Maternal health and patient charter training program and norms about Ebola virus

Maternal health is still a major issue that Ghana is still grabbling with and Agona East District is no exception. It is for this reason that various intervention programmes by Alliance for Reproductive Health Right (ARHR) and The Young and Lonely Foundation (YLF) and other stakeholders have been instituted to grind maternal death to a halt.
As part of the activities to improve maternal health in the District, The Executive Director of Young and Lonely Foundation Mr. Gilbert Kofi Germain organized six (6) midwives, which were selected from five health facilities in the District namely Nsaba Health Centre, Kwanyako Health Centre, Mensakrom Health Centre, Asafo Health Centre, and Mankrong Health centre to undergo a maternal health training in Cape Coast to enable them enhance service delivery in their field.
The in-service training for the midwives came off 3rd October 2014 at the Central Regional capital, Cape Coast. During the programme, YLF collaborated with Alliance for Reproductive Health Right to impart knowledge into the health personnel (midwives). The training was based on customer care, patient rights, patient’s responsibilities, maternal health care and good delivery services. With the advent of Ebola in the West African sub-region, there was the need for health persons to acquaint themselves with it knowledge and how to eradicate it. As such, the health personnel were given a thorough presentation on Ebola. And also all participants collaborated to sign a pledge of good health delivery service to all kinds of persons.

Details about the meeting
The meeting commenced with registration of participant name the organizations they are coming from. The facilitator for the programme was then introduced to the participants. She is in the person of Mrs. Susana Larbi Wumbee. She is a National Care Trainer. Before she commensed her presentation, she outlined the learning objectives for the programme. This can be seen as follows:

Understanding the importance of providing customer feedback
Identifying the sources of customer feedback
Familiarizing with the methods used to collect feedback
Demonstrating how to provide effective patient/ workers feedback
Understanding the right and responsibilities of a patient
Understanding the meaning of Ebola virus
Where it was originated
How Ebola is transmitted
Who is a susceptible to Ebola
Some sign and symptoms of Ebola
Measures and precautions to prevent the Ebola virus.

The participants were taken through the various presentations. She charged the participants or health workers to respect the views of their clients and always give them a feedback and clients will be very happy to know the health personnel are concern about their problems.
She emphasized that the few clients who do complain will remain customers if their problems are resolved. 54 to 70% of complainants can be won back and 95% of this group will become loyal. She talked about some major causes of complaints thus delays in attending to patients, discourteous behavior of health workers, lack of knowledge on the part of health workers, inadequate logistics or medical supplies, not keeping to working hours, playing favorites, unhealthy environment- inadequate space, poor sanitation. She hinted on why customers do not complain. Surprisingly research has shown that only one out of every 27 clients would complain about a bad service or treatment received. Those who do not complain just switch too existing competitors. Client does not complain for the following obvious reasons. There are no clear procedures or structures for complaining. They think that complaining would not do them any good nothing will be done about it. According to her, there is competition in the system and it makes it easier for clients to switch to other health care providers to meet their health needs. She said it is important that we respond positively to customers complaints because every complaint gives Ghana health service or the hospital the opportunity to differentiate itself from its competitors.
She also took the participants through the rights of patients. These rights can be see below:

The patient has the right to quality basic health care irrespective of his or her geographical location.
The patient is entitle to full information on his or her condition and management and the possible risks involved except in emergency situations when the patient is unable to make a decision and need for treatment is urgent.
The patient is entitled to know of alternative treatment and other health care providers within the service if these may contribute to improve outcomes
The patient has the right to know the identity of his or her caregivers and other person who may handle him/ her including students, trainees and ancillary workers.
The patient has the right to consent or decline to participate in a proposed research study involving him or her after a full explanation has been given. The patient may with draw at any stage of the research project
A patient who declines or withdraws from a research project is entitled to the most effective care available
The patient has the right to privacy during consultation, examination and treatment in cases where it is necessary to use the patient or his/her case notes for teaching and conferences the consent of the patient must be sought
The patient is entitled to confidentiality of information obtained about him or her and such information shall not be disclosed to a third party without his or her consent or the person entitled to act on his or her behalf except where information is required by law or is in the public interest.
The patient is entitled to all relevant information regarding policies and regulations of the health facilities that he or she attends
Procedures of complaints, disputes and conflict resolutions shall be explained to patients or their accredited representatives
Hospital charges, mode of payments and all forms of anticipated expenditure shall be explained to the patient prior to treatment
Exemption facilities, if any shall be made known to the patient
The patient is entitled to personal safety and reasonable security of property within the confines of the institution
The patient has the right to second medical opinion he or she desires.
Having gone through the rights of patients, the responsibilities of patients were also read out the participants. The responsibilities are codified below:
Providing full and accurate history for his or her diagnosis, treatment, counseling and rehabilitation purposes
Requesting additional information and or clarification regarding his or her health or treatment, which may not have been well understood
Complying with prescribed treatment and reporting adverse effects and adhering to the following up requests
Obtaining all necessary information which have a bearing on his/her management and treatment including financial implication
Acquiring knowledge on preventive, promotive and simple curative practices and where necessary to seeking early professional help
Maintaining safe and hygienic environment in order to promote good health
Respecting the right of other patient or client and health service personnel
Protecting the property of the health facility

