In life, there are few entities and institutions that can be said to have God-like powers

over life and death.

Doctors
Doctors
In a developing country like Ghana, mothers and doctors are high on this list. In

a society where people have no recourse to health but only seek treatment when they get sick, we

don’t have a health-care but are saddled with a ?sick-care? system. Chronic diseases such as heart

disease, cancer, diabetes and hypertension are gradually taking a greater percentage of the

morbidity and deaths among Ghanaians. We still have over 90 percent of the causes of diseases

in our society being preventable.

But too many Ghanaians fail to get the screenings and visits they need to help them prevent these

conditions and stay healthy in the first place. Our life expectancy is around 50 years. We are able

to live for that long because we exercise everyday by walking long distances to farms, to the tro-

tro stations, and walking all day in the streets selling things. The truth is our country doesn’t

really have a health-care system. We have a sick-care system. Our system is not primarily

designed to keep us healthy; it’s organized to get us some treatment when we get sick.

In such a society, doctors who take care of the sick are regarded as Gods. They are the first

professionals who see the ailing person and has the ability to help the one overcome his pains,

and the society gives them the respects they so deserve. Unfortunately, on many occasions these

Gods put up some behaviors that sometimes are seen as unethical, betraying and down-right

blackmail.

Since the beginning of August this year the Ghana Medical Association (GMA) has called its

members out on strike over conditions of service. In spite of the reports of suffering and death as

a result of the prolong absence of these doctors from the consulting room, the national executives

have urged the striking doctors not to even see emergency cases.

They say in medicine that the real challenge is to get the diagnosis right. If there’s too much

focus on the cure before it’s clear what the problem is, the ?solution? won’t stick. So what is the

problem? From the little I have gleaned from pronouncements on the strike, it does not look like

the problem is not that doctors are not paid but they want some agreement on extra privileges.

About three years ago, doctors went on similar strike because they did not like to migrated to the

Single Spine Salary Structure and when they finally agreed, they did not want to accept the level

they had been assigned because that would narrow the gap between them and other health and

government workers ? what the then Deputy Minister of Health, Mr. Rojo Mettle-Nunoo

described as ?relativities in terms of medical doctors and all the other professional bodies. Now it

is about promotion structure, free gasoline, free scientific journals, and exorbitant incentives they

call ?conditions of service?. Should innocent Ghanaians die because the government has not

agreed to give them the equivalent of 15 years? salary when they work for 15 years? And they

want it NOW even though most of them have not worked for 10 years yet?

The truth is these kinds of negotiations where privileges and not salaries will have to be

addressed in view of the single spine structure of salaries take time and from the aggressive

negotiation stand of the doctors may demand a lot of financial resources to satisfy them. This

means the government of Ghana should have the means to pay what they are demanding. If not

then people Ghanaians will have to die.

Thirdly, there is a vicious cycle of strike and counter strike by health care professionals in Ghana

based on wage disparities amongst the different professions. Dapaah Gyamfi (2011) in his

publication on strikes among health care professional stated that statistics from the Ghana

Labour Commission in 2008 depicted that out of twenty eight major strikes which occurred in

Ghana within a few years period of the data collection, Korle-Bu Teaching Hospital recorded

thirteen representing 46 percent. The main complaint of the striking nurses was ?the disparity in

the pay structure which was skewed to favour Medical Doctors and the other non medical staff.?

They were not asking for equal pay but were complaining about the wide gap between the nurses

pay and that of the doctors. This means that if the government yields to the pressure of the

doctors and pays their prohibitive demands, Ghana will have another strike on her hands this

time from nurses and paramedical staff and other professionals in the public sector. Can we

survive that wave of protest?

The striking health-care professionals were of the view that any attempt to segregate and

motivate staff differently created disunity within the health sector and led to a perception of

discrimination and favoritism which was likely to impact negatively on total patient care. All of

them accepted that their strike actions had serious adverse effects on their patients. Most of them

also agreed that their strike tarnished the image of the country internationally, led to brain drain,

brought about increase in the family expenditure of their patients, reduced their productive time

and led to contraction of communicable diseases from the hospital. It should be noted that all

these health-care professionals including doctors worked ?fulltime? in government institutions

with protected salaries.

Doctors provide an essential service whose withdrawal is capable of causing great hardship to

those they serve, including potential loss of life. For this reason, there is a need for doctors to

morally justify any decision for collective action. The history of health-care delivery is full of

heroism. History tells us that for many, or most, of the people who decided to work in the health

care sector, the idea of helping or supporting ill or handicapped people is one of the reasons why

they chose their particular profession. If they then go on strike and really want to stand by their

claims, then someone will get hurt. Inevitably, this is the patient, but hurting patients is contrary

to what doctors and nurses normally do or desire.

In their case, the key to a successful strike is whether public opinion is on the side of the strikers.

