Recognition for MAPs
Behind Mr Baah’s consulting chair is a graphic warning poster of ‘the Smoker’s Body’; printed in 2004 by the Ghana Health Service. Surrounding it are a collection of curling postcards from around the world, including two male and two female, short-sleeved London bobbies in front of Tower Bridge. Most eye catching of all is a dated British scene of a man and smiling woman stood at a urinal checking their pee companion’s progress. ‘Equality’ proclaims the postcard.
This office wasn’t always Mr Baah’s. The postcards were sent to the psychiatrist and medical director whose framed family photograph now rests on the floor. Although the office’s former occupant died five years ago, much remains preserved; the hospital respectful of its previous leader’s 15 years service, his wife still unable to collect his belongings.
Aged 42, Aaron Baah’s legacy at Pantang Hospital is nearly as long. He began there as a nurse in 2000, working on the admission and rehabilitation wards, as well as the same out-patient clinic where patients now consult him. In 2005, he began 18 months of training to become a medical assistant (MA) and medically manage patients. After a mandatory six months as an MA houseman in a general hospital, he returned to Pantang where he lives with his wife and three children in one of the several soviet style residential blocks that appear incongruent in the tropical hospital grounds. Mr Baah may have a doctor’s office and perform a doctor-like role but he doesn’t believe that his role is truly appreciated.
“We are always overworked and the staff [available] is not enough. Worst of all, there is no motivation”, he says, feeling there’s no incentive for his career development. Certainly the lack of provided water and food while on duty or air conditioning that works are practical complaints but what upsets him most is the limited status of MAs. “We are not recognised for what we are doing but we are doing much! You can just imagine, how can they cope without us? They can’t!”
Pantang Hospital is on the outskirts of Ghana’s capital, Accra. It has some 500 in-patients with varying degrees of mental illness while its outpatient department performs nearly 15,000 psychiatric consultations a year. There are two psychiatrists, including one who works tirelessly as the current medical director and a medical doctor for physical illnesses. Thus with only three MAs to perform the majority of the psychiatry and medical duties, you can see why Pantang – and Ghana itself, which is said to have only 15 psychiatrists – needs more psychiatry specialists.
It’s because of that I’m in Ghana for three months during my Specialist Registrar training on a placement arranged by the Royal College of Psychiatrists and Challenges Worldwide. Four trainees from the St George’s Higher Specialist Training Programme have been to Ghana already to leave sustainable change by providing supervision for the MAs, while I’m the first to be released by my employers, Sussex Partnership NHS Trust.
This week I’m at the Kintampo Rural Health Training School (KRHTS), nine hours by road from Accra in the geographic centre of Ghana and which also happens to lie on the Greenwich meridian. Here I’ve joined a group of mental health professionals from Hampshire Partnership NHS Trust who are collaborating with KRHTS and Ghana’s Ministry of Health on the Kintampo Project; a training programme that aims to increase the number of middle level specialist mental health workers in the country over the next five to 10 years. Mr Baah is enrolled on this 18 month course but a week before my colleagues from Hampshire were due to arrive for two weeks of intensive teaching, he was still uncertain about whether he would receive funding to attend.
The Kintampo Project’s curriculum was developed jointly with the University of Winchester for MAs to specialise in psychiatry and thus be known as Medical Assistant Psychiatry [sic] (MAP). There are also plans to run a 12 month course that will leading to community nurses taking up the role of Community Mental Health Officer (CMHO). With there being limited training available for Mr Baah at work, this would seem precisely the kind of opportunity to further develop his knowledge and skills. However, what rankles him is the term ‘assistant’, when he performs many of the functions of a doctor at work including admission, management and discharge of in-patients.
Mr Baah is a committed and concerned professional who says ultimately he would like to train as a psychiatrist. He works “for the love of the job” and will even reach into his own pocket for patients who can’t afford vital treatment for conditions like epilepsy. His suggestion for a more fitting title would be that of Clinical Psychiatry Officer, which he says more accurately describes what he does and would be respected by employers who currently don’t accept his ‘assistant’ opinion about their returning to work employee. “Feed us with the knowledge” he says of the Kintampo Project “but give us the legal backing. We are being prepared ‘half-baked’; you get the picture?”
So were things ever better? “It has not been better but things are becoming worse of late in the sense that psychiatrists in Africa or Ghana are not motivated, so people don’t want to be there. The problem they are having is to nominate people to the regions (rural areas) but most people won’t want to go. If people are not responding, it is because they don’t see anything positive ahead of them. Even now we don’t know our new pay structure that should come in. If you want this programme to ‘kick off’ and you still don’t decide how much to give the people; do you think you are serious? It doesn’t show any seriousness.”
To be fair to the Kintampo Project, it aims to provide a serious, dedicated specialist training in psychiatry for health professionals who will be working in the community, far away from the three large institutions that are based along the south coast. As an experienced MA already working in psychiatry, Mr Baah – whose funding is later confirmed – is among a select group accessing this new training that future aspiring MAPs will benefit from. However, if Mr Baah is typical of the MAP students I will be teaching, the Kintampo Project may also have to recognise his concerns and address the career prospects that its students might expect to look forward to.
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