“I’ve always said that people die a lot in Africa from not knowing enough,” Nana Assah, a third year pharmacy student, explained as what he believes is part of the cause of the continent’s historic plight. Assah is originally from Ghana, West Africa and, as a native, understands the public health issues populations face in West Africa. The knowledge gap is glaringly deep and wide, he said. And it is due at little fault to the patients—Ghanaian doctors are increasingly being held accountable for how information is shared.
“Patient-caregiver interaction is very limited,” said Assah, recent recipient of a MUSC Center for Global Health (CGH) trainee travel grant. “Some doctors get upset when patients question them, and it causes more downstream problems.”
The issue is systemic: doctors are outnumbered by patients at a ratio of 0.9 to 10,000 Ghanaians, underscoring the growing need to spend minimal time with patients. Encounters with patients are rushed, and they often leave more confused than when they began seeking care. Assah decided to turn this philosophy on its head while working alongside another Ghanaian pharmacist with Project Okurase in a dispensary as part of Village Health Outreach (VHO). Project Okurase’s mission is to address the devastating effects of poverty, illness and a lack of clean water, infrastructure, medical care, and education in Ghana by helping vulnerable women and orphaned children.
“It’s the nature of the practice in Ghana: no one has the time to consult with patients about their medical conditions and the prescriptions taken to treat or cure symptoms,” said Assah. “While working in the clinic, I took time to talk with the patients and consequently they opened up.”
Assah found that the people he saw at the clinic were reticent in talking about prescriptions and associated health conditions. He was persistent in his line of questioning when he needed important information to determine what prescription was needed for the health condition diagnosed during triage or ailments that predated Assah’s time in the clinic. Volleying back and forth from English typeface on medicine boxes to Twi, one of Ghana’s local languages, Assah managed to educate his patients on their conditions and the importance of prescription adherence.
He even went as far as taking an average of three to four blood pressure readings of patients at the clinic to more accurately diagnose hypertension, a condition that requires medication with side-effects that can be mistaken for other ailments. He implored nurses and other providers checking patients’ blood pressure to do so carefully in order to minimize the number of false-positives.
However beneficial, Assah’s time spent with patients was met with restlessness and frustration, “The patients started to get impatient,” said Assah. “They didn’t understand my rationale for wanting to know more about their health. We eventually got an official diagnosis for some conditions, and we prescribed accordingly.”
Cindy Swenson, PhD, professor at MUSC and co-program director for Project Okurase, said that having Assah work in the clinic was important not only in communicating with patients, but in applying his knowledge, flexibility, and willingness to take time to educate patients on prescription drugs.
“It truly strengthened our health outreach to have Nana Assah as part of the team,” Swenson remarked. “His understanding of the culture and ease moving in and out of multiple languages greatly facilitated communication with our more than 1,000 patients.”
Avoiding misdiagnoses and providing the best information on proper usage of prescription medicines became Assah’s primary objectives. He attributed his ability to communicate information effectively and understand health history to his training at MUSC. “One of the key areas MUSC trains us on is medication safety and patient counseling,” Assah said. “It’s a big thing in our program because it’s very important!”
Lessons of placing value in patients and their safety were imparted by Assah to his counterpart in the clinic. He recalled a time when the pharmacist he was stationed with looked at him, his face ashen at the amount of time Assah spent providing detailed information to patients. At one point he caused a backlog in the clinic. Initially, it annoyed the other pharmacist. Then he realized that one of his own, Assah, was dedicating his knowledge, time and skill, once again bouncing from the English writing on pill bottles to Twi, to a patient he barely knew so that he or she could make better, informed healthcare decisions then and in the future.
“You can’t talk about patient safety without counseling,” Assah explained. “The patient should know everything about any prescription provided to treat symptoms of an illness. Effectively sharing information is important for all areas of health, not just pharmacy.”