Discussing Healthcare in Ghana with Dr. Michael McCarthy of Sinel Specialist Hospital

Interview with Dr. Michael McCarthy, CEO of Sinel Specialist Hospital

Give us a little background of Sinel Specialist Hospital.

My dad started Sinel Specialist Hospital in 1982. His vision was to provide services for women specifically, because he was a gynecologist. He trained in Switzerland and moved to Ghana in 1977. Sinel was a huge and awesome success at that time. During my dad’s time, there was a lot of innovation to include; pap smears, cervical screening, laparoscopy and ultrasound. That was the time ultrasound was just coming out, and he was one of the first to have an ultrasound scanner in Ghana. Even the innovation to have a hospital just for women was something unique which was not happening in Ghana at that time. It is now very common to see women’s hospitals in Ghana. I joined Sinel Specialist Hospital full-time about 12 years ago, and we have been able to grow the hospital from the entrepreneurship time to this current time where we are a huge corporate entity in this space. Currently, we are not only focusing on women, we are also focusing on children and families. The fourth focus that we have is operating theater accessibility. And recently we were awarded as the best surgical hospital by the Ghana West Africa Healthcare Excellence Awards 2022 as a testament to how we have been able to keep our theaters open 24 hours for the past 40 years. In a nutshell, that is Sinel from its beginning 40 years ago to where we are currently.

Can you describe into details all the services that Sinel offers?

We started as a full hospital, but this hospital is focused on healthcare for women specifically, obstetrics and gynecology. This was important because the vision was to offer specialist care as that was something that was lacking at the time and is still a challenge. We have now expanded with this model of specialist care. We have specialist care in pediatrics, obstetrics and gynecology, urology, internal medicine, chronic care and psychiatry. Then we have specialist care in surgical and disciplines more focused on general surgery, breast surgery and some plastic surgery. We have also in the past few years, focused more on the family in a specialized way. We know and COVID has also taught us that a disease can affect the whole family; for example, when one person contracts COVID the whole family may get affected, therefore, healthcare cannot just be compartmentalized into specialties. We need to also look at the entire family. When I am treating a disease like polycystic ovary syndrome and the issue is excessive weight, can we reduce our weight so that we can have ovulation and therefore solve the fertility problem? I involve the whole family in this, because if the woman is on a diet, maybe she is no longer taking high concentrated sugar drinks, but those drinks are still in the refrigerator and the husband and kids are taking them. After three weeks of such a program, the client will probably default because her family is not cooperating. But if the family is joined in this kind of treatment, then the kind of interventions that we want to give as doctors and as healthcare practitioners end up causing a lifestyle change, causing a prolonged and a sustained change for better health, and also gives us the kind of results that we want. So family care is extremely important to us at this point.

What is your competitive advantage?

The reason our founder wanted to set up the hospital was to focus on a particular type of patients and to solve particular types of problems. That is what has kept us afloat, even though we have now expanded into family, each of those expanded components still focuses on the client. Hospitals have a business component, there needs to be money flowing so that we can get more equipment, we can give better care and the stocks are available, etc. But the key driver of a hospital is the client. So focus on the client, not just client service or making the client feel at home, but also focus on the real issues that the client has. That has been our differentiator over the years. Even though people try to copy our model, which is good because we need more health facilities that would offer the kind of care that we give, we still have the edge because we continue to do things the same way we did them at the beginning, always focusing on the client and ensuring that we get the kind of traction with the client and the kind of results that the client is looking for.

What is your general assessment of the healthcare system?

