionals work. that way at the time of renewal of lic. the board may make a decision to to re-issue the lic. or suspend. we need to do that in ghana.

  6. It is so sad that the Medical and Dental council which is the sole body
    regulating medical, dental and other practices, is only interested in collecting
    huge fees from members and not doing ‘who te’.
    We need to have a alternate high powered neutral committee to police our doctors
    and other health workers.

    • Phyllis, I think that if we resource the GMDC; and its role and some of its decisions and sanctions are made more public, the confidence and respect of the general public and doctors in their work will be greatly enhanced.

      I know they are doing a challenging job and if we got to know some of the things they are doing, I believe that we will all see what good job they are doing inspite of the challenges.

      I believe that the GMDC has the most unique role to protect patients and enhance the effectiveness and respect for the medical profession in Ghana.

  7. This is an exellent discussion. I think most doctors trained in the last few jss/SSS era are a problem. There should be no new medical school without a well equipped teaching hospital. If we have to report the bad ones and the proper action taken, we will loose more than half of them to sanctions. There are too many people dying needlessly due to misdiagnoses.. The medical profession in Ghana is fast loosing respect.

  8. Hospital engineering is very important in all aspects of hospital establishment.
    Without proper equipments, doctors cannot diagnose and treat patients.

    There are good and bad in every profession however,criminal negligence on the part of medical doctors is due to lack of proper equipments. The truth of the matter, we do not have proper engineering set in place that is why malpractices are more rampant in Ghana.

    There are so many areas we can prevent malpractices and negligence in our society, without basic water and electricity we can not move forward.

    Hand washing can prevent all kinds of bacteria and pathogens. We live in a country nobody cares about the healthcare, without research, proper equipments and also updating data, medical doctors cannot do so much.

    Medical ethics involves personal hygiene, societal and environmental atmosphere contributes to host of complications in human genes. What is the government and policy makers doing? Create an environment which will be less susceptible to pathogens, virus, bacteria, fungi etc.

    It takes proper equipments to deal with each particular case. The best way to deal with medical malpractices is to create an environment whereby we will be able to identify each particular case.

    Medical ethics applies to every doctor, however, not all doctors are professionally trained to deliver services. Those involve in medical malpractice need to be reprimanded.

  9. The Medical negligence and malpractices rate in Africa especially Ghana, is very high, as a result, there are so many deaths which in actual fact, could have been prevented by the various Hospitals. Because there are NO known mechanisms to check on the Hospitals and clinics, their medical staff (doctors and nurses)continue to kill, molest and maltreat patients frequently and egregiously.

    It seems the Ghana Medical Association apparently finds it difficult policing their own members for negligence and malpractices and so the Association always only try to seek the interest of their members and against that of the general public. As a result, the GMA all the time try to shield the medical staff against the general public whenever there is a complain about medical abuse from patients / family members.
    It also appears most of the legal practitioners in Ghana are also not very comfortable handling medical negligence and malpractice cases due to perhaps,lack of relevant case laws, so they do not encourage ligations against the hospitals and their medical staff.

    Dr Boateng, it is hard time we take this issue very critically as a nation and set up proper mechanisms like Medical Ombudsman and/or medical courts to legally prosecute and punish egregious medical staff (bad doctors and nurses) in the country to bring sanity in the medical profession and confidence in our hospitals and clinics.
    That Ghanaian mantra of fama Nyame(leave it to God)attitude when somebody dies in hospitals due to surgical operations etc should drastically be discouraged to allow family members make a case against the hospitals and their medical staff whenever there is a suspicion of medical negligence and malpractices.
    Patients safety and comfort should be our hallmark as a nation. Thank you Dr Boateng, for your initiative.
    Long live Ghana.
    Opoku Bonna, LL.B, LL.M

    • I have been on self-imposed exile from this site, but I am with you all in spirit.
      Mr Opoku Bonna come again and make a more balanced statement.
      NB the entity in charge of medical malpractice is GMDC not GMA. You do not have to be a member of GMA to practise medicine in Ghana (it is just a trade union) But you cannot legally practise medicine in Ghana without the registration and approval of the GMDC.

