Who is a radiographer?

Radiographers, also known as radiologic technologists, diagnostic radiographers and medical radiation technologists are healthcare professionals who specialise in the imaging of human anatomy for the diagnosis and treatment of pathology.

Radiographers use different kinds of radiation to treat ill or injured patients. There are two kinds of radiography: diagnostic – where you use radiation to find out what injury or illness someone has and therapeutic – where you use different kinds of radiation to treat an illness or injury.

Currently to become a radiographer in Ghana you need to do a degree in radiography that has been approved and accredited by the Allied Health Professions Council (AHPC) and the National Accreditation Board (NAB). Upon successful completion of the degree, you are then required to do a one-year compulsory internship under the supervision of a qualified and accredited senior radiographer. After the internship, you are then required to sit a licensure examination that one must pass to be given a license to practice as a radiographer. It is illegal to practice as a radiographer or seek to perform the duties of a radiographer without being registered with the AHPC as a radiographer.

Who is a biomedical engineer?

Biomedical Engineering (BME) or Medical Engineering is the application of engineering principles and design concepts to medicine and biology for healthcare purposes. Also included under the scope of a biomedical engineer is the management of current medical equipment within hospitals while adhering to relevant industry standards. This involves equipment recommendations, procurement, routine testing and preventative maintenance, through to decommissioning and disposal. To become a biomedical engineer in Ghana one requires a degree from a university accredited by the NAB.

The genesis of the current problem

Sometime in 2016, the National Tuberculosis Control Program (NTBCP) took delivery of some digital x-ray equipment for deployment across the country. The Ghana Society of Radiographers was informed about the arrival of the equipment in the country. The society had not been involved in the planning process this project and at no point was the society involved until after the equipment had arrived in the country. Again, none of the radiography departments in the two universities (University of Ghana and University of Cape Coast) was involved in any way in the project. The Ministry of Health, Ghana Health Services and the NTBCP did not see the need to involve the two bodies to ensure that the human resources needed for the successful implementation of the project were taken into consideration.

Interestingly, the Ghana Society of Radiographers did not get any further information beyond being informed about the arrival of the said equipment. The society, however, intercepted a letter signed by the Director-General of the GHS dated 19^th July 2017 which amongst other things requested regional directors of health services to employed people he described as ‘unlicensed radiographers’ on a temporary basis to operate the x-ray equipment. In this letter, the director general also claims to have gotten a waiver from the Nuclear Regulatory Authority to employ these unqualified persons to operate x-ray equipment. Interestingly, the Nuclear Regulatory Authority is not the body that regulates the practice of radiographers in Ghana and yet it is the body that is supposedly giving a waiver to allow untrained persons to operate x-ray equipment.

The society of radiographers, therefore, protested this action of the Director-General of the Ghana Health Services and also the Nuclear Regulatory Authority. The protest was what lead to the first involvement of the society of radiographers in the whole of this project. In a letter dated 5^th March 2018 signed by the Director General of the GHS, the society of radiographers was invited to a meeting to address the shortage of radiographers. The letter listed four issues that were supposed to be discussed at the meeting. These issues are

• The current challenges regarding recruitment of radiographer into GHS
• Efforts made to attract radiographers into the GHS
• Short term measures to be put in place to attract these officers
• Long term measures to be put in place to address recruitment challenges.

The society of radiographers decided it was important to go to that meeting prepared to deal with the fact that the GHS had shown clearly it was interested in employing unqualified persons to handle radiation even though that was not part of the items listed for discussion in the letter. A three-man Committee was put together to draft alternative solutions to the problem at hand. The Committee was made up myself, Kojo DeHeer a consultant radiographer (currently consulting for the WHO on structuring Radiology services in Sierra Leone) and Ntiri Theophilus the Head Radiographer at Akai house. The committee proffered alternative solutions to engaging unqualified persons to handle radiation. Amongst the solutions was to use newly qualified radiographers who would be available from September 2018 to cover these areas where the equipment has been installed. As part of the legal requirement to be registered as radiographers they are required to do a one-year compulsory internship under a senior radiographer.

Our proposal then was to zone all the areas where the equipment had been delivered to and appoint senior radiographers within these zones to supervise their operations. The fear that the students will leave after a year was also addressed in a way that every year new students will graduate and can replace those who are done with the compulsory internship should they decide to leave. It was also anticipated that some of them will wish to stay on at these places if they are offered a job. Unfortunately, the GHS refused this proposal and almost a year later we are back here and they are screaming emergency. If they had adopted this solution the equipment would be working now and operated by qualified radiographers but for whatever reason the GHS rejected it.

This September, the University of Ghana will again graduate 25 radiographers who will be available for this scheme and from September next year, University Cape Coast will also graduate its first batch of 50 radiographers who will also be available for such a scheme. The committee gave the ministry of health and Ghana Health Services the current enrolment figures of students in Radiography in UCC, Legon, UHAS and KNUST and showed clearly in the next 4 years on the average the 4 institutions will be producing in excess of 125 radiographers. From next year between Legon and UCC, 75 radiographers will be graduated.