The healthcare system in Ghana is on a very positive footing. We have a great healthcare system as well as the people working in our healthcare. We have high caliber people working both in government and in the private healthcare sector. Ghana is a destination for a lot of African countries when it comes to healthcare, because of the kind of expertise that we have. Ghana is one of the biggest exporters of health personnel, probably to the whole world. Huge numbers of Ghanaian health workers go to other countries and offer services all over the world. Over the years, there has been a lot of improvement in the healthcare system in Ghana. For example, we used to be in the control phase for malaria, but Ghana is currently one of the countries that have managed to get to the elimination phase for malaria, and that is a huge success. That shows that the potential for change and intervention is available. The second thing is training. There has been a huge jump in training both of medical students, nursing students, and other paramedical workers. There is a lot of specialization going on. In my dad’s time, they had to be sent to other countries for medical training, and that showed the type of training that was available at that time. The training program later became much stronger in Ghana and medical schools became extremely strong. I attended medical school in Ghana from beginning to completion, and that was a fantastic opportunity for me. Now, there are medical schools in almost every region in Ghana and that shows the kind of growth we have had. Training in specializations has also improved. At the time I was training, it was not very easy to complete a specialist program, and the numbers were smaller, but currently, there has been a huge growth in both the number of people going through training programs and their scope. Our healthcare provision is on a tangent to get to that excellent point. There are still challenges with the healthcare system, but the challenges are not just health systems, it is tied to the entire economy, for example; access to care, cost of care, and availability in terms of distance, in terms of the kind of specialist available close by and maternal mortality. All these cannot just be changed by telling doctors to work harder or telling nurses to be nicer, it is an economic issue because if you want to address a problem like maternal mortality, it is not just the last care that is given on the last day in the hospital. It is the care given from when one was a teenager, her nutrition, her education and empowerment, to how she grew up and finally the pregnancy itself, and the type of care that she is given till the end of the delivery. We need to continue to strive to ensure that we become excellent because the opportunities are available.

What is the vision regarding innovation and technology at Sinel Specialist Hospital?

I have always been proactive in terms of technology, specifically related to healthcare. Mobile telephone has a very high penetration in Ghana. It was not so many years back, and in those times, all we had was text messaging and phone numbers. Since there were not many doctors, it was a bit challenging to let your phone number be available. For me, it was an interesting concept to make my phone number available at the time for phone calls and text messaging, and then leverage that to ensure that we maintain the clients that come in, because acquiring a client can be very challenging, and to maintain them, you need to put in some work. But that was real basic and things have escalated beyond that. We have gotten to the point where it is all about apps. It is about hospital information management systems and so on. Now, we do not need to go to the ultimate and do everything, we need to be able to recognize and see what is important and what causes have changed.

During COVID, as hospitals could have closed down, we were working and throughout those difficult times we still maintained our 24 hour theater services, our delivery services and the emergency care services. We were able to provide remote or telemedicine services to patients, now it seems odd, but during COVID we were doing Zoom. That was not the case when COVID began, but we were able to open up a free online clinic that patients could contact us through and we would link up with them and address the things that could be addressed on a telephone. Obviously, not everything could be, but it was a good point because it showed us that you could actually treat patients at home. That could increase access, scope or even multiply the effect of a specialist, because he did not need to be present to physically see the patient, but could triage the patient online, address some issues, and then refer the patient to the hospital for different kinds of treatment. Technology was available as some smartphones even have oxygen sensors on them and one could measure his/her SPO2 at home. From a simple observation point of view, the smartphones were accurate enough, and for some of our patients, we monitored the oxygen levels on their phones from home which was interesting. We need to use technology in Africa and leverage on what we have. Just an SMS message can do a lot. We need to know the features of various phones as a lot can be done through that. We also need very strong and robust systems which could be apps, online systems or hospital management systems that can solve the basic problems.

