The Agony Of Physician Assistants (PAs) In Ghana

"The road to health is paved with good intestines"-Sherry A. Rogers.The intestines refer to our health officers, resources and institutions and all those who form the basis of the health care system. And so if we make good use of our health workers by providing them with good training and facilities then health of people at large will be improved. It suddens my heart to see, hear and watch individuals loosing their lives either as a result of an infection, a chronic or acute disease, or even lack of financial support. Some of these lives could have been saved if there were sufficient health care providers who seek to provide quality health care to partients at the minimum level, by using the preventive and not curative services.

The preventive service will serve a long way to preventing patients from spending unnecessarily on diseases that could have been easily prevented. As the saying goes"prevention is better than cure". Which is why most resources should be centered at providing preventive services since its necessary for our survival. Physician assistants play a major role in primary helath care,these alarming situations of ill health could be as a result of shortage of physicians in the country. I therefore use this medium to enlighten us all on the PA profession, its benefit and roles, some challenges and how PA can contribute to improved healthcare in Ghana.

A physician assistant (PA) is a healthcare professional who works under the direct supervision of a licensed medical doctor. The job description of a physician assistant is similar to that of a licensed doctor and spans a wide range of duties, from taking the medical history of a patient to setting simple fractures.The name is self-explanatory: physician assistants assist licensed physicians with the examination, diagnosis and treatment of patients in all kinds of healthcare settings, from small private clinics to larger full-fledged hospitals. The only thing they are not trained to do are procedures that are extremely intricate and complicated.

In Ghana PAs are licensed by the Medical and Dental Council (MDC) of Ghana, they form the bedrock for Primary Health Care throughout the country. The PAs work mostly in primary health care seting as they make ammendments for the 8 elements of primary healthcare to be observed. As primary healthcare is aimed at providing preventive care rather than curative, it has encouraged PAs to work harder since they have more time for patients than most medical doctors.

Some clinical roles of Physician assistant include: Recording patients history, Interpreting X-Rays and laboratory tests, Patient examination,Treating minor illnesses and injuries,Suturing ,Administering medications as well as injections,administering First Aid when immediate treatment is necessary and Undertake managerial duties depending upon the job setting .

Some general functions (non-clinical) include;1. Perform comprehensive and problem focused history and physical exams ,2.Collaborate with the other members of the patient's health care team in order to provide an appropriate plan of care ,3.Discriminate between abnormal and normal findings to recognize early stages of physical, emotional, and/or mental problems.4.Documents and communicates relevant patient information comprehensively and in a timely manner ,5.Counsel and educate patients regarding health maintenance and disease prevention" some of the skills one will need to excell in this field include,6.Compassion- a PA must show compassion toward their patients and families who may be in distress, Active listening-The ability to understand what your patients are telling you will allow you to respond appropriately,Verbal communication-You must be able to explain procedures and treatment to patients and caregivers and must be able to Solve problems and think critically- When treating a patient, you will first have to identify his or her illness or injury and come up with a treatment plan. The ability to think critically will allow you to evaluate all possible treatments before choosing the one that is most likely to have the best outcome.

Some challenges and argony PAs face include:
1. the unclear statutes limit their ability to participate in innovations; this is because,PAs are under the supervision of medical doctors and so he or she has to consult first before making any descissions unlike medical doctors who are not under any healthcare professionals supervision .

2. lack of clinical training sites for PAs : in ghana, medical doctors have a sites that helps them improve on their clinical skills, even during clinical presentations but PAs are restricted and so will only have to learn from the medical doctors site.

3. overly strict statutes interfere with physicians ability to delegate task to PAs: in the medidcal field anything that should go wrong will be questioned to the one in charge and so if the physician should delegate his work to the PAs, he would be questioned for any wrong doing so to avoid this, everyone has to play his or her part which goes a long way to restric the PAs.

4. lastly, PAs are most at times not respected by nurses and doctors. the doctors are of he believe that the PAs are taking their work and the nurses dont agree to the fact that a PA who just started work is so superior. This has created a lot of tension and enemity among these 3 groups whose work are interelated as studied in functionalism theory.

5. PA are not paid in Ghana which has lead to the varoius strikes that take place most of the time and the government looks unconcerned.

There is less value attached to the PA profession but am hoping from the enough detailed description given above, the PA program will be understood. and last but not the least, most PAs are either without jobs or are posted to some remote communities of which they have no interest. This limits them from their family and so they are not able to provide necessary care to their patients as well.

To improve the PA program the following should be considered: First of all, create a system for staff/colleague input. Ongoing mechanisms for staff/colleague input can be integrated into monitoring activities. Ensure that these strategies include opportunities for confidential input and feedback. This may be especially important if you are concerned that not all staff are confident speaking openly in meetings such as suggestion box, web based survey etc. Also, develop a strategy for patient feedback. It is equally important to get feedback from patients and their families, and for documenting their responses and questions.

Some mechanisms you one may find useful are: PAs in consultation with other clinicians and staff,can establish a system of tracking patient questions, concerns, or any complaints,at regular staff meetings. Document all comments, and share these with the PA and other providers, confidentially as required . Lastly, PAs assigned to deprived regions or catchment area should be given more incentives that will encourage them to stay in these deprived communities. I also entreat PAs to be devoted to their work with passion to enable individuals to see the effort for their value to be appreciated.

The PA program is worth investing in,considering the many opportunities that comes with it in its provision of healthcare at the basic level. PAs create awareness of most diseases and also establish good interpersonal relationships in the hospitals and communities they operate in.The government together with society should be sensitized that PAs are not competeing with doctors and beseech that the efforts of PAs are recognized and appreciated..THANK YOU.

Ramatu Adamu
LEVEL 200
PA student, UCC