      —–The Medical negligence and malpractices rate in Africa especially Ghana, is very high, as a result, there are so many deaths which in actual fact, could have been prevented by the various Hospitals. Because there are NO known mechanisms to check on the Hospitals and clinics, their medical staff (doctors and nurses)continue to kill, molest and maltreat patients frequently and egregiously.—–that statement is too sweeping and unfortunate, Africa and Ghana have their challenges but no Doctor will say such things about lawyers and politician —most of whom are lawyers
      TWI proverb ko nsuo na obo ahina—
      come again My learned friend Opoku Bonna, Thank you Dr Boateng.

  10. the GMA is over protective of it’s members,and some doctors are very bossy on their nurses n eill not listen to what the nurse who has stayed with the patient all the night has to stay n some just diagnose missin all the patients complaint .

    • First of all I am very impressed that there is at least a governing body (GMDC) that deals with malpractice cases. I am sure the GMDC has documented an alarming incidence and severity medical errors caused by adverse events (instances of patient harm) but who knows why and how they occurred except the practitioners involved and the members of the GMDC. I will encourage the GMDC to have a NATIONAL PRACTITIONER DATA BANK (Electronic Data of course, not cabinets with full of papers) to establish a clearinghouse of information on medical malpractice and any adverse action taken against them. Hospitals and other healthcare organizations can use this data bank to restrict the ability of incompetent physicians, dentists, and other health care practitioners to move from city to city, without disclosure or discovery of previous medical malpractice and adverse action history. This will help improve health care quality, protect the public, ensure patient safety and reduce medical errors.

      There should also be a credentialing system that tracks provider credentials and generates notices of the need for re-credentialing, based on license expiration dates, the date on which the provider’s credentials were last reviewed, continuing education requirements etc.

      Addressing patient safety should be taken seriously and example of steps that need to be taken are:

      (1) Creating medical error reporting systems that allows healthcare providers and facilities to analyze common errors and identify aspects of the healthcare delivery process that result in such errors.
      (2) Drug checking systems that alert physicians and pharmacists of possible drug interactions or allergic reactions to prescribed drug.

      All these are achievable if those responsible at the top really mean business and want to help the country attain a quality healthcare delivery system.

      • Ceedoo, a national doctors’ data bank resulting from detailed and unimpeacheable investigations will be a great deterrent and, as a single process, be the most effective way to ensure professionalism and physician responsibility in Ghana.

        We have to ensure that innocent doctors are not wrongly damned. That will be absolutely unacceptable.

        However we should not use the possibility of an innocent doctor being wrongly tagged as a reason not to create a doctors’ data bank. We just have to do it with the appropriate checking and cross checking and relevant appeal processes.

        • Exactly! and with regards to the concern you raised about the possibility that innocent doctors could be wrongly damned, I can’t think of any better solution than what you said in your last sentence. And to add to that, I will suggest all doctors, regardless of whether any adverse action have been taken against you or not should be given access (viewing only) to the data bank so they can frequently do the checking themselves to avoid any such error.

  11. Dr Boateng, the issues you raised are very very interesting. These doctors are having a field day in practising their nefarious activities because there are no ACCOUNTABILITY SYSTEMS to check and control their activities.
    What I mean by Accountability Systems are methods and procedures for monitoring and reporting every activity conducted by any professional or non-professional in an organised setting which may impact on the community, the economy of Ghana and the society as a whole.
    In the Accountability System the monitoring and reporting captures the evidence, then the most import aspect is TO ACT on the evidence by way of punishment (of penetrators), reward (good behaviour), reprimand (poor performance), sanction (perpetrators), adjustment, correction, improvement and review of the system for better performance
    An effective Accountability system empowers beneficiaries to complain for the betterment of the whole system and it must be on-going (continuous improvement).
    Empowering beneficiaries mean providing dedicate access by way of a accessible location, office, IT systems for two way communication, making easier to beneficiaries or stakeholders to complain or give feedback and ACTING on the feedback.
    Anything less than that, then we should be content with the current chaotic state of affairs

  12. A lady friend of mine visited a Tamale hospital because of persistent acute abdominal pains. The doctor tested for typhoid and malaria and found nothing, and that was it. Yet the abdominal pains continued. What did typhoid and malaria have to with it? Wasn’t there anything else that the doctor could have looked for? How could a lay person realise that this probably was a case misdiagnosis, in a society where doctors are revered? How could such person know where to launch a complaint?