One of the big problems is availability of blood and blood products, and it is one of the things that are important because one of the biggest contributors to maternal mortality is postpartum hemorrhage. To some point, blood products and blood transfusion is a solution to many of these cases. The availability of blood and blood products can be a challenge, not just because they are not available, but because they are not distributed correctly. For example, in my blood bank in Sinel I may have two units of O negative blood. Another patient in another facility probably needs O negative blood and it is not available, as O negative blood is not very easy to combine. It is very important because it can be transfused to almost anybody if there are no other complications. So where are all the O negative blood units? In which blood bank are they? If blood is needed at midnight, how do we access it? We can use just simple technology with the existing technology we have. We do not need to invent anything new, but how do we organize that, how do we test and try that in very simple ways in jurisdictions, in cities like Tema, where we have quite a number of private hospitals? This is how we can use technology, and it does not have to be huge but it can be very simple and very smartly deployed.

Is Sinel still a family business or are there stakeholders? How is the structure of the hospital now?

It has grown from the initial vision to the corporate entity it is now with partners from different groups and the stake of the family as well. So it definitely has grown from that one entrepreneur to the point where it is now a corporate entity that is able to attract other investors and partners to come in.

Are there projects that you are currently working on, just completed or are about to complete?

We have just completed the expansion project and renovation of our legacy building. We were to create new wards, so we have a new block for inpatient care, and we have also completed our outpatient department block with administration space. A very important aspect is the completion of our dedicated pediatric space. We created a space that is dedicated to children’s care building off on what our founder’s vision was with women’s care. We are building that up, scaling up children, and that has a different and new physical space. It also has its own dedicated doctors and nurses. So function wise and care wise, it works on its own. It used to be a daycare place but it is now running 24 hours with a doctor on site to attend to pediatric emergencies, pediatric care, and so on.

What would be your proudest moment with the hospital?

I am a gynecologist, so the proudest moments are when we deliver a baby and complete that family. It happens every day, it is a joy to see that all the time and every baby has been special. The big significant thing is that we won the Surgical Hospital of the year award last weekend and recently that has been our proud moment. I am excited that we have been able to build up on what we started with up until this point. In the 70s, there were even times one could not move from home. How could you even organize a surgical operation at 2:00 AM with the political unrest? That was quite challenging. Even during the COVID season we were open 24 hours for emergency surgeries. Last night, we did two emergency surgeries at 10 and at 12, so having that kind of thing, scaling it, increasing it and making it both available and accessible are what excites me and makes me feel fulfilled in what we are doing.

What would you want Sinel to have achieved in the next five years?

The first thing I want is to strengthen our 24 hour emergency care. The second thing is access to care, both in our facility and remotely. But that is one of the biggest challenges that we have in healthcare in Ghana. Most of the time, people say healthcare is expensive, and they cannot access it because of financial reasons. That is true, and it needs to be addressed too. Is the care available? Is it possible to reach such a specialist? Is it possible to get advice, education, counsel and triaging when we need it? I am leveraging on our telemedicine and hospital information management system that is able to see the patient, even if the patient is not physically present. We will also have the pediatric services, obstetrics and delivery services, general surgery and psychiatry. The unique services we are offering are psychiatry services and clinical psychologist counseling services which are neglected and stigmatized in Ghana but they are extremely needful, because even delivering a healthy baby is a huge stressor, and can tip some women into postpartum depression. So recognizing the importance of this aspect of health and being able to access psychiatric and psychological care when you need it is important since a lot of things we do in hospital go with psychological issues. For example, patients with chronic conditions when first diagnosed, is not a very easy thing for them to accept. So you need some additional care, which may not be given by one specialist.

What is your inspiration? What drives you to do what you do every day?

I am a consultant obstetrician gynecologist focusing on women, babies and fertility issues. What drives me is people. I interact well and more deeply with people. I wrote two books, one on uterine fibroids and one on menstruation, because I felt that there was a lot of information that was required and was not easily available in clear language and ways to drive the point home. So those two books were basically patient education booklets to educate women and men on the issues that I wrote about. Interacting with people and getting them to the point where the health challenges are addressed and solved is what has pushed me so far to continue with the kind of legacy that my dad left, which also has to do with people. He was interested in solving the problems that existed in Africa, even though he had an option of staying in Europe and could have done extremely well there.

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