By Jonathan Bill Doe, student of Heritage Studies and Technoscience Studies, Brandenburg University of Technology.
What has become known in Ghana as the “No Bed Syndrome” is a situation where patients go to emergency health facilities, and they are turned away with the ominous explanation that there are no beds to accommodate them for treatment. One of the recent incidents involved the late Charles Amissah, an engineer who had a motor accident in Accra and was rushed to three different hospitals, only for a chain of the No Bed Syndrome to begin. An ambulance arrived at the accident scene and rushed the victim to three emergency hospitals in the city: Police Hospital, Greater Accra Regional Hospital and Korle Bu Teaching Hospital. However, the doctors on duty turned him and the ambulance crew away, because there were “No Bed…”. After visiting three hospitals, the ambulance crew refused to move to another health facility, and Charles Amissah was pronounced dead 118 minutes after the ambulance had first reached him at the motor accident scene.
Of course, Ghanaians voiced their revulsion about this new fatal outcome of the persistent No Bed Syndrome, in both mainstream and social media outlets—an indication of Ghanaians’ value for human life and the tragic but avoidable canker of a No Bed Syndrome that had caused the untimely death of Charles Amissah. In response, Ghana’s Minister for Health, Kwabena Mintah Akandoh, established a fact-finding committee to investigate the entire incident. The committee was headed by Professor Agyeman Badu Akosa, a retired pathologist and the current chairman of the Ghana Medical and Dental Council. The committee concluded that Charles Amissah died of medical neglect. Some medical professionals mistakenly confused ‘medical neglect’ with ‘medical negligence’, while others argued that inadequate resources in health facilities, including the phenomenon of the No Bed Syndrome, were also to blame for the entire incident.
Anyway, as part of a solution to the No Bed Syndrome, the Ministry of Health is planning to introduce an IT (Information Technology) bed management system. From the explanations so far, the bed management is a technology solution. With this solution, an ambulance crew would know in real time which hospital has a vacant bed to accommodate people in medical emergency situations. This looks and sounds good, so far. The question, however, is “How about if the ambulance crew know in real time that there are no beds in any of the hospitals?”. In such a hypothetical case, we are then back to the same old No Bed Syndrome. Well, this is where Professor Akosa’s suggestion of home care—which ensures prompt release of patients from the hospital to continue recovery at home—might be plausible. Home is rest. Rest is recovery. Recovery makes way for healing, whole and wholesome.
This Home Care solution evokes the concept and culture of the Ghanaian home, and its nuanced interconnectedness with rest and recovery and healing from sickness, as it pertains to the medical situation to which the No Bed Syndrome is immanent. If indeed the recommendations given by Professor Akosa will be part of the bed management policy, then the next question becomes, “Whose imagination of the concept and culture of the Ghanaian home will the implementation of this policy take into consideration?” And also “What kind of home care is being imagined that a sick or recovering person receives from whatever, again, is imagined to be the concept and culture of the Ghanaian home?” That is, “What are the conditions of this concept and culture of the Ghanaian home?” In addition, “Will there be a way to assess the conditions of a given Ghanaian home, before a sick or recovering patient is discharged from a health facility to this home care solution?” And if yes, “What will be the criteria for assessing these conditions?”. In all this I assume the doctor will be making the decisions that go to answer all these questions. And it is in keeping withthe foregoing questions that I appeal for a Healing Imagination about the concept and culture of the Ghanaian home, the sick or recovering person who is released to this home or home care solution, and the medical condition of this person.
