Knowing Your Rights As A Patient (Part 1)

The constitution of Ghana according to Chapter 5 deals with the fundamental human rights and freedoms of citizens and all who reside within the territory of Ghana. It guarantees a right to life which is further enveloped by the Universal Declaration of Human Rights (UDHR) of which Article 3 is of most importance for this discourse. Article 3 says, “Everyone has a right to LIFE, liberty and security of person”.

This piece was necessitated due to the barrage of negligence and unethical as well as unorthodox interventions and activities which have contributed in no small way towards defeating the spirit and letter of Article 3 and contravening ultimately the constitution of the republic of Ghana. As a flu or an epidemic, a lot of Ghanaians might have caught the cold of death from medical ineptitude or negligence, a relative may have lost a limb or a breast, a brother may be resting peacefully in Awudome or Osu cemetery, a friend could have been saved during childbirth and some orphans wouldn’t have been fatherless if a few of the laid down documents, precepts and regulations that govern the practice of medical science are followed to the heel.

Medicine can’t or shouldn’t be equated to the complex theorem of Calculus or Atomic physics, why should the theme be set in the proper context? Firstly, the human body continues to be in a state of constant change yet always adjusting to its environment, this is called homeostasis. Thus an ideal situation or an ideal premise becomes nearly fictional or unattainable. This doesn’t mean and shouldn’t be construed to mean a dose of 1.5g should be converted to 15mg. In writing this piece, I look at the long list of faces, a tile of emotions busting from the faces of relatives as they have had to watch relatives and loved ones gasp for their last breaths. Indeed the greatest of men are most driven by passion.

Secondly, medical science can’t be equated to the perfect calculations of Newtonian Mechanics because; its practice is not set in inanimate objects. Medical science has been found to be a rather complex and an open system whose confounding factors and variables could range from just a white coat as in giving a false blood pressure result or having a phobia which can’t be measured scientifically using our devices of stethoscopes, a copplin jar or a meter rule. This creates an avenue where scientific and medical measurements only approximate the true value.

Then comes the characteristic caricature of human Anatomy and Physiology, as an example, there are some people whose normal body temperatures are above what is considered normal and yet may show no signs or symptoms of pathology. There are some whose basal metabolic parameters such as hormones and enzymes may well be below or above the reference ranges but show no signs of illness.

Some people have their regular hemoglobin levels being as low as 7.0g/dl and yet aren’t considered anemic. These few limiting factors which in itself may not stand as caveats or be exhaustive enough affect the outcome of medical interventions and initiatives. The pivot around which this piece is set has to deal with human deviations from the bullseye of the medical practice (near - ideal situation).

The Ghana Health service (GHS) is a public service body established under Act 525of 1996 as required by the 1992 constitution. It has as its mandate to provide and prudently manage comprehensive and accessible health service with special emphasis on primary healthcare at regional, district and sub-district levels in accordance with approved national policies. It has as its functions amongst others been, to establish effective mechanisms for disease surveillance, prevention and control and perform any other functions relevant to the promotion, protection and restoration of health. Of key interest is the PROMOTION, PROTECTION AND RESTORATION OF HEALTH.

In as much as the ultimate liability and responsibility towards healthcare delivery is vested in the GHS, the patient must also know the rights he/she has under the laws of Ghana as is enshrined in the PATIENT’S CHARTER. All patients must come to an understanding that services rendered at hospitals, clinics, wards and health posts as well as Centers aren’t privileges. These are due rights. They are your rights as a human being first, as a Ghanaian and also because your taxes are serving you. The health and patients charter can be succinctly outlined as;

