Cuban doctors and doctors’ strike

Without intending to, Cuban doctors working in Ghana and their 300 colleagues recently contracted to come, became unwitting tools of the recent industrial warfare between doctors and FWSC/government.

By fate or design, the recent announcement by the government to recruit 300 Cuban doctors three weeks into the doctors’ strike ignited interesting talking points. To some, it was government’s way of saying “to hell with the doctors.” Perhaps, it was to tamper with this notion that the Minister of Health is reported to have explained that the recruitment was part of a long-standing bilateral agreement between the governments of Ghana and Cuba. The timing was, however, certainly, most curious. If, indeed the government’s aim was to create a sense of expert crisis containment, even a false one, then it must have been positively amused if some of the feedback was anything to go by. To quote Joy FM’s Afi, “To me as a citizen, I feel sort of comforted to know that government is bringing in doctors at a time like this.”

From the doctors’ perspective and in times such as these, it is perhaps natural to seek to downplay the possible positive impact of the 300 recruited Cuban doctors. In this frame, wholesale ridicule of the past and ongoing contributions of Cuban doctors, however, minimal to Ghana’s health system, may become an inevitable unfortunate consequence. This is a path to be wary of and one worth avoiding.

With a doctor to population ratio in the region of 1:10,000 with regional variations in the area of 1:50 000 in places such as the Northern region, the need for more doctors could not be more obvious. In many remote areas, Cuban doctors, with all their linguistic and other challenges, have been all that our people have and they continue to be grateful to them. 

My appreciation notwithstanding, three issues continue to bother me, none of which is a statement on the professional competence or lack thereof of Cuban doctors as they ply their professional trade in Ghana.

If government is really keen to address our shortage of doctors, it is obvious that 300 Cuban doctors is hardly the fundamental change required. If necessity is the mother of all invention, then an impossible working environment in our villages has compelled our district medical practitioner to assume the guise of a master specialist. The district doctor is in addition to being a general practitioner, a pediatrician, obstetrician, internist and surgeon. He/she sees everyone that walks into the hospital with minimal exceptions. We do not have the luxury of the Cuban context where with Fidel training so many, doctors have ended up so specialised that a Cuban doctor, posted into Ghana as a pediatrician may never be able to respond happily and with equal dexterity to the call to go and perform a Caesarean section on a woman who has been labouring for days in obstructed labour. He is a pediatrician only and not an obstetrician. 

This is the reason why I argue that one Ghanaian doctor is doing the job of about four other specialists, for which reason, if government truly wants to replace 2000+ Ghanaian doctors, then 8000 Cuban replacements would be more like it.

For me, this simply gives an inkling of just how many doctors we need to radically shift our thinking on the needed capacity. The deficits we have are not the kind that 300 Cuban doctors, or producing about 350 every year from Ghanaian medical schools can significantly ameliorate. The point is that, if Fidel can afford to train so many doctors and other professionals, if he can afford to use this cadre to create a first-class health system in Cuba that is the envy of ‘so called’ first-world countries, if he can train so many doctors to enable him to swap their expertise for oil imports from neighbouring Venezuela, what stops Ghana from same, especially when Ghanaian doctors, the world over, have distinguished themselves with knowledge, competence and professionalism? What stops us when every year, only a tiny fraction of high grade applicants gain admission to Ghanaian medical schools? 

There is hidden treasure here! We are in a position to train more than enough doctors to tackle both our deficits and to export to other countries at great benefit to the country and the doctors themselves. Why can’t we train 1500 doctors every year? A fundamental redesign is called for but for as long as we bask in the anointing of recruiting from elsewhere instead of redesigning our training, retention and utilisation approaches, we shall continue to look where there are minimal solutions only.

Secondly, government officials are often at great pains to flaunt the readiness of Cuban doctors to serve in remote areas. Why do they never tell us the details of the logistical arrangements that make it possible for this to happen; the contributions of the Cuban government in their home country coupled with the stipend paid by the Ghana government plus accommodation etc.? It is obvious some compensation for service in remote areas has been arranged. Instead of learning from it, we pretend that some angelic doctors have suddenly flooded our rural areas.

Numerous pay reforms later, from GUSS through HSSS to SSSS, we have not succeeded in causing the radical shifts in human resource alignments to needs. How is it that government is lamenting increase in public sector wage bill from two billion to eight billion Ghana Cedis at the end of which we still have not succeeded in shifting critical staff to deprived areas? For a ‘so called’ under resourced country, we appear to have pretty expensive tastes!

Finally, Ghana’s quality control standards for permitting doctors to practise in Ghana are either not being fully being adhered to or are being subverted by our governments through blatant violation and/or abuse of procedures outlined by the Medical and Dental Council, the regulatory body. To ensure that aspiring practitioners are competent to manage the common case mix, the Medical and Dental Council insist that those intending to practise in Ghana write registration examinations. On passing, they are certified to practice. So strict is the MDC on this that even Ghanaian doctors trained in Ghanaian schools certified by MDC, who do not start house job training within two months of completing school, are required to write these registration examinations. Why are Cuban doctors not required to write these same examinations?

Without passing judgment on the competence of the Cuban doctors, this practice is discriminatory and unjust and does not assure us that professionals with the highest Ghanaian standards are being given access to Ghanaian patients. I, like many others, call on the Ghana Medical Association, to pursue this matter to its logical conclusion. We are all either writing the examination or we are not, in which case, some other way of assessing competence to practise in Ghana is called for.

Written by Dr. Sodzi Sodzi Tettey

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