    What I think needs doing is for the Ghana Medical Council to acknowledge that there are doctors with inadequacies and if they want to root out the problem, launch a public campaign to encourage patients to understand they have a right to complain of bad or wrong treatment at the hospitals. This has never been done and so most people in Ghana still believe doctors are always right.

    • Azaato, I agree with you that a public campaign to educate the public on what the GMDC does, how to contact them and the rights of patients is important and I would even add, imperative.

      I suspect that there would be an avalanche of complaints at the initial stages so we will need to strengthen and resource the GMDC to do a good job that can engender confidence.

      I believe that this issue of curbing malpractice and negligence rests massively on the shoulders of the GMDC.

      A strong and proactive GMDC will be one of the greatest assets to protect patients and sanitize the medical profession in Ghana.

    • Azaato Asignaba: I am very sorry to hear the sad story of your friend at the hands of the medical system. This is a story that is all to familiar and one that has been discussed ad-nauseum on this forum. While the issue of medical negligence is one that needs to be worked on, I feel that the problem is broader than negligence on the part of doctors.

      Having knowledgeable and competent doctors will not solve the problem IF the system they work in is not equipped to maximize their potential. You can have the most brilliant doctors in the world, but if they work in a healthcare system that is not equipped to diagnose and manage acute illnesses, there will be no benefit.

      In the case of your friend, I think the doctor did the right thing to order the tests that he/she could order, however your friend probably required more testing (perhaps abdominal imaging or other blood tests) to evaluate the cause of her abdominal pain. The question is:
      Does the hospital have the resources to provide those services when they are needed?

      I think a critical inquiry of so-called negligence on the part of physicians in Ghana will reveal that a lot of hospitals lack the basic resources to make accurate diagnoses- which is a pre-requisite for giving the right treatment. In that case, the government will not want anyone opening up a can of worms exposing the incompetence of the system when they (the state) is liable. A doctor who works in a hospital that does not have the resources to diagnose and treat an illness CANNOT be found “negligent”; the hospital on the other hand CAN be found negligent for not providing the right services.

      How many times have we had patients with asthma exacerbations and heart failure in whom we cannot even provide OXYGEN for? The fact is: our hospitals are so under-equipped that doctors are forced to practice “shotgun medicine” aka “Galamse medicine”.

      You can have the most lethal ammunition in the world (doctors/nurses/medications/vaccines)to hit an enemy (disease) but if you don’t have an efficient weapon (Healthcare delivery system) your ammunitins are as good as nothing…..because they cannot be delivered to their target in an efficient manner.

      • Dr Fambondi:

        Thank you for your input on this subject. That was insightful and thoughtful. You guys are doing great and I hope the knowledge being poured out here will be tricking down to others to bring a change in our health care delivery.

        I met one Canadian medical doctor and his reason for moving to the United States was government interference on their practices; for example, putting cap on tests they deem fit. This is a country with universal health care access, however, he thought their delivery is poor because of that restrictions from the government.

        So you are right. How do you blame a medical doctor who can’t ask you to get a Head CT Scan for a persistent headache that is worse in the morning than afternoon associated with nausea or vomiting to rule out Brain Tumor? And instead, keep on ordering say, Tylenol 3 for that symptom in emergency room. What happens when that patient is flown to say Buffalo, Niagara and Washington – 3 Cities close to Canada, where rich Canadians go for their CT Scan & MRI- and diagnosed with brain tumor, would that be a case of negligence from his doctor or the Governmen. This is why your response is very, very apt.

        How can we offset this problem? I found Dr. Boateng’s answer to be very helpful and efficient if doctors really want a change in healthcare delivery in our backyard. If the GMDC are going educate and encourage the masses, cases like that of Azaato’s friend would not be blamed on doctors but on the government. I believe when cases like this are explain to the people, it will help them to understand the situation Medical Doctors are in Ghana. This will even cause people to agitate for better health care delivery from government who found it a hip to seek medical help in the UK and USA, while there are no portable X’ray in emergency department of most of our teaching hospitals?