• The patient has the right to privacy during consultation, examination and treatment. In cases where it is necessary to use the patient or his/her case notes for teaching conferences, the consent of the patient must be sought. The dignity of the human person must be respected and duly upheld at all material times. “There are two kinds of pride, both good and bad. Good pride represents our dignity and self-respect. Bad pride is the deadly sin of superiority and reeks of conceit and arrogance”. This quote by John C. Maxwell aptly captures the power play that unfolds in consulting rooms and wards across this country. Most times the docility of the Ghanaian prevents him/her from demanding what is morally and humanly right. How many male nurses haven’t walked into a consulting room when a lady lay naked having a pelvic examination?
• How many female nurses haven’t made silly comments about the size of a patient’s manhood? How many Laboratarians haven’t made silly remarks about the pain they cause to their clients during the taking of blood? How many patients haven’t had their cases used for numerous conferences and symposia without their consent? How many record keepers or archivers haven’t insulted patients who misplaced their cards? There’s a subtle power play going on, the patient been the victim in most instances. This doesn’t rule out the unruly and disturbing behaviors of some patients, but most times the patient naturally feels a sense of discipleship and followership of the deity called a healthcare giver. This trust bestowed on them must not be abused.
• The needed respect and dignity must be accorded them. The deadly sin of superiority, self-conceit and arrogance must be eschewed. As a patient, you need to first and foremost accord yourself the due respect you demand. This would be demonstrated in your demeanor and how you behave together with the sort of questions you ask. A nurse once told me how a patient had insulted her after seeking permission to dress her gangrenous wound which was anything but pleasant.
• As a patient, you need to also understand that respect is reciprocal, health professionals are there for your wellbeing. Don’t feel intimidated by any white coat. Ask for privacy when any consultation or examination is to be done on your body. That is a right and not a privilege.
• The patient is entitled to confidentiality of information about him or her and such information shall not be disclosed to a third party without his/ her consent or the person entitled to act on his/her behalf except where such information is required by law or is in public interest. Our society is one whose roots run deep and wide. Societal interconnections in Ghana presents us with a great sense of belonging as well as the adversity of less privacy.
• Your Uncle who works in Winneba Government hospital may know the Father and brothers of your boyfriend who suffered from epileptic seizures and fits very often. He’s been their physician for a long time and could vouch for a hereditary pattern to their peculiar illness. He comes to Accra to see you planning to get married to one of their brothers he treated a few weeks back. What should be his reaction? Only a few companies and health facilities have confidentiality clauses and contracts. I remember working at a hospital facility some time ago where patients details including family history where normal talk among health care givers. You’ll hear these from the grapevine.
• Nurses would gather and talk, some would even go as far as pointing to the particular man or woman who had such a condition. If you were unlucky to have the dreadful HIV/AIDS, “damirifa due” is what I wish for you. It’ll have to take a Florence Nightingale of a nurse to attend to you and make you feel human. A lot of people have had such challenges with the system at one point in time or the other. Their health issues have escaped the secure vault of consulting rooms and wards.
• There’s been occasions where people at home hear of the loss of a baby even before a woman leaves the labour ward. What happened to confidentiality? We need to wake up as health professionals and stick to our code of ethics. Ours is a divine mandate, lives entrusted in our hands, futures and nations, word travels fast and could destroy lives of people. As a patient, you may ask, what can I do? Make a specific request to the Health giver to treat all information as confidential as possible.
• If you need the results of your test to be sent to a particular doctor, make the request so and hold them accountable to it. The laws of Ghana provides avenues for redress anytime you feel your privacy and confidentiality has been breached. Perhaps you didn’t die from knowing that your family knows you’ve got Gastric ulcer though you didn’t tell them, but someone hanged himself on a tree when his sister asked how he contracted Syphilis. Demand for what is right. It’s our collective responsibility to make our nation great and strong.
• Hospital charges, mode of payments and all forms of anticipated expenditure shall be explained to the patient prior to treatment. Many are surprised when I tell them that the hospital environment which is supposed to be a recuperative and curative one, akin to an NGO or a not for profit organization is sometimes more profitable than a banking or commercial enterprise. In this, I’ll walk you through what a typical retinue for a person seeking treatment for appendicitis may have to go through. This illustration may not hold true for all patients but some may easily identify with some aspects.
• If you come to the hospital in a car, you’ll have to pass through the gates, if you’re generous enough to look at the Security man’s face you’ll realize there’s a tradition that must be done. Some people ignore this and move on to the reception. If your case is an acute one you may likely be sent to the Accident and Emergency center. The hustle starts from there; you’re likely to meet a few nurses on duty who’ll have to direct you to the registry or records department where you’ll have to buy a folder. Based on how quick you want the folder considering the queue available, you’ll have to grease a few palms to facilitate this process. Some workers are bold enough to demand extra for the work done. As a meek lamb, you dole out a few notes and continue the journey.
• The nurses would then have to take your “Vitals”. Depending on the in-house policy, you may likely dole out some housekeeping monies. From there your consultation fee comes up, after paying that at the cashier, you’re made to go see a doctor. He examines you and makes a few laboratory and drug requests. Getting to the Laboratory, you see a long queue there too. You’ll have to grease a few palms there too if you want express service as by this time you’re in severe pain. Your blood may likely be taken or any other specimen required, from where you may proceed to the pharmacy to buy a few drugs to help with your pain before any other interventions.
• The same cycle repeats itself again and then you come back to stay in a ward where ward dues are becoming a norm. Which of these transactions have you really budgeted for?, The medical directors would tell you to ask for receipt for any payments made, how do you ask for a receipt when the system places no checks and balances to rectify these irregularities? At the end of the day, the purses and wallets of Hospital staff are fattened at the expense of the patient.
• So sorrowful isn’t it, imagine coming to the hospital in a rush, you’ll have to go back home and bring these monies requested for. The currency of life is a privilege to serve , how many people become doctors, nurses , pharmacists , lab scientists , receptionists ,dentists and the like out of a desire to serve and make the lives of people better ?. Our very human nature has been so tainted by corruption and evil, we’re just thinking about the best ways to extort and make our lives unbearable.
• The patient should be the center of all healthcare initiatives. Quite undeniable is the role education and literacy plays in this matrix. A huge chunk of people who patronize public hospitals are our local folk who’ve merely had any sort of elementary education. The system cheats them of their cocoa monies, it pilfers on their ignorance and extorts from them, what option do they have?, who’ll speak on their behalf?, though they feel the pinch of corruption do they even know what to do about it?,
• I cry silently in my closet when I watch such distasteful acts perpetuated by a few miscreants paint the entire health profession black. Patients must ask and need to know. Ask for your receipt for whatever payments you make. Hold people accountable for their actions! Sorry for delving into a period of momentary melancholy, sometimes great people even cry , Obama cried on gun violence , Cronkite cried on the assassination of John F. Kennedy, George Washington cried during his inauguration and I cry for my people and country as well. I’ll be back with part 2 soonest.

The writer is a champion of preventive healthcare, and has a passion for stemming the ills in society through constructive pieces and articles. He’s a Scientist and takes key interest in prevalent public health issues. This he does as his contribution to knowledge advancement and a cure to the ills of society. He can be reached on [email protected].