The last but not the least presentation was based on Ebola disease awareness and prevention. This presentation could not have come at a better time than this as the Ebola virus is gradually creeping it way into various countries in Africa and other parts of the world.
According to the facilitator, Ebola is a severe illness caused by the Ebola virus. It is highly infectious, rapidly fetal. It is caused by a virus (Filo virus hemorrhagic fever) and spread by direct contact. It kills within a week and does not give enough time for the individual to receive treatment. It has a death rate of 90% but preventable. It has not known vaccine; currently it is not certain there is treatment for it. She said it was originated in central Africa; however the disease has travelled to the West African sub Region. The name Ebola originated from Central Africa and there have been reported cases recently in Guinea, Liberia, Sierra Leone and Nigeria. The major hosts are in species such as Bats but monkeys and apes are easily infected. She said, the virus can be transmitted. The spread of the virus is through direct physical contact with body fluids such as saliva, stool, urine, blood, sperm, sweat etc. from an infected person or someone who died of Ebola. Direct contact with contaminated surfaces such as door knobs, stair case rails or equipment, including linen soiled and infected by body fluid. It can also be transmitted by the use of piercing instruments that have been used by an infected person. The touch or handling or eating fruits and other foods that have been partly eaten by infected animals such as bats and monkeys. She did mention of some susceptible thus individuals close to infected patients. Those whose delicacies are bush meat such as monkeys and bat are likely to be infected with Ebola. She added that sex workers or those with multiple partners can get the virus. The following are some of the symptoms she stated:
Flu like symptoms such as fever

Myalgia
General malaisis
Diarrhea
Vomiting
Bleeding from orifices
Patient become anxious

Measures for prevention

Wash hands regularly with soap and water or with alcohol rub especially after shaking hands with someone
Do not touch infected patient or allow their secretions or body fluid to touch you
Avoid contaminated materials and utensils
Watch out and stay away from people with flu like symptoms
Take a hand sanitizer with you and use when necessary, place them at vantage point at home or office
Avoid hand railings, door knobs and other utilities used by the public
Shaking hands should be avoided
Observe personal cleanliness and sanitary environment conditions
Avoid improperly cooked meat especially bats and monkeys
Avoid and possible unprotected direct contact with blood and body fluids of other people
Report any case of flu like fever

Hospital level prevention

Medical staff should be sensitized and trained in infection techniques
Case identification, detection and contact tracing.
Case finding in the community
A distance of more than one meter should be maintain when interviewing a suspected case
Patient identified should be isolated
If single isolation rooms are unavailable for isolation cohort these patient in specific confined areas
Do not allow visitors to enter the isolation room
Ensure all health workers ( including aids and cleaners) use personal clothing should be worn for working in patient areas
Staff should apply strict barrier nursing with the use of personal protective equipment
Hand hygiene should be performed within the isolation room also before and after removing gloves
Traditional burial rituals such as embalming of bodies should be discouraged or modified

She said Ebola virus has been found to be relatively easily eliminated by heat, alcohol based products, sodium hypochlorite, calcium hypochlorite (bleaching power) at appropriate concentration. The Ebola is real and currently in the West Africa sub region. Individual need to take the necessary precautions to protect themselves and report suspected cases. Hospitals should be on the alert to ensure that the disease is not spread and health staff also protected from contracting it.

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