The aftermath: Reflections on events surrounding the end of the President’s life.

This might have been the one of the few occasions he may have kept anyone waiting

because his schedule was no longer his. It was slightly overcast and a gentle breeze was blowing from the ocean nearby, as the mass band completed "It is well with my soul". Another group was hitting a steady konkoma rhythm closer to the Independence Monument.

Praise dancers were trying to extort what they could from the gullible.

Independence Square was waiting, dressed in black and red. It looked like everyone was gathered for a great football match with both teams playing for a charity gala. We were all on the same side. Mildly festive, we were sadly awaiting the arrival of the self -classd "Asomdweehene" as the late president was known. "Hallelujah - awurade wo ahene so” (God your domain is great). The crowd sang along with the mass choir. The groove was now on, we were ready to finally receive him and bid him farewell. Ghana's colors were red and black this morning. Citizens were still streaming in.

Politely, gently everyone was getting seated with our little flags and our programs. The funeral service for the professor was about to begin. He was still receiving foreign delegations at the state house, working to the very end. It was almost festive but on the last day of national mourning, we were allowed some catharsis. All week, citizens lined the streets, waiting patiently for 4-6 hours to catch a glimpse of the fallen president and their turn to salute, bow and curtsey to the man who demanded not much formality in his 3 and a half years as President of Ghana. I hear the sirens... Everyone is standing up. The Calvary unit is escorting him in.

The mood was best captured by the military whose actions throughout the proceedings broadcasted their loyalty and deep respect and affection for their Commander - in - Chief.

Millions more were watching at home and on strategically placed mega screens around the country. It reminded me of how my late father described what it was like in the Gold Coast on Empire Day, when King George V would broadcast to British Subjects around the world.

Subjects gathered around rediffusion boxes all around the Gold Coast Colony to listen to their King.

As we listened to the successor president laud his former leader and listen to the family tributes and the homilies from the clerics, most of the conversations centered around exactly what might have felled the president and what alternative actions could have been taken to

ensure a different and less tragic outcome. The president died just like the average Ghanaian does. No functioning ambulance available, arriving through choked streets in a moribund

condition at a hospital with a less than stellar immediate emergency response capability.

From my review of all the information available to me as a citizen and a physician, it appears that the president's initial complaint of severe neck pain could be consistent with a Cerebro –Vascular Accident or stroke (whether he had pre-existing throat cancer or not). In any event, he suffered an apoplectic event. This was a medical emergency. It is also apparent that there was no protocol in place for such an unlikely medical emergency at the Castle. If one existed, it seems not have been rehearsed or adhered to.

As an example, this is why in most developed countries, fire drills are conducted regularly. This ensures that in the unlikely event of a fire, panic does not ensue and that an orderly response with minimal loss of life is the outcome.

There are some very troubling dimensions to what we have all learnt from the President's untimely death. It appears that no one called ahead to the hospital to which he was being transported. If an existing protocol included this simple step, those with the president may have been advised not to attempt to transport him in a vehicle that was not medically equipped. A chopper could have been quickly mobilized and help could have been delivered to him on site in less time than it took to get him to 37 Military Hospital. All these "what ifs" are important because we should judge ourselves only by outcomes and not good intentions.

The medical care of the president, whoever they may be, should be institutionally addressed. A

president is entitled to their own personal physician. However, a carefully chosen medical team based on anticipated health needs guided by his confidential medical record on assuming the presidency, should be in place. This role can easily be fulfilled by senior physicians at an institution like the Ghana College of Physicians and Surgeons who have knowledge of all specialists available in Ghana and many overseas. The president's privacy can be protected while ensuring that the best in preventative health is available in addition to well thought out crisis response protocols.

Of course, every possibility cannot be accounted for but we must deliver the best response possible. There was apparently no credible system in place so we cannot say we did our best. There is a broader lesson here. In Ghana we plan poorly and hence do not anticipate problems but we are always ready for a post facto crisis response. The results are never the best. We failed in this instance but lessons learnt here will help future office holders and the nation so that H.E. John. E.A. Mills would not have died in vain.

One truth is evident in all of this. That Ghanaians are experts in organizing funerals. The whole world saw that our reputation in that aspect of life, if we can call it that, is well earned. The funeral committee is to be congratulated on an exemplary job. They did Ghana proud. Now let us serve the living with the same efficiency and forward planning and really do our nation proud in other areas of the Ghanaian experience where we are still found wanting.

Prof T.P. Manus Ulzen
Tulzen@yahoo.com
August 15, 2012

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