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Ghana Life: It's a Rich Man's World
Like most developing countries, Ghana struggles to maintain a state medical service at free or low cost, that is intended to be accessible to all its citizens. The poor must rely on this service, though many find it difficult to afford its modest fees, and few can readily find cash for the pharmacist's bill. The situation provides opportunity for a thriving private sector that provides modern medical support for the wealthy and for the staff of foreign agencies operating in the country. In his novel The Colonial Gentleman's Son, John Powell describes a visit to a private clinic in Tema near Accra in 1994.
The abdominal pains had been growing more acute and more frequent. Kwame could procrastinate no longer. So he telephoned Dr Kwapong and made an appointment for the next day. This was Kwame's first visit to the clinic but he was not surprised to find that it was newly built on a grand scale. A large car park extended in front of its dazzling white walls but the only other car was a new Mercedes Benz coupe. Was this an indication that business was bad or business was good? Kwame hurried in through the double doors into a large waiting room, devoid of waiters. His footsteps echoed as he walked across to the reception desk and gently roused the receptionist from her slumbers. "Mr Mainu?" she yawned, "Go right in; Dr Kwapong is expecting you." She indicated a door on a corridor to her right.
Kwame had met Dr Kwapong only once before. He was a short slim man with horn-rimmed glasses who hastened Kwame into a chair beside his desk to lessen his physical dominance. After the usual greetings and noting Kwame's name the doctor asked, "Now what's the problem? If it's something nasty picked up from the girls, don't worry, I have all the latest treatments from London." Kwame was somewhat taken aback by this overture and could only assume it was intended to put at ease patients with a sexually transmitted disease. He imagined that many of the big men, who were wealthy enough to afford the doctor's services, often brought this problem to him. He wondered how the doctor would deal with the problem of HIV/AIDS. The professor he met at Televideo had told him that there was no known cure - not even in London.
Kwame made an effort to reply in the same vein, "Not this time, doctor, but I'll bear it in mind. No, my problem is a little higher up."
"In your stomach?"
"Yes, just here." Kwame indicated an area just below his breastbone.
"When do you get these pains?"
"Usually an hour or two after meals and sometimes in the night."
"Please lie on the couch and I'll have a closer look."
After Kwame was settled horizontally with bared stomach the doctor continued, "Is it here?"
"No."
"Here?"
"Yes that's it, agyei!"'
"Well it's not appendicitis. I think you know what it is."
"I suspect it may be a stomach ulcer."
"You're not being treated for arthritis or rheumatism, are you?"
"No."
"Then I would like to do a test for H. pylori. Have you been taking any antibiotics recently; say in the last four weeks?"
"No, doctor."
"Any other medications?"
"None at all."
"Then I can do the test today if you have the time."
"Yes, I want to sort it out as soon as possible."
"Of course! Please wait outside while I get set up."
Kwame went back to the waiting room where the receptionist had resumed her slumbers. At least here the reading material is a little more to my liking, he thought, recalling his wait at St Louis school in Kumasi. He reached for a copy of the Economist and settled back for a long read, but a nurse came to call him much sooner than he expected. The more interesting the reading material, the shorter the wait, he said to himself; I think I'll call it Mainu's Law. Kwame looked at the nurse and then glanced back at the dormant receptionist. Dr Kwapong certainly has an eye for the girls, he thought, I wonder if he sometimes has to self-medicate. Then recalling his mind to his own problem he followed the swaying hips back into the consulting room.
Dr Kwapong took two samples of Kwame's breath. He was reminded of the test for drink drivers in England. Then he was asked by the nurse to drink a foul tasting concoction that he was told was C-urea. After a short interval, two more breath samples were taken. "We'll have to send these off to Accra for analysis," said Dr Kwapong. "We'll have the results within a few days. I'll give you a ring. If the result confirms my diagnosis, we can start the treatment right away."
"How long will it take?"
"I employ a one-week triple-therapy regimen."
"Will that cure the problem?"
"The treatment is said to be effective in about 90 percent of cases. I expect it will clear up the present problem, if, as I think, we've caught it in time, but it's once bitten twice shy with gastric ulcers, I'm afraid. You must eliminate the irritants that brought about the first one."
"Does that mean no more pepper?"
"I'm afraid so, and it's best to cut out alcohol as well. It's good you're not a smoker or you'd need to stop that as well."
"Are there any pleasures I don't have to forgo?"
"Only one!"
On the way out the receptionist was wide awake. The nurse slipped her a note. "We will require a deposit, Mr Mainu," said the receptionist with well rehearsed authority, "There's the consultation, the fee for the test, including the analytical services at the laboratory in Accra, the nurse's fee, plus overheads and tax." She mentioned a substantial sum. "You don't charge for the car park then," said Kwame with a grin. "No, that's provided free for the convenience of patients," she replied, trying to suppress an answering smile. "By the way, Dr Kwapong has asked me to inform you that this will be the cost of your treatment if the test results are positive." She scribbled on an invoice pad, tore off the top leaf and passed it to Kwame. He decided to look at it later. It was bad enough having a stomach ulcer; he didn't want to add a heart problem.
Akwesi Berko
To learn more about the intriguing story of the grassroots industrial revolution in the turbulent Ghana of the second half of the twentieth century, read John Powell's novel The Colonial Gentleman's Son or his non-fictional account The Survival of the Fitter. More details of these books and photographs of the informal sector artisans of Suame Magazine in Kumasi will be found on the following websites.
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