        Also, recent researches have shown us that when medical doctors are quick to accept their mistakes, the people are more forgiven and even that brings more understanding and trust between the people and providers. This is what GMDC should understand and don’t feel apprehensive to encourage people to bring out complains to them. With their complains, the GMDC would be able to educate the masses while simultaneously enrich and enhance their professions.

      • Fambondi, fantastic piece. I agree with you, absolutely.

        Healthcare delivery is a complex process. In a developing country such as ours the complexity is multiplied several-fold by numerous factors.

        We must approach the search for solutions in a comprehensive manner. I suspect that as we tackle one problem such as negligence, the effect of other factors such as poor therapeutic equipment and services, poor or lack of diagnostic services, substandard or lack of needed drugs etc. will become more evident.

        My hope is that our negligence investigations will unearth the real causes of adverse outcomes so that innocent doctors trying to do the best they can under difficult conditions will be exonerated.

        I believe that the process will be educative for all: family members, the medical profession, the policy makers and government.

  13. The way forward is not about suing for malpractice but it is about identifying the right institutions which people can report to and those institutions applying the law to the maximum to deter others from doing the same. In the US due to mal-practice laws suits, patient are charge unbelieveable fees. Why because Doctors pay high insurance premium and this is pass on to the final consumer who is the patient. As a developing country setting up strong institutions who will enforce the law without fear or favour will in the long run help our course.

    • DON-willies, malpractice litigation will not work in Ghana except for some very egregious cases where great harm has been done to a patient and there is an incontrovertible need to compensate him/her. The public institutions such as GMDC will not have the legal mandate to determine compensation.

      Personally, I do not believe that the legal route will become anywhere as common as we find in the US where all sorts of forces encourage and promote it.

      It should, however, remain a reluctant option for the very terrible cases of malpractice and negligence.

  14. What Dr. Boateng has done is a huge accomplishment — providing a a forum for voices to be heard on one very important sector of the society,i.e.s health service delivery. No one has ever done that before. It shows the concern he has towards medical practice in Ghana. I would suggest he set up a health advocacy group to pursue the issue or get a few like-minded medical practitioners around a table to begin a process on needed reforms in medical practice in Ghana. With reference to the case above of a surgeon in Bomso in Kumasi, who loses 90 per cent his patients,it is obviously not in any one’s interests to have practically a serial killer practicing medicine.

    All the needed institutions are, to me, already in place. All that needs to done to prod them into action.

    • Azaato, I have noted your advice. Thanks.
      I also agree that we have the system in place to deal effectively with this healthcare delivery problem.

  15. Thanks for bringing to the fore such important issues and providing insightful comments too. It’s sad to hear some stories and my condolences to those whose relatives have suffered death on account of negligence or malpractice.
    I think the Ghana Medical and Dental Council is not doing enough in this regards.
    They should move beyond just being interested in collecting retention fees and actually start looking into some of these issues. After all their motto is guiding the profession, protecting the public.
    Dr. Boateng, I have worked with you before in Cape Coast and I can attest to your professionalism. Let me not keep it personal. I hope these discussions will not end on this platform but will be taken up a step higher to influence policy and cause a change in our dear nation.

    • Dr. Banin, thanks for the compliment.

      We are working hard to ensure that the ideas that have been generated on this blog do not become sterile.

      Some very good ideas have been generated which have been constructive and very eye-opening. I am very encouraged that the discourse on this blog has been courteous (mostly!), serious and wide-ranging. I am looking forward to more ideas and contributions. We all need to contribute to improve healthcare delivery. Hopefully not but we could find ourselves in need of a responsive quality healthcare for ourselves and/or our loved ones.