To win a strike it is necessary to have public opinion on one’s side and involve the public in

raising the pressure. Can you hurt people this bad and for this reason and expect them to support

you from the heart or do you want to force support by withdrawing services even from

emergency cases?

According to the World Medical Association declaration of Helsinki, it is the duty of the

physician (health worker) to promote and safeguard the health of the people. The health of the

patient is the first consideration of the physician (health worker). The main aim of medical

practice is to save life, preserve, promote and manage health. It is generally understood that

health workers should always desist from harming their patients, and their actions should always

be in the best interest of the patient. On the other hand health workers that are employed on

agreed remuneration packages have the right to be paid and they have the right to express

dissatisfaction and protect themselves from unfair treatment and exploitation. However, their

own rights are limited by their responsibilities to save life and promote health as laid down by

the medical profession’s code of conduct. It is, therefore, important for the striking doctors to

find a better and more humane way of fighting for the demands without endangering the lives of

patients any further. Therefore, it is not helpful to hear pronouncements from the GMA that

borders on total disregard for life if their demands for privileges are not met immediately.

When two rights are in competition or conflict as in this case, the right to all the extra privileges

immediately and the right of the patient to care, the impasse can be solve by resorting to re-

evaluation of moral values. You see, not all moral values have the same weight or scope; there is

a hierarchy of ethical norms and principle. In our case, I believe the right to care (and implicitly

life) on the part of the patient is overriding to immediate satisfaction of demands of privileges

from government. Therefore, if health workers want to improve their working conditions, LET

THEM ALSO FIGHT FOR CARE CONDITIONS AND THE LIFE OF THE PATIENT. For the

working condition of the health worker is the living condition of the patient; both are two sides

of one coin and one cannot be without the other. Nowhere in the list of demands of the doctors is

anything about CONDITIONS PATIENTS EXPERIENCE IN THE CARE SETTING. Is that no

important to them as care giver? In our society doctors are generally held in high regard

particularly in a sick-care system where they have power over life and death. But if doctors in

Ghana don’t take care, a time will come when the high regard with which the public holds the

medical profession will not be a given. That it can be lowered.

A great writer once asked these questions. Why is the medical profession respected? Why is it

intrinsically meaningful when doctors have something to say? What is that added meaning?

Understanding the answers to these questions is essential to gaining an accurate sense of the

boundaries of doctor’s behaviours within social and political spheres, including public protest.

Public regard for the medical profession is the residuum of daily patient-physician encounters,

especially in those times when a patient trusts in the doctor’s integrity, is soothed by the doctor’s

knowledge, and accepts doctor’s honest, calm, and methodical approach when they reach their

individual professional limitations. Are the current doctors’ strike actions threatening this

standing?

If care is not taken, the medical profession in Ghana will erode away if doctors undermine its

standing. The quickest way to that end is abusing the public’s understanding of the physician

(health worker) narrative. The physician narrative is the default credibility a doctor is given by

doing nothing more than entering the profession — it is that collection of concepts, generally

positive, that people think they know about doctors the moment they learn that they are doctors.

Doctors trade on it to do their jobs and also when they advocate for any issue they believe in. So

when the matter prompting protest is explicitly in a doctor’s personal financial interest, public

protest is never the appropriate avenue.

Doctors have achieved their standing in society through the delivery of highly skilled services to

those in dire need. So when you engage in hotheaded public protest and civil disobedience, you

must have a reason that rises to the level of endangering your ability to practice medicine at all,

and a clear explanation for how your actions fit into the medical narrative. If you do not manage

your messages well, others will interpret your actions for you, and you cannot expect their

version to be favorable.

First and foremost many people think that doctors are paid too much, but cannot do anything

about it lets they go on strike and let innocent people die. A section of the public has already

started impugning political motives to this strike action and already, there are speculations in

Ghana that about 95 percent of materials and equipment supplied to government hospitals end up

in private clinics own by doctors. A very serious charge to all those doctors who toil day and

night to save lives with limited resources and under harsh conditions.

The fact is that physicians provide an essential service whose withdrawal is capable of causing

great hardship to those they serve, including potential loss of life. For this reason, there is a need

for physicians to morally justify any decision for collective action. The most effective moral

justification occurs when the central issue of the strike relates to the quality of health care or to

the doctor?patient relationship. When collective action is taken solely to further the interests of

the profession or its members, strikes are probably not morally justifiable.

I will, therefore, plead with the doctors to find an alternate way to fight for their rights without

creating problems for the patients and sacrifice the trust of the public which they need to be

successful in their profession. I will also plead with them not to treat public outcry over their

strike with contempt and ignore calls from society to resume work.

I am also calling on the traditional and religious leadership of the country to get involve in

bringing this impasse to an amicable settlement before further harm is done to innocent citizens

of the country.

Wishing you all a successful but reasonable negotiation.

Kwame Yeboah

[email protected]

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