To begin with, there is a difficult historical gap in the willingness of Ghanaians to go to a health facility as a first and immediate attempt to resolve a medical condition. This is partly because, historically speaking, the hospital was first set up to care for only white Europeans and the military personnel in the then Gold Coast, now Ghana. With time, Ghanaian elites were accepted in the hospitals, or they had access to be admitted to the hospitals. After Ghana’s independence from British colonial rule in 1957, hospitals became open to the larger and general Ghanaian public. With the idioms “healthy nation” and “health is wealth”, medical professionals and government officials encouraged people to visit the hospital for care whenever the need arises. What now tacitly keeps the historical gap is the cost of healthcare—but this too, to a significant extent, has been remediated through the introduction of the National Health Insurance Scheme, and recently, also the Primary Care and Mahama Care. We are now faced with the remnants of the colonial healthcare infrastructure, the postcolonial additions to this infrastructure, and the overall and agelong medical bureaucratic regime. All these exist in and are further complicated by the political economies of both national and hospital administrative management, which combine to form the basics of not only hospital culture in Ghana but also, by extension, the aforementioned concept and culture of the Ghanaian home. In some cases, the moral agency of the Ghanaian cannot be observed through the hospital culture. It seems we now have to use home care.
Home Care is not a strange phenomenon to the Ghanaian. Indeed, it is at home that people display the Healing Imagination, and specifically, in relation to the concept and culture of the Ghanaian home. The imagination is a product of long-held communal cultures that have been forged within homes in Ghanaian society. This shared community includes how members in Ghanaian society are quick and generous to offer suggestions about remedies that can bring healing to a sick or recovering person. In the words of the character, Ababio, in his novel, The Healers, Ayi Kwei Armah posits, “What you know commits you”—which is to say, what we know obligates us. In the Ghanaian and African worldview, knowledge is a moral force, oftentimes handed down by the ancestors from one generation to another, and even more often, circulated through social networks, all to maintain a holistically wholesome and good life for the individual and the society as a community, or simply, a totally healed and therefore, thriving society.
To this end, healers and sources of healing, healing words and knowledge/es // knowledge systems, healing plants and ecologies, healing acts and ceremonies, and healing spaces and places like Ghanaian communal societies and homes, all part of the Healing Imaginal Repertoire. The repertoire of the Healing Imagination. A person in this repertoire is an active moral agent in search of a solution to sustain life—their own life, the life of others, and the life of the community at large. And so the holder of healing knowledge discharges the duty of this moral burden with great thought and careful responsibility. In most cases, the knowledge holder engages in the imaginal exercise after seeing the sick person, and within hearing range, the mind of the sick person follows the imaginal exercises. The hope of healing turns out to have an association with the benevolent knowledge holder and the Healing Imaginal Repertoire. In all this, however, the hospital culture and its inherent medical bureaucracy seem to reduce this somewhat solemn sense of the moral burden of the healing agent, and thereby, of the moral agency of the Ghanaian home, as the space in which the healing agent functions and in which healing itself occurs. In the one and the same turn, an example of and also an explanation for the hospital culture’s reduction—if not elimination altogether, at this rate—of the moral agency is this No Bed Syndrome, this turning away and warding of people who are sick and in need of urgent help and care. And now with the suggestion Home Care in the midst and outcome of the same hospital culture, new questions emerge: “Will the Home Care become a new guise to turn traffic away from hospitals?” Or “Will the Home Care rather turn out to make beds available for elites, a class of people who the colonial rulers first allowed and gave access to the hospitals, for people who can afford to pay for this privilege or for being prioritized in such a manner?” One might argue that even at their best, these questions are still only speculative, and that there is neither material reality nor tangible evidence to answer these questions. However, and despite such a diversion, one way to answer these questions to return to the crux of previous questions: “Whose imagination of home do we have to work with in the suggestion of Home Care as some attempt of solving the problem that the No Bed Syndrome has come to be?” This answer to this question is critical, at the very least so that no doctor or other health professional can flippantly discharge a patient to go home to continue recovering and healing at home, in keeping with the Home Care suggestion.
Anthropologists have been discussing imagination and care. The use of imagination in that sense also builds on the concept of moral-imagination in conflict resolution. In a conflictual situation, a simple attempt to find a common ground has the potential of resolving the most complex of problems. The anthropologists combine imagination and care to expose a dual effect: thus providing care to others as though they are providing care to the self. The Biblical reference for that duality is clear: “do unto others as you would have them do unto you”. The same principle is repeated in Immanuel Kant’s moral philosophy as the categorical imperative. But it goes beyond following the moral principle. How would a doctor be able to imagine the home of a Kayayee? (female itinerant head potter in the cities). This calls for a careful moral imagination.
