St. Patrick’s Hospital
The St. Patrick’s Hospital is a non-profit Catholic mission institution, first established in 1951 as a clinic by St. Louis Sisters from Ireland. It was later upgraded to its present status as a hospital in 1957. It operates under the umbrella of the Catholic Archdiocese of Kumasi but is duly registered under the Christian
1 There was a second session of fieldwork between November 2009 and January 2010. This makes the
Health Association of Ghana (CHAG)2 and also the Private Homes and Maternity Board. The hospital is located at Maase, a suburb of Offinso, 45 km to the north of the Ashanti Regional capital, Kumasi. In view of its strategic location on the main Kumasi-Techiman-Tamale road to the north, the hospital serves as a referral point for all other health facilities in the Offinso-South Municipal Assembly3, Offinso- North District Assembly and beyond.
The hospital has a total staff of 280 comprising professional nurses, medical officers, auxiliary nurses, administrative and support staff; and paramedical staff. It has 160 beds and the various services provided include a general out patients department (OPD), in-patient services, a laboratory, ultra stenography, antenatal and postnatal care, laundry, dental services, ophthalmology, surgical treatment for both major and minor cases including urology, antiretroviral therapy treatment, a pharmacy, maternal and child health, public health, a diabetes clinic, HIV counselling and testing, an x-ray unit and many other services. St Patrick’s Hospital recently added a physiotherapy unit to its existing units with help from the O’RIEN Foundation from the Netherlands. Besides its busy hospital-based work, the hospital holds regular clinics in outlying villages reaching people who live in areas too remote from the facility to have access to care and treatment. The hospital has an adjacent midwifery training school, which is independently run but receives support from the hospital clinical staff.
The VCT centre at St. Patrick’s Hospital is located close to the injection room and the x-ray unit. To access counselling and testing, clients must walk past other patients who are waiting for services in front of the injection room and the x-ray unit, and pass through the same corridors after the service. The ART clinic4, on the other hand, is located near the main entrance of the hospital through which patients, visitors and vehicles get access to the hospital premises. Some food vendors used to sell at the main entrance of the hospital and they could see clients who entered or came out of the clinic. During the second part of fieldwork, the hospital authorities moved the food vendors away from the main entrance to another location where
2 Christian Health Association of Ghana is made up of missionary-based health facilities in Ghana. The
association coordinates the activities of member institutions and also acts as the link between Ghana Health Service and its members.
3 The Municipal Assembly is an administrative area under the local government system in Ghana. It is
made up of a number of towns and villages within a specific region. The Assembly’s membership comprises people elected through district level elections and government appointees. A Chief Executive nominated by the president and confirmed by the Assembly members heads it. Under the local govern- ment system of Ghana, an assembly area could be classified as Metropolitan, Municipal or District depending on the size of the capital town and the availability of certain social amenities in the administra- tive area of the assembly.
4 This clinic is called the “Special Clinic.” According to the medical doctor in-charge of HIV/AIDS
programme, the clinic provides treatment services for special health problems like diabetes, hypertension, tuberculosis and HIV/AIDS. The name thus makes it difficult for other people to know that the clinic is for HIV treatment.
they could not see patients and visitors entering and leaving the hospital. There was also a parking lot for taxis at the main gate where patients and their relatives could take transport to town after treatment. Like the food vendors, the parking lot has been relocated to another place far away from the main entrance. The distance between the centre and the clinic is about 70 metres.
Komfo Anokye Teaching Hospital5
This is a public health facility established in 1954 and located in Bantama, a suburb of Kumasi. It was upgraded to a teaching hospital in 1975 and affiliated to the Kwame Nkrumah University of Science and Technology in Kumasi. It is the second highest tertiary hospital in Ghana after the Korle Bu Teaching Hospital6 in Accra.
The hospital has a workforce of over 1,000 comprising professional nurses, medical officers, auxiliary nurses, administrative staff, support staff and paramedical staff. The hospital has specialised units in Medicine; Surgery; Obstetrics; Gynaecol- ogy; Paediatrics; Dentistry; Ophthalmology; Orthopaedics; Ear, Nose and Throat; Pathology and Communicable Diseases. The other major departments are Pharmacy, Radiography, Radiotherapy, Physiology and Occupational Health. A recent addition to these units is the ultra-modern Emergency Accident Department. As a tertiary hospital, it is also a referral health facility for other hospitals, health centres and clinics in five regions in the middle and northern parts of Ghana. Its central location in the country makes the hospital accessible to patients from neighbouring countries such as Burkina Faso and La Cote d’Ivoire.7
Komfo Anokye Teaching Hospital is host to other institutions attached to the Ministry of Health, and also has links to several autonomous institutions. These include: the Nurses Training School; the Midwifery Training School; the Medical School of Kwame Nkrumah University of Science and Technology, Kumasi; the Blood Bank and The Health Laboratory Services.
The VCT centre here is located within the same block as the postnatal care clinic and some of the hospital’s administrative offices. Clients must pass through these places, facing mothers waiting for services or administrative personnel, in order to receive HIV counselling and testing. Unlike St. Patrick’s Hospital and Suntreso Government Hospital, there are two separate rooms for counselling and testing in this hospital. That is, clients went for counselling in one room and walked about 25 metres to another room in the same block for testing. In other hospitals, I observed
5 The hospital is named after one ‘fetish priest’ of the Ashanti Kingdom called Komfo Anokye. Kumasi
where the hospital is located is the capital town of the Ashanti Kingdom and the second capital city of Ghana after Accra.
6 Korle Bu Teaching Hospital is the premier public health facility in Ghana. It is affiliated to the University
of Ghana Medical School in Accra.
that counsellors did counselling and testing in the same room. The ART clinic8 was located on the ground floor of a five-storey building made up of offices for medical doctors, nurses and other health workers and admission wards. Adjacent to the clinic is the emergency accident department, which was built recently. The distance between the centre and the clinic is about 300 metres. From the centre, clients go through a number of units in the hospital to reach the clinic via the backyard of the storey building.
As indicated earlier in Chapter One, I also collected data in the VCT centre of the Suntreso Government Hospital. This hospital is located in Suntreso, a suburb of Kumasi. The centre in this hospital is located between the antenatal care and postnatal care clinics, and the maternity ward. Clients accessed services in the vicinity of the antenatal care and post-natal care units. I also visited a private clinic (Quality Care Clinic) in the Offinso municipality to observe some post-test counselling sessions. This became necessary when I found that a significant number of ART clients in St. Patrick’s Hospital were referred from this private clinic. Only post-test counselling sessions were observed in this facility because all the tests were diagnostic or provider-initiated without pre-test counselling. The tests were usually done in the laboratory with the ELISA, a method of testing that will be explained later in this chapter.
Finally, I visited a counsellor at Nkenkasu Government Hospital in the Offinso- North District to participate in and observe counselling and testing because a number of positive persons were also referred from this facility to St. Patrick’s Hospital for treatment. However, there was no case for the counsellor to attend to on the occasions that I visited the hospital. During this period, no one voluntarily walked in for counselling and testing and there was no provider-initiated testing. The majority of descriptions in this chapter and thesis are based on research in St. Patrick’s and the Teaching Hospital and to some extent Suntreso Government Hospital since data were collected mainly in these facilities.