  16. Dr. Boateng, thanks again for giving us this platform to share our experiences and to suggest ideas.
    My observation has been the lack of an appropriate standard of care in most of our facilities. You can only hold our medical personnel accountable if they don’t follow laid out steps for treatment. How can we in 2013 still suggest that we treat patients for malaria if they complain of fever? Should we have rapid test even in pharmacies to confirm the parasite before treating?
    The medical boards are doing a good job, but there is a lot of room for improvement. The disciplinary board can’t only comprise of doctors, there should be patient advocates in the form of lawyers as part of the group. It’s a conflict of interest o have practicing physicians who make some of these same mistakes police their colleagues. It won’t work and hasn’t worked.
    I had a friend who was treated for malaria and typhoid for 5 months before they realized she was only pregnant. What were the effects of the misdiagnosis and treatment on the baby.


    • Agyaaku, my condolences on the loss of your mother.

      When you write “he killed my mother’, you should remember that blame is seldom 100% to one party.
      We all know that money alone can’t solve all problems – if you were here, you may have had a detailed face-to-face conversation with the doctor and may have been in a position to influence her management.

      My point is that when people choose to go abroad for extended periods, they gain something and lose something.

      The current condition of the country is the sum total of the actions and inactions of all those who profess allegiance to it. Those who are not part of the solution are part of the problem.


      • Atta your latter comments do not justify your opening comments. The issue here is the integrity of the practitioner in question. Agyaaku’s presence is not needed for effective healthcare rather the system lacks check and balance which led to the lost of his beloved. A face to face encounter with a crocked practitioner would have yield the same result. After all my friend, a snake in a suit,tie,lab coat and a stethoscope is nothing but a well dressed snake with a stethoscope. These are the very things the article is trying to address. Your comment is insensitive and indirectly justifies the doctors behavior. A sick person and their family are vulnerable and should not be taken advantage of regardless of their circumstance. After all ,it was a fee for service yet he didn’t get what he paid for. Someone mentioned educating the masses in their post and I strongly agree because an educated consumer will demand a better service. Every sector of our system preys on vulnerability hence nothing gets done in a proper manner. There are so many factors precipitating these behaviors yet it is not worth losing life secondary to malpractice. Healthcare is one of the most powerful profession without a gun. The point am trying to drive home is that your doctor or nurse can ask you to strip naked and in a heart beat you will follow that command. The command is followed not because of ignorance or dumbness rather on the trust that your disease will be taken care of. Now ,why should somebody violate this trust for personal gain? My friend put yourself and your loved ones in the same situation and I bet the conversation will be different. No matter how you slice and dice it ,it is wrong and it will only end if we stop accepting such practitioners. I look forward to learning some strategies from you to solve our healthcare system. Thanks much.

  18. Well done doc. The problem here in ghana is that those with the ability to be in medical school are are not given the chance, but rather to those who can pay bribes, as such you can pay to become a medical doctor, but not by your your ability.

    • This is a public forum for voicing concerns on a highly relevant issue in the country, namely health service. In that connection we should provide quality debate to advance the issue. In that connection I would politely disagree with the comment by Tamil Toure.

      Everyone who enters the medical school must meet minimum qualification criteria. Due to the highly competitive nature of the entrance some get admitted while others don’t make it not because they didn’t qualify but because those admitted scored higher. I don’t believe that money power alone could allow anyone to burst into the medical school with a string of failures. So the claim that chances are given to those who can pay bribes shouldn’t be made lightly. It should be backed up with evidence. If two people meet the selection criteria with one a little lower than the other, even if the lower scorer gets selected because of his or her relative’s influence, it doesn’t mean that he wasn’t qualified to study medicine. Having said that I am in no way condoning such practice, I am only trying to point out that most doctors in Ghana entered the medical school genuinely. The bad practitioners among them could also be those who were “more qualified” than the rest. There is no way of distinguishing them. So the PROBLEM, as Toure would like to claim, cannot be reduced to the selection process alone; in fact that is only a minor part. The real PROBLEM lies somewhere else and that is what this forum is trying to analyse and resolve or mitigate it.

  19. Thanks Azaato
    medical school, at least the one I attended was not a TEA PARTY, we had to work very hard and you had to be very brilliant.
    Initially,I tried to correct such sweeping statements in this forum to avoid DOCTOR BASHING but I was outnumbered and did not get any support despite the fact that all my assertions were proven right. So these days I live on the fringes.
    There are still very good contributions such as yours and I like reading them.

