The eyes have it but who cares?

I have always had problems with my eyes and, in the course of a fairly physical as well as intellectual life I have suffered just about every operation on them known to ophthalmologists.  If eyes are the windows to the soul, then whatever spiritual essence resides inside must be mutated out of all recognition!
Anyway, my retina managed to throw up another problem three thousand miles from my regular consultant in the UK.  A good friend arranged a private appointment with an ocular expert in Accra (actually, nearly all Ghanaian medical treatment is private).  I arrived at the clinic in good time, registered and paid for the consultation.  Then I sat and waited for the doctor to arrive.  His list was full and the waiting room crowded.  Nearly an hour passed and then he phoned to say he was stuck in traffic.  This is normal for Accra but, if I had been the doctor I would have taken account of it, wouldn’t you?  I decided to abort the appointment, feeling demeaned and angry.  I wondered whether a doctor who shows that much respect for his patients would be any good, anyway?  The more a professional feels accountable to customer, client or patient the more he or she ratchets up the quality of his or her work.  For a number of years I worked across the medical firmament in England, developing appraisal measures which might improve not only the quality of expertise among doctors but also their attitudes to patients, nurses, managers and juniors, their time keeping, their team work and their self-critical faculties.  It was a rocky ride because there was so much professional arrogance abroad at the beginning.  But it helped to change the culture.
Many if not most of the consultants here in Ghana train in the UK or US.  If in the former then they would have had to abide by the appraisal system to which my team and I contributed.  Then they return to Ghana and a proportion of them are too delighted to embrace arrogance and dump any notion of accountability.  They have re-joined the Ghanaian middle class.  When I asked the receptionist whether the doctor was usually late, she smiled benignly and said, “He is a doctor”.
In Ghana, accountability hardly exists in practice though the rhetoric is very western in language and structure.  If someone sells you a bum service there is little redress.  Socio-political reforms show hardly any palpable result. The general populace is utterly cynical about government bodies, professional services, corruption and backhanders.  It is sad because ordinary people in their towns and villages are remarkable in their general capacity to get by.  Change will only occur here when the middle classes forget about feathering their nests and maintaining their vantage point in the class system and begin to institute hard-edged offensives against corruption and grossly unprofessional conduct.

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