However, the GHS showed that it is a confused entity that did not know what it was about. It had initially started by requesting the regional health directors to recruit persons to occupy these positions and then after a while it decided it was better to rather recruit biomedical engineers for this job. Clearly, this is just a trial an error thing that is being done at the GHS. This is clearly shown in a letter signed by the regional director of health services in the western region requesting that the staff the radiology department at Effia Nkwanta regional hospital should train an unqualified person to handle radiation.

What is surprising is that when there was a shortage of medical officers in the western region, the regional director of health services in a letter dated 10^th April 2018 addressed to all district directors of health services within the region stated amongst other things that to attract medical officers to the region they should be offered the following incentives;

• Decent accommodation furnished with soft furniture and satellite TV.
• Supported with fuel and per Diem to attend CPD programs, monthly meetings with the Regional Director of health services, GMA meetings and occasional transport to see family if they are not together.
• In addition, the medical officers should be sponsored for further studies where he or she decides to go for specialisation.

However, the DG claims radiographers were refusing to take postings to the areas where the equipment would have been installed, his solution is that unqualified persons should be engaged to handle radiation. When it had to do with medical officers, they offered incentive packages to attract them to these areas but in the case of radiographers, they can’t be offered incentives because they are fewer Ghanaians than the medical officers. This shows the total lack of respect and regard for radiographers by the DG which is unbecoming for someone occupying his position.

Falsehood by the Director-General

The Director-General of GHS in an interview on TV3 argues that there are just a little over 140 radiographers in Ghana. That is an untruth being perpetrated by no less a person than the DG of GHS, even if he does not have the figures of radiographers in Ghana, a single phone call could give him the numbers of radiographers in the country. The society of radiographers has 300 plus registered members and mind you it is not compulsory for all radiographers to be members of the society; it is therefore very likely there are some few radiographers who are not members of the society. I have personally worked with some radiographers who are not registered members of the Society. Why the D-G of GHS will intentionally peddle obvious untruth beats my mind.

Additionally, the consensus the D-G refers to in his interview with TV3 is the first proposal in the list of proposed solutions offered by the society of radiographers. At the said meeting, it was not agreed that unqualified persons be given a short training to go handle radiation. Agreeing that unqualified persons should handle radiation is equivalent to giving a trigger-happy drunk teenager a loaded gun to protect your life. It is therefore absurd and most ridiculous for him to attempt to create the impression at the stakeholder meeting, the consensus reached was to allow unqualified persons to handle radiation.

Director General Must Resign

The D-G in his interview with TV3 clearly admits that he knows of persons who are operating x-ray equipment who are unqualified and do not have any training whatsoever. He uses that as a basis to argue that what he is proposing is better since in his case the persons will be given some short training. Firstly, to admit that he knows of the illegality being committed but he has looked in the other direction for the illegality to be perpetuated means he is not fit to be in office. Clearly, he has shown that he does not care about the general population in Ghana. For someone who is a trained medical practitioner of his experience he should know the dangers associated with putting radiation in the hands of unqualified persons and for him to know that persons were being exposed to danger by unregistered and unqualified persons and decided to look away makes him an accomplice and unfit to occupy his position. Can he, in all honesty, say that if the said practitioner was posing as a medical officer in a facility without a medical officer he would have looked away?

Secondly the fact that he is aware there is a law ACT 857 2013 that requires that for anyone to practice as a radiographer or performs the duties of a radiographer the person should be registered by the AHPC, failing to do so commits an illegality and yet not only did he look away when others were doing it, he is now actively promoting an illegality to be committed and defending same on national TV. This is not a person fit to lead Ghana Services, he is not just incompetent but he is perpetuating and supporting illegalities.

Again, in the same interview, he argues that the training will be done in conjunction with the Nuclear Regulatory Authority which regulates the practice of radiography in Ghana. It is not just shameful, but embarrassing that the D-G of GHS does not know the body that regulates the practice of radiographers in Ghana. I would want to know from the DG who will regulate the practice of his biomedical engineers since they are not radiographers and can’t use the title and the health professional regulations ACT 857 does not make provision for them? He also argues that it is a stop-gap measure, so what happens to them when the gap is filled, what becomes of his biomedical engineers? There is a shortage of surgeons in Ghana and since the biomedical engineers fix the equipment used in the theatre just like they fix those used in the radiology department why don’t we train the biomedical engineers to become surgeons as a stop-gap measure? Why will the DG and GHS prefer to use biomedical engineers over newly qualified radiographers to handle the equipment and yet run to the media proclaiming a shortage of radiographer?

In conclusion, I am of the considered opinion that the D-G has shown he is not fit to be in public office by his deed, actions and inactions. The occupants of public office must show some level of integrity and should be seen as upright and exemplary citizens. They should be seen to be law abiding and not acting as accomplices and also perpetuating illegalities and in the process exposing the very citizens whose taxes are used to pay them to danger. The people most at danger are women of the reproductive age and infants. We should not be surprised if Ghana begins to record high numbers of cancer cases if we allow this policy to proceed. That is a scary possibility. I write this piece not just as a radiographer but as a citizen who comes from one of the places where this insensitive and misguided policy is to implement. I will fight this illegality with my blood and as for the bodies like the NRA and Radiation Protection Institute their loud silence has been noted and their support for this illegality is being communicated to the IAEA.

Disclaimer: The writer does not speak for the Ghana Society of Radiographers.