  20. Azaato,
    i couldn’t agree with you more . You are right, to gain admission into medical school is mostly based on academic performance and other tested and proven factors- in Ghana and many renowned countries. I get the impression from Toure however that there are some frustrations and given the slightest opportunity or acccasion, a person will voice/write it out even if it is not germaine to the issue at hand.

    However, what worries me about this issue at hand is that there are many doctors in the rural areas who are using the “lack of resources and equipments” as an excuse to wrongly diagnose and treat diseases and are getting away with it. I personally had experience with some doctors who had come from various countries to do housemanship at Korle bu. They were hardly impressive in their knoweledge and skills. Infact some did not know anything that will make a person confortably call them doctors. they were like people with advance knowledge of biology and biochemstry who were having attachment program in a science facillty to understand how medicine works and entails. This was years back. Most of them decided and went to practice in remote district hospitals where they claim they will have “some respect” compared to being at Korle bu They all chose not to stay to re-learn the medicine from those there before going out there with no supervision. I worried about their knowledge and their ability to save lives then and i still do. Some friends of mine spend a year for language studies studies in a country where they met so many young Ghanaian students who had been sent to the same country during the so called revolution, the govenmnet of ghana at the time use send to do: Send some A level or form 5 graduates to to study.Some of those Ghanaians who where there were deemed to be studying medicine= My friends reported that they were always partying and hardly studyiing – I personally read from one of them talking about a medical issue with less informed mind and was quoting from a book i used in my undergrauduate biology class.She quoted the book like a medical pathophysioogy textbook to support her case- wrongly i might add.

    It was shameful knowing the deficit in her knowledge as a doctor. Icould not believe she is a doctor going to handle a poor sick person in a village far from Accra or open her own clinic and in Accra or Kumasi and “kill” as many as she can get away with.

    A colleague of mind took it upon himself to re-teach one of them but had little time at hand and this person completed one year husemanship at the time and left. I always schudder and pray that God will help those that these “doctors” trained fromthose countries will threat. This is my personal experience so bear with me, its NOT a generalized statement about anyone trained in another country other than ghana. In the USA doctors take 4 national exams USMLE step 1, 2 CS and 3 to test their knowledge before they can ever practice whether the person graduated from his or her own country USA or not besides all the exams everyone takes in medical school.AS I said these national exams accesses a persons knowledge before anyone who claims to be doctor with documents fo rm harvard or any Highor low class medical school can get a license to practice and also complete or continue a specialty training.

    This is not the case in Ghana. there is only one exam ( 100 or so quesitons with one time committee questions/interview and english language testing) for those who trained outside the country and not those who trained in it. Now i hear You basically go to Tamale to join a group and be coached a bit in TROPICAL DISEASES AND A FEW OTHER DISEASES OF INTEREST if interested and you can take the test- almost assured of passing after Tamale a week or so coaching. Medicine is being cheapened, why wont people die after seeing a “doctor”. LATELY I HEARD A FEW WHO FAILED WRE COMPLAINING THAT THE TEST is BIAS towards those who studied medicine in a foriegn language other than English- REALLY!!! its medicine- its the same human disease whether in russia , usa or niger, we suffer from the same HIV< DIABETES< Heart diseses,liver dieseases etc go study and don't kill people, "DOC"!!!!

    The assumption is that one exams is ok and those tho trained in the country( GHana) are ok without further national exams.They say if the foreign trained fail it 3x then they asked to attached to a medical school for 1 yr. There is no board certification, perhapds until now ( west africal college of physician & surgeon or so the so called residenciesprograms started recently) and what happens to those who never participated in those West Africa thing and residencies? does anyone know how good they are to touch and treat patients? Some may be destroying peoples lives and they free in in some towns and villages lording over the people as " docotrs". So if they they in ghana, they do not need to take a national exams, how about the USMLE whihc tests everything?

