Religion and Healthcare Behavior: Analyzing Physician-Patient Social Relationships in Ghana

Ghana -  Summer 2017

I think [religion] should give hope; hope to patients...because sometimes you reach a point where medications can’t do everything. Therapy is not enough...sometimes they need a place of solitude. Religion should be part of hospitals, so that patients can fall, or even the staff, can fall on their Maker in times of crisis where medical therapy has a limit” (Dr. Claudia Agyekum*, personal interview, 14 Jun 2017).

During my time at Komfo Anokye Teaching Hospital, I was able to interview 30 patients and 30 health professionals about the integration of religious language and beliefs in physician-patient interactions. I also had the opportunity to observe physician-patient interactions as I shadowed doctors during patient consultations. Religion is a social institution recognized as being central to Ghanaians, and it has had effects on the healthcare system. For example, there is a correlation between religious orientation and health services usage. Religious beliefs also affect how patients seek primary healthcare. For most Ghanaians, the hospital is usually the last resort following herbal medication, traditionalist medicine therapy, and religious healing beliefs and practices. This is due to a number of reasons; some of which include financial factors, physical access to hospitals, and misconceptions or myths about hospitals and Western medicine. Another reason as to why hospitals have become a last resort for patients in Ghana was disclosed to me at Komfo Anokye Teaching Hospital. From the interviews that I conducted, I learned that pastors, imams, and herbalists give their members or clients the full attention and sympathetic concern that patients are craving for in the hospitals.

When asked if they had any suggestions as to what health professionals can do to improve interactions with patients, many patients suggested that nurses should be more cordial in communicating with them and should also be more concerned and respond quickly when patients call for them. Some patients also suggested that doctors should spend more time with them, explain things to them more thoroughly, and create a space for them to inquire further about their diagnosis and prognosis. After asking health professionals the same question, similar responses were echoed. Most doctors claimed that the doctor-patient ratio does not allow for them to spend as much time as they would like to with their patients. I observed this during the consultations that I shadowed. On some days, some doctors were completely booked for the day and only had time to listen to the patient’s complications then hand the patient a prescription note. The doctor-patient ratio also causes nurses to constantly be on demand, thus triggering compassion fatigue.

There exists a divide between patients and health professionals resulting in doctors not being able to thoroughly explain conditions to patients, and patients not being comfortable enough with health professionals to ask for those explanations. Some patients feel as though if they ask questions or ask for explanations, then they are challenging the knowledge and authority of health professionals. On the other hand, some doctors feel as though the illiteracy of some patients will prevent them from fully understanding the explanations. As a result, several doctors sometimes avoid giving patients complete explanations about their conditions. This compromises the health literacy of many patients, creating problems for them in the future with other
providers.

My research project sought to identify how Ghanaian medical professionals integrate the religious beliefs and orientation of patients in physician-patient interactions and analyze how the integration affects satisfaction. Based on the conversations that I had with health professionals and patients, if compassion and attention become main features in healthcare provision, then patients would not mind if religious language and beliefs were not integrated in physician-patient interactions. Many patients across all levels of religiosity, however, still greatly appreciate the integration of religious language and beliefs in physician-patient relationships. This integration plays a role in helping doctors connect with patients and could bridge the divide that exists between the two groups, setting both health professionals and patients on the same platform as limited beings dependent upon a limitless Maker.

Before pursuing this research project, I was not expecting some of the challenges that I encountered in the field. My identity as a Ghanaian-American, not fully belonging to either culture, was difficult for me to accept at first. I later realized that having access to both cultures further empowers me and gives me a unique perspective of the world. Walking through the hospital during the first weeks and witnessing some of the heartbreaking conditions that I did made me reflect deeply on my decision to become a physician. I also began to question the validity and importance of conducting my research. On a daily basis, I dealt with feelings of frustration with the healthcare system and frustration with the everyday challenges that people faced in the country. I was greatly humbled by the tenacity and resilience of people living in Ghana. In these moments, it was very challenging for me to be a researcher only observing, not able to help out in any capacity. I had to constantly remind myself that I was not merely observing, but I was learning and gaining a better understanding of challenges within the overall systems of Ghana.

Despite the challenges that I faced, there were many rewards that I enjoyed in the field. Through the engaging conversations that I had with patients and health professionals, I was able to discover many things about the healthcare system of Ghana. Deciphering the similarities and differences between Ghanaian-American and Ghanaian culture allowed me to understand more things about my life and upbringing and gave me a deeper appreciation of who I am and where I come from. With the goal of working in Ghana as a physician for some time in mind, it was very beneficial for me to encounter the challenges associated with practicing medicine in Ghana and experience daily life in Ghana. It is one thing to hear accounts and read articles on how things
run in Ghana, but it is a totally different thing to have that real experience. Through my experience, I believe that I have gained a richer understanding of the truth.

I would like to thank everyone who supported me in the completion of this project: my field advisors Dr. Ken Sagoe, Dr. Daniel Ansong, and Dr. Caleb Odotei; my research assistants, Juliana Antwiwaa and Irene Agyeman; my advisor Professor Paul Ocobock; faculty mentors Professor Erin McDonnell and Fr. Bob Dowd; and the staff and patients at Komfo Anokye Teaching Hospital. I would also like to appreciate the generosity of the Kellogg Institute of International Studies. This summer I have been able to truly experience the world of Ghana for myself. This experience will be something that I will continue to cherish in my mind and heart as I continue to pursue my academic, personal, and professional goals.

*Names have been changed to protect the privacy of participants.