The "Working in Ghana" Project


[Nurse Al-Hassan, a woman in her early fifties, works at a military hospital in Accra. Her husband lives abroad; they have been separated for more than ten years. A Muslim, Nurse Al-Hassan's home village is in Northern Ghana. She now lives in a suburb of Accra. There are ten people in her household, including three adopted sons. She has three children of her own who live with a relative. She attended nursing training college in the early 1960's and has been a nurse for about thirty years. After several attempts, Philip Awekeya succeeded in meeting with this busy woman at her home, where they conversed on the verandah.]

On any given day, I have both official and private duties. As a woman forced by circumstances to be head of a household, I have learned to do many things each day in order to earn enough income to meet the household commitments. These include providing money to pay my children's school fees as well as to help support them when they are staying with their aunt. To meet all these heavy financial demands I have arranged with my superior at the military hospital to put me on night duties for a continuous period of two weeks. That way I have the daytime free to attend to my own small private clinic here in town and to supervise my adopted sons in selling sugar, bread, flour and soap to market women.

When I go for night duties for a two week period, I am entitled to one full week off duty. I usually use this one-week period to convey some of my goods, such as sugar, bread flour and soap, to sell in Northern Ghana. I return towards the end of the week to resume my night duty schedule. When I travel out of Accra I arrange with a qualified nursing friend to attend to the outpatients in my small private clinic. I never allow it to be closed down for a day; a friend or I are always present to attend to patients who may call for consultations.

At the hospital I report for night shift work at 8:00 p.m. and finish at 7:00 a.m. As head of the maternity clinic, I assign duties to the nurses under my supervision. I query anyone who persistently reports late for duty or refuses to carry out her assignment. I also write personal reports on each nurse for the confidential file and I write progress reports on patients.

In addition to these administrative duties I do consultation whenever needed. Qualified gynecologists are few, yet the patients are many. Whenever a patient is having difficulty in labor I am the first person the nurses call on, provided it is not a complicated problem. In such cases I carry out the necessary tasks to ensure that the woman gives birth safely. However, if the problem is beyond my capability, I ring or send for any of the gynecologists on duty to come to save the situation.

I am very pleased to be a nurse. My profession enables me to help save human life, and it allows me to run my own private clinic, which brings extra income to the household. It also opens me up to very many people, both at my official work place and in my private clinic. From my contacts I can easily get assistance when I am searching for goods to transport to the North for sale.

The joy of saving human life makes my job quite satisfying. However, the whole process is frustrating and disappointing when you watch patients slip away from your hands and die just because there are no basic drugs or equipment to save them. Whenever lives are swept away, not because one is not competent, but because the items to save lives are simply not there, then one is bound to feel frustrated and curse herself for joining a service which is quite incapable of performing a task it is set up to accomplish.

I view the present lack of basic logistics as temporary, reflecting the lack of serious commitment by the government. I believe the day will come when authorities will change their attitude and work towards a general improvement of the health delivery service in this country. When that occurs, it will be quite interesting and joyful working as a nurse to help prevent untimely deaths.

I would strongly encourage any young lady who has love for patients and is imbued with patience, kindness and the willingness to serve the sick, to join the profession, despite the present lack of logistics and the non-recognition from the government. The willingness to serve others should be paramount. Since nothing in life is permanent, no one should be scared away because of the present bad conditions. If new people don't join the nursing profession because of poor pay or conditions, then the whole health delivery service will eventually grind to a halt. Nurses form part of the bedrock of the health delivery service in any country; Ghana is no exception.

One might assume that since where I work is not a mental hospital, there are no dangers involved. However we sometimes experience serious threats from people who lose their loved ones and blame it on us. Quite recently a military officer who has three daughters and who expected the fourth birth to be a boy, lost the baby through stillbirth. He became instantly mad and began knocking down anything he could lay hands on. He said that we, the nurses, were fowls and thus could easily be killed. He claimed he single-handedly had killed over a hundred people in the Congo war. He said they were mere ants which he could easily do away with in a few seconds. Seeing the seriousness of the officer's threats, we had to lock him up in one of the rooms to prevent him from going back home. If he were free, he could come back with a pistol and would pose a big threat to our lives.

In a military hospital, one would expect to find the drugs and equipment needed to do our work. Unfortunately, the situation of drugs is the same in both public and military hospitals. The "cash and carry" system operates in all Ministry of Health service delivery systems. Money must be paid before drugs are issued, no matter how serious the case. And often the drugs are simply not there, so people have to buy from private pharmacies or drug houses at very high prices. Woe be to you if you cannot afford to buy the prescribed drugs. In such cases you simply die, no two ways about it. A large number of patients have died through this lack of drugs, or due to lack of oxygen to sustain the patient during major operations.

I regret that my output sometimes is pulled back through no neglect of mine but because of something beyond my control. It is rather the failure of some policy makers of this nation, who have misplaced priorities and pushed health service delivery to the background while putting other concerns high on their agenda.