    I also know some doctors who were sent for a 6 MONTH or ONE YEAR attachment course in programmes such as neurosurgery, pediatrics, ophthalmology etc in countries such as USA, BRITAIN, RUSSIA and are back in the country as claiiming to be SPECIALISTs & treating people and taking the money. i was in one of the so called neurosurgeon'soffice the other with a sick person and andthis so called specialist was basicallly interested in money.He took an attachment course for less than a year or 2 years and he is now "cutting and opening peoples skull to exam thier brain". Why wont they be "killings" people.

    In USA it takes 5years of general surgery specialty training after medical school and addtional 2 to 4 years in subspecialty such as neurosurgery to call yourself a real specailist in that. If you graduate from medical school, finish 1 year housemanship and work in the surgery dept without testing/major exams under any real highly trained specialist and you go on a short 6 MONTHS course IN holLand or USA ETC for cardiosurgery or neurosurgery etc yu do not QUALIFY TO OPEN MY MOTHERS SKULL TO EXAMINE HER BRAIN in the name of "he is the only one available or lack of equipment", you will kill people be it korle bu or else where. This is happening in our country and the so called doctors and smart people are defending it. It is better to have few qualified better trained doctors even if you have to travel 1000km to see them with acute diseases than to see a quake, half trained, money conscious indivividual in a village or town or city who will "kill you instantly" with no regret or redress.

    There're many of such so called doctors in our system some from so called country X and most of us know them.Some also attended medical school in ghana and have since never taken a book to review or medical journal to update their knowledge or skill. They are waling about receiving gifts and presents and enjoy accolade " oh Doc, Oh doc is here, doc, doc …" and they know they have rusted and have forgotten how diagnose and managed simple diseases let alone acute complex ones.

    You are dead in their hands and they know it. They are just simplying around with eir patients and nurses and bossing over everyone. Those in the districts areleaving in doctors mansions iwth cars and yet killing other innocent unsuspecting patients. Its a shame. let them all take and pass USMLE exam which can be taken in Ghana except the CS to prove their knoweledge and skill, else kepp them home.

    Enough of "killings" and stop the excuses like all the doctors have left for foreign countries and only "few have stayed behind to help". Some of those are "destroyers and killers" not doctors. Test them and weed them out. USMLE is done at mobile house in Accra. All should study, pass and show their results before being allowed to go practice and stop killing people – prescribing malaria tabs to anyone who show with fever or chills. Shame on them!! i hear a doctor at police hospital will take a big fat book in front of a patient to check for diagnosis right in the consulting room- ok may be she is trying but its a shame still!!

    I have said my mind though i dont know it all – but it really hurts to see a relative or friend die when its the doctor's fault.- dont blame the pre or post operation or anaesthesia or nurse. it was the doctor and i know it even from other doctors knowledge of the cases said and believe the same thing. Take USMLE all of them!!!

  21. Amazing blog! Do you have any hints for aspiring writers?
    I’m hoping to start my own website soon but I’m a little lost on
    everything. Would you propose starting with a free platform like WordPress or go for a paid option?
    There are so many choices out there that I’m totally confused .. Any suggestions? Cheers!

    • I am not an IT enthusiast and my knowledge of IT is, at best, very poor. I do not know enough to help answer your questions or make any meaningful suggestions. Sorry.

  22. I’m sorry I’m late to this forum but reading through some of the contributions, I do have a few comments to make.There are definitely a lot of things going wrong with the health delivery system in the country. In the first place there seems to be a merger of trained doctors and charlatans. the first two cases mentioned by the moderator of the forum were not doctors but charlatans, yet the author choose to call them doctors! At some point there seems to be no difference between those charlatans and some trained doctors and some actions of the medical and dental council!
    From my point of view, the problem is lack of leadership. This lack of leadership is so widespread in the society but I will limit my comments to the medical field.
    1 How can there be so many charlatans in the system without them taking any action.
    2 How can so many trained doctors perform so badly and so many patients die out of negligence without them taking any action?
    3.The Ghanaian patient is certainly an endangered species and cannot be sometimes be blamed if they choose to die at home,a prayer camp, a witch camp, a charlatans camp or a private hospital or a ministry of healths facility