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The Royal College of Psychiatrists Improving the lives of people with mental illness

Accra Psychiatric Hospital

Accra, Ghana

Week 3

I had my first full day of work at Accra Psychiatric Hospital this week in the centre of the city; I am scheduled to go there every Friday to do an outpatient clinic in tandem with one of their MAs, and then series of teaching tutorials with all 5 of the Accra MAs in the afternoon. Even though the hospital is probably only about 20km away from Pantang, I had to get my lift to pick me up at about 7am to ensure we got there for 9am because of the choking rush-hour traffic.

Accra psychiatric hospital was opened in 1906. It has some 700 in-patient beds wards and currently houses approximately 1200 patients. Those numbers speak for themselves. There are 5 doctors (two consultants), 5 medical assistants and a clinical psychologist. Like Pantang, the hospital is in a serious amount of debt. There has recently been a big push to try and discharge patients back into the community but unfortunately, often the community and more specifically, their families, don’t want them back. And community services for psychiatric patients in Ghana are very underdeveloped currently. So many of the discharges are simply brought back and left...or sometimes they never leave in the first place. As we are all too aware in the UK, in-patient provision is expensive, so a huge proportion of mental health funding is spent on providing bed and board for a lot of patients who would be much more appropriately housed and looked after elsewhere. But for the moment, there doesn’t seem to be an “elsewhere”.

As I walked around the hospital, it had the feel of an old asylum. I had been warned what to expect, but the wards were still quite difficult to take in. The level of overcrowding meant that sometimes patients had to sleep on mattresses on the ground, outdoors on terraces. The male “locked ward “in particular was full to the rafters (about 35 beds and 220 patients) - this seemed to be the equivalent of our forensic wards where patients were sent on “court orders”. However, as far as I could discern from the nursing staff, men arrived here regularly, but the outward traffic of discharge was much less frequent. Although there were lots of patients, there were no discernable outward signs of psychosis or aggression, just lots and lots of men, milling around looking bored. There was also an addictions ward, where people were admitted with substance use problems, mostly “wee” (cannabis) and alcohol. However, apparently there weren’t any in-patient resources for psychological treatment of addiction (although there was an AA groups within the hospital) and it seemed as if the patients were just taken off the streets to live here instead, out of sight.

I had a chance to spend some time talking to some of the in-patient staff. As ever, I was impressed with their professionalism in the face of very difficult working conditions. They told me of the stigma that mental illness faces in Ghana, even from within its own medical profession at times. They said that often they had experienced reactions of abject horror from their friends and family when they said that they wanted to work in Mental Health, and that their still remained a great deal of superstition and fear around psychiatric illness, with even some educated Ghanaians attributing its aetiology to spirits and demons. They described the difficulties they often faced in accessing appropriate medical health care for their patients. One nurse tells me of an incident where her patient needed to be taken for a blood transfusion at a local physical healthcare facility. During the treatment, she heard a member of their staff say loudly, within earshot of the patient, that this kind of medical treatment shouldn’t be “wasted on animals”. Obviously this is not an opinion held by the majority of educated Ghanaians, but still, it is indicative of the level of prejudice that exists in some quarters.

Probably the most starkly difficult part of the hospital to take in was the Children’s ward. This comprised a large compound which housed about 30 patients with moderate to severe learning disabilities, aged between about 8 and 35. The staff told me that children with intellectual disabilities (often with concurrent physical problems) were abandoned at the gates of the hospital by their families, or sometimes found on the streets. Once here, most had no further contact with their families and remained on the ward until their lives ended. The nurses explained that having a disabled child, particularly a child with a learning disability, can be very shaming for a family, and that it is sometimes taken as a sign of some sort of malevolent influence at work.

There are 2 nurses on duty and a couple of Ghanaian volunteers who are here three days a week to help care for the children and who also try and organise activities such as art or games. But it is very clear that relative to the individual needs of the children, the wards are critically understaffed. It is all the nurses can so to keep the children clean, fed and safe and there is precious little time left to think about their emotional or learning needs. I noticed some of the children sitting quietly rocking themselves. For the brief periods that I have been on the wards, individual children come up, grab on to you and don’t let go; I left with scratches on the back of my neck because one little girl was holding on so tightly. I try not to be the overwrought, overemotional visiting westerner, and fail. It feels like quite a lot to take in. Currently there is no available input from speech therapists, physiotherapists or child psychology.

I spoke to staff and volunteers to see if there is anything practical we could do, in conjunction with Challenges Worldwide, the charity that is supporting me in Ghana. I was thinking of trying to fundraise for some educational and art materials for the ward and I asked the staff for a list of things that the children need: although the list did include toys and art materials, at the top were more basic requirements such as detergent, gloves, nappies and second hand clothing. I need to have a think about how best to take this forward, and I leave feeling a bit numb.

Ghanaian flag
I continue with my clinic, in-patient and tutorial work with the Accra and Pantang MAs. In the main, they are enthusiastic, keen to learn and a privilege to work with. But I am starting to learn lessons that I am sure most volunteers in developing countries learn on the job (people tell you these things before you go, but they don’t really sink in).
Firstly, you can’t just go in to a new place and expect people to want to hear about how to make things “better”, especially from an outsider who is used to working in a vastly different environment; this seems hugely obvious when you see it written down, but I assure you, it is easy to lose sight of this fact. Secondly, you can’t presume that your own, dearly held professional values are going to necessarily be entirely shared by those you will be working with. This can feel frustrating at best... and at worst discharging in brief paroxysms of rage and disbelief (hopefully in the privacy of your bedroom). I am learning...not to take it personally, to reconvene my list of “goals for the week” into “goals for the month”, to be flexible and to seek compromise. Dr Dzadney, the Medical Director told me something very useful when I was sounding off about a patient who I felt had been poorly cared for at a medical facility; she told me that sometimes here we cannot always do what is best, but only the best we can manage with what we have.

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Re: Accra Psychiatric Hospital
I am really touched by this piece of information. I am currently training in UK in Mental health. I would like to work in Ghana to help the vulnerable patients
Re: Accra Psychiatric Hospital
Thanks so much for the profound information provided in this message.
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About this blog

Susie Easton

Hello, my name is Susie Easton and I am an ST6 on the UCL/Royal Free Hospital General Adult Psychiatry Rotation in North London. I have just got my CCT and when I return from Ghana, I will be moving home to Glasgow to take up my first consultant post.

When I saw the Ghana post advertised, I thought that it looked interesting, a bit scarey and an opportunity for a professional and personal adventure.

This personal blog reflects Dr Easton's own views, and not neccessarily the organisations that she is working with. However Dr Easton is indebted to the partnership between South West London and St Georges mental health Trust, the charity Challenges Worldwide and the Royal College of Psychiatrists for providing an opportunity to take part in this excellent project. She is also very grateful to Dr Peter Hughes for his regular and invaluable clinial electronic supervision, Challenges Worldwide for their excellent logistical support, and Dr Anna Dzadney the Medical Director at Pantang hospital for making her feel so welcome. And last but not least, she is indebted to the Ghanaian Medical Assistants with whom she works, for helping her learn about how mental illness in West Africa.