The ICU is small, with 6 hospital beds laying side by side and only a foot of space in between them. Four nurses are crammed behind a desk, reviewing James’s file.
James has ascending paralysis with an unknown cause, a UTI, is hypertensive, hyperglycemic, and is currently in septic shock. James is not conscious, or maybe he is semi-conscious. The doctors cannot seem to agree. As the doctors debate, Nurse Samuel walks up to James and taps his shoulder before administering an IV. James stirs. Nurse Samuel rolls his eyes at the doctors before making eye contact with me. “Conscious”, he whispers.
For my first week at the hospital, James was the only patient in the ICU. His condition was not getting better, but at the time, it was not getting worse. He was stable. The nurses informed me that in the ICU, with patients who lack insurance, stable is all the hospital can provide. In Ghana, all citizens are granted a baseline form of healthcare. Any additional medications or procedures that can improve quality of life has to be covered by the patient’s private insurance, and if he has none, than the financial obligations fall to the patient and his family.
A patient has to have paid for the medication prior to receiving it, and surgeries are expected to be paid in full before the patient is discharged. What shocked me the most, was hearing that patients were expected to hire, or pay, for an ambulance before the ambulance can rushed them to the hospital. Those who couldn’t afford the 200 cedis for an ambulance often will have to pay for a taxi instead. Because the financial strains of being in the hospital was such a burden, families who could not afford the treatment did not come to visit their love ones. It was five days before a family member was able to visit James.
As the nurses rushed to tell me all the issues they observe in their hospital, from patient’s inability to pay for treatment to nurse shortages to social hierarchies, I could not help but look at James. How much of his condition could be attributed to these problems? Would his prognosis be influenced by social factors beyond his, or even the hospital’s, control? If he was a wealthier man, or was admitted in one of the hospitals in Charlotte, would he have survived?
I later learned that James drifted into a permanently unconscious state before silently passing on.
*No real names were used in the making of this blog.