The Human Cost of Inequality in the Provision of Neuro-oncological care
About two weeks ago, as part of a regular eye check-up, I was referred by my primary healthcare optometrist to another eye care facility for further testing as the necessary equipment was not available at their facility. I quickly rushed to this specialized eye clinic but was informed I had arrived too late hence, it was impossible for me to get the tests done. I was asked to come back the next day before 8AM. Four visits later, I ultimately was denied the opportunity to get two tests that would take less than twenty minutes to get done. I was frustrated. Being passionate about oncology, I can’t imagine what this experience is like for people with brain tumors that require timely eye evaluations.
Photo Credit: Soweto Graphics
Having worked as a medical laboratory scientist and now being a medical student, I am not oblivious to the challenges Ghanaian patients face as they seek care. Ghanaians who live in rural areas face even more challenges compared to their urban counterparts, and this is the same story across most of Africa.
Delayed diagnoses are amongst the challenges brain tumor patients face in Africa. My experience at the eye center led to frustration but in the case of brain tumor patients, these delays can lead to death. It is for this reason that diagnosis and management of brain tumors require a multidisciplinary team of neuro-oncologists, neurosurgeons, radiation therapists, neuro-ophthalmologists, neuropathologists, and neuroradiologists. Every member of this diverse team is essential and without this sort of approach, patients more often than not are robbed of an individualized management plan and as such suffer avoidable disability or premature death.
Thinking back to my experience at the eye center, I wonder if low staffing contributed to me having to be sent home a few times before ultimately being rejected. One can make an argument that it was probably the primary reason especially when you see the length of queues at our hospitals. The low provider-to-patient ratios is a cause for concern that has a seemingly straightforward solution - train more providers. However, I have learned that being trained is not enough. In my experience, there are very few job openings within the Ghanaian healthcare system at the time of graduation so many providers have to wait a significant amount of time to get a posting from the government or an offer from one of the few private healthcare facilities around the country.
“Lack of data is another contributor to delays in receiving essential care.”
This takes us to the second contributor of delays in our healthcare system. Ghana and many sister countries lack appropriate infrastructure required in the management of patients with brain tumors. Advanced imaging methods like MRI and CT scans, which are essential for precise diagnosis and ongoing monitoring of CNS tumors, are still not widely available. First, most of these equipment are concentrated in Accra and Kumasi and it is not uncommon for them to break down. Unfortunately, rural Ghanaians are left with the short end of the stick because they may make the trip to the city only to find out the equipment is not functional.
Lack of data is another contributor to delays in receiving essential care. W. Edwards Deming said it best - “In God we trust. All others must bring data.” Consistent monitoring and assessment of health systems is warranted in order to improve the neuro-oncological care. How do we reduce the barriers faced by brain tumor patients if we do not know the extent of the challenges they face?
There is good news, however. Some African countries especially in the Northern and Southern regions have developed health systems that provide apt brain tumor care. By identifying these healthcare systems, as well as those healthcare systems that are struggling, we can be intentional about learning from one another. This can be done with a standardized yardstick such as the African Neuro-Oncology Access Disparity (ANAD) Index. The index looks at different factors like healthcare systems, economic conditions, and the availability of medical resources in different countries using information from organizations like the World Health Organization and the World Bank. This index helps to show which countries have better or worse access to brain tumor care. As a result, the ANAD index allows stakeholders to objectively identify which countries perform better in the provision of neuro-oncological care.
I think the index highlights the importance of African-led solutions and for a while I wondered how we can inspire and train the next generation of individuals who will work to improve care for Ghanains with brain tumors? I am happy that I am finding answers to this question every day. As a medical student at the University of Ghana Medical School, I have been privileged to attend conferences such as Society for Neuro-Oncology Sub-Saharan Africa (SNOSSA) 2024, where I presented an abstract, Africa HepatoPancreatoBiliary Cancer Consortium (AHPBCC) where I served as a science communication fellow, and the International Society for Pediatric Neurosurgery (ISPN) where I helped organized the meeting. These opportunities helped me understand my role in improving healthcare for fellow Ghanaians.
Photo Credit: Fortune Kekeli Avorgbedor
My colleagues and I are blessed to be in this position and we understand and welcome the responsibility that comes with these opportunities. Importantly, these opportunities have helped me understand that physicians have a lot more to offer their patients outside the hospital/clinic. I am grateful to God, my family, the medical school, and mentors for putting me in the position to become a doctor that can not only impact patients I see on a day-to-day but also those who I may never get to see. Ultimately, I hope that as more medical students buy into this strategy, we will help make sure that no Ghanaian has to go to a health facility 4 times before they are told they cannot get a test or treatment - especially those in rural Ghana and those living with brain tumors.
On the matter of gratitude, there is a special type of help anyone with my ambition needs - mentorship. While I think I have worked hard for the opportunities I have had, I realize that a significant number of them were made possible thanks to mentorship. For this reason, I strongly recommend that every medical student finds a mentor that will help them get opportunities, hold them accountable and keep them on track.
My experience with Ghana’s healthcare system has opened my eyes to the harsh reality faced by many Ghanaians, particularly those in rural areas, seeking healthcare. Delays in diagnosis and treatment for brain tumors can be devastating.
However, there is hope. Initiatives like the ANAD Index are crucial steps in identifying areas most in need of improvement. This allows for targeted solutions based on data, not guesswork.
While challenges like staffing shortages and limited infrastructure remain, I am inspired by the success stories of other African nations. Through collaboration and knowledge exchange, we can build on each other's strengths.
The future of Ghanaian healthcare rests on a foundation of proactive medical students who understand the power of advocacy and mentorship. As I embark on my medical journey, I am committed to using the knowledge and connections I gain to make a positive impact, especially for those struggling with brain tumors. My hope is that by working together, we can ensure equitable access to quality care for all Ghanaians, regardless of location or disease.