My relationship with my immediate supervisor--a military officer--is quite cordial. He likes my attitude towards work because I take time to carry out my expected scheduled duties, such as drawing out a well prepared duty roster for the nurses under my supervision. I also ensure that the nurses carry out their duties, such as giving drugs to patients at specific times, feeding the helpless ones, and nursing them appropriately, such as providing toilet facilities to those who are too weak to walk to the toilet.

Some of my subordinates see me as a bossy lady. I am even called "Margaret Thatcher" behind my back because I do not easily give in or let them have their own way. Some would rather sit together to discuss trivial matters such as whose husband chases which lady, and the latest styles in hair-dos, dresses and shoes, rather than attending to patient calls for assistance with toilet facilities or even to have a drink of water just before they die. All these instances of lack of commitment to work get on my nerves. I never spare the nurses who have formed these bad habits by querying them verbally or through writing.

As far as the patients are concerned, there appears to be none that does not like me. A good number of those who have been under my supervision love and admire my absolute concern for them. Some show their appreciation for my devotion to duty by calling on me either in the house or work place to show their gratitude. Their kind gestures make me feel that what I am doing to save lives is being appreciated by the public. I am thus spurred on continuously to do my best at my private clinic and at the hospital.

I think the ministry is doing its best to streamline promotion opportunities in the health service. Once you get your required General Certificate of Education, Ordinary Level or two science Advanced Levels and go through the nursing course, you stand the chance of being promoted to the rank of hospital matron, though it requires hard work and commitment. I think there are now more chances for hard-working nurses to advance to the highest professional level than there were some years back.

There has been a markedly improved pay structure for nurses and most public servants in Ghana. However, the whole exercise is worthless because what the workers take home as monthly pay cannot provide them with a decent meal and basic needs for two weeks. The high inflation in the country has neutralized the recent pay increase in salaries for nurses and other workers.

As an employee in the Ministry of Defense, which is one of the few privileged service units, I am entitled to a professional allowance, car loan and free medical care for myself and my children. In the public hospitals most of these benefits are merely on paper. People cannot easily receive repayment for drugs they have purchased for themselves or family members. How much less to talk of achieving far fetched dreams like car loans! I count myself lucky to have a chance of enjoying a bit of the national cake by working with the Ministry of Defense as a senior staff nurse.

I belong to the Ghana National Association of Nurses. The Association is trying under very difficult circumstances to better the lot of nurses. But in recent years the government has turned its attention from all sectors that are in the national interest. We nurses embarked on a one-and-a-half-month-long sit-down strike to back up our demand for better benefits such as good pay, risk allowances, transport and professional allowances, and improved health delivery services in hospitals, such as the provision of basic essential drugs, wheel carts and oxygen, and other essential equipment to facilitate our work. The government closed its ears to our request. Through the withdrawal of our services, many people lost their dear lives during the strike. Yet the powers that be merely turned their back on us.

The nurses association executives are zealous, but they are dealing with political officials who have no sympathy for suffering people, while claiming they are in power to assist the poorest of the poor. But very poor people cannot enter hospitals in this country because everyone is expected to pay for all hospital services, ranging from registration card, through medical consultation, to drugs, should such drugs happen to be in the hospital dispensaries.

My children and husband are very happy with the work I do because I am able not only to take good care of their health needs but also to earn extra income through the private clinic. The fact that I do not rely solely on government employment but combine it effectively with trading and private consultation makes my family members admire and respect my good sense of time management and the wise way I look for decent money through extra jobs. I love doing many things and doing them properly through conscious time planning and self-sacrifice. Given that my husband has had to live abroad, if I had not learned to do many things well, my children's education would have been in jeopardy. Thanks to God I am blessed with ample health and vigor to be able to provide bread for the table and to provide for the children's education.

I am widely respected by both the young and old of the community. Some people call me "doctor" because they call at my private clinic for consultation when they are sick. Some even consult me at home no matter the hour of the day or night. A good number of the community members are confused as to the exact nature of my work. Some see me as a person who buys and sells sugar, bread flour and what not, and at the same time see me as a nurse at the hospital and a "private doctor" in my clinic. Most of the people refer to me as the lady of three jobs: trading, nursing and private medical consulting. My work as a nurse has won me respect in the neighborhood because I am always ready at any hour, provided I am in town, to listen to their health problems, give first aid, or advise them to go to the hospital.

I believe that whatever is worth doing, is worth doing well, and that one can live above the poverty line in this country only through careful time management and hard, consistent work. I am not surprised that most people in the neighborhood show respect by calling on me from time to time to offer gifts in appreciation for the services I rendered them, whether at the hospital or at my clinic. Hard work never kills--it adds vitality to one's life. Every young person should learn to work consistently hard each day in order to earn an honest income, thereby raising their standard of living.