There is a certain shared concept of what a home is in Ghana. This concept is cultural and pervasive in Ghana. It is believed that every Ghanaian comes from a home, and so no one is really home-less in Ghana. In fact, all Ghanaians also come from a home-town, and family houses or homes are full of information about which home we come from, which people are our kin and kith. Having established this, two difficulties arise. The first difficulty is that the situation of homes in urban areas does not illustrate and support this prevalent cultural concept of a home. A concrete and ready example is this cultural concept of home as it pertains to head porters, popularly called kayayei, in urban areas like Accra, Ghana’s capital city. That is, although these kayayei do have homes some 900 or so kilometres away from these urban areas, they make ‘homes’ under the sheds at marketplaces and bus terminals and stations in the cities. The second difficulty is that even though we all have homes, in certain instances, there is no guarantee that we will all have the space and even the mere sense of a bed at home, a bed on which one can rest, a bed from which one can heal and recover from sickness. In these instances, the people who are one’s kin and kith would have to decide whether there is room and facility for a bed, and if yes, where to make space and accommodations for a bed, for the sick person. That is, whether or not one has or finds a home is a matter of decision and discretion of one’s family, the people that one is supposed to have some relationship with by way of kinship. And this is where things can become tricky—although kin and kith love all the members, there is an implicit judgment that goes into the decision and discretion about whether or not and what kind of sense of bed or home that a person would be given. This judgement is based on the conduct of the person before the sickness, as well as notions about the kind of sickness and its gravity, and also notions about the cause or root of the sickness. And all these notions entail and are accompanied by elaborate social perceptions, which oftentimes are outright stigmas that the sick person’s kinfolk would rather distant themselves from, and therefore, would not want to give the sick person give or share the sense of a home—not to even talk of a bed—with the sick person. All this also depends on how the social network of the members of a home decides to volunteer resources and help of all kinds that go into the making of a home and bed for the sick person. The Ghanaian anthropologist, Albert Awedoba, even extended this line of thinking in relation to how Ghanaians celebrate funerals: the contents and quality of life that a person led—as judged by kin in particular, and by society at large—would determine if and how their funeral would be celebrated.
To this end, a sick person, in that moment of weakness and vulnerability due to sickness, suddenly sees the world with new insight and clarity. And upon healing and recovery from the sickness, can put on a new and different conduct and relationship with kinfolk. This change in character is informed by the insight and clarity gained during the time of sickness, and more specifically, the treatment from the kinfolk during the sickness. And so knowing quite well about this implicit judgement as it pertains to the cultural concept of home in Ghana, and even more so, knowing what treatment the sick person would get from kin folk based on their specific judgement about the sick person prior to and in the moment of the sickness, some sick people would not want to go to heal and recover and rest at home; they would rather go to the hospital to do these. In such a situation, the hospital doubles as and becomes home to some people when they become sick. And this is where the medical condition of a sickness becomes intricately intertwined with the social condition as a result of the said implicit judgment one stands to receive.
In conclusion, the recent No Bed Syndrome that led to the death od Charlse Amissah, Professor Akosa’s suggestion of home care is not simple at all. There is a need for a critical Healing Imagination of the conditions of Ghanaian homes. The Ghanaian cultural concept of home might help define this imagination, and thereby, in arriving at solutions that are, at once, practical, sustainable, and meaningfully relevant to and informed by the Ghanaian’s conception of what a home is. And so while there is no evidence yet that home care will become a guise for quickly discharging patients regardless of their home situations, how a doctor imagines the homes of patients is crucial to healing. And in relation to the suggestion to introduce bed management technology, it will also be important that care is taken to ensure that the bed management technology does not take out the embodied Ghanaian healing imagination. The hope is that this bed management technology will not be another bureaucratic layer that becomes an impediment to the moral agency of doctors. The skill and knowledge of a doctor are to save lives. As is consistent with the Healing Imagination, what we know commits us to sustain the life of the other.
