September 1, 2023

Study describes COVID's impact on Ghanaian physicians

The paper, by Michigan Medicine and Ghanaian collaborators, offers a rare glimpse into the pandemic's impact on providers in an LMIC setting. 

Nearly 10% of the working physicians in Ghana contracted COVID during the pandemic's first year, according to research between a Michigan Medicine faculty member and her Ghanaian partners.

During the first year of the pandemic, about 1 in 10 Ghanaian doctors were infected with COVID and 9 succumbed to the illness.

The numbers come from a collaboration between UMMS physician Emma Lawrence and Ghanaian partners—one of the few research studies to look at the overall burden of disease and individual impacts of COVID on healthcare providers in an LMIC setting.

“COVID raised lots of questions about physician burnout and wellness, but most of the data we have comes from high-income countries. There is not much information from LMICs,” said Lawrence, an Assistant Professor of Ob-Gyn. “Even in normal times, there just often isn’t capacity to think about how the doctors are doing. Their doctor-to-patient ratios are already far from ideal as it is.”

With longstanding partnerships in Ghana, Lawrence typically makes multiple trips there each year to advance research projects on maternal mortality and related topics. But as travel restrictions brought on by the pandemic put those projects on hold, she and her partners shifted gears.

“Our ideas for planned Ob-Gyn research were paused, because obviously COVID was top of mind,” she said. “It was new and scary. Doctors were being effected and my partners had the idea to try to quantify that impact.”

The resulting study, published in Ghana Medical Journal, relied on information from the Ghana Medical Association, which collected aggregate data on the number and characteristics of physicians infected between March 2020 and March 2021, as well as qualitative information about the challenges encountered as a result of their infections. Some highlights:

    • Of about 6,100 doctors working in Ghana, 544 (8.9%) reported COVID infections during the study period.
    • The majority of infected doctors (59%) were symptomatic but stable, and 1.7% were in severe/critical condition.
    • 9 physicians died of COVID-related causes.
    • More than half (60%) reported either patient management or contact with an infected colleague as their likely source of infection.
    • House officers (those working the longest hours) and Consultants (the most experienced physicians and the most likely to be engaged in the caring for acute COVID patients) were more likely to become infected than medical officers, the most common physician classification.

The vast majority of respondents (75%) reported some kind of challenge associated with their infections, the predominant themes being difficulty getting medications; trouble accessing daily needs like groceries; and delayed test results.

“One of the challenges in that first year was that there just wasn’t adequate testing capacity. Doctors would be exposed, get tested, but then wouldn’t have results until weeks later,” Lawrence said. “Consequently, if folks were really sick, they stayed home. But if not, they continued to work because the need is too great.

“Just as happened here, doctors were faced with these impossible decisions,” she said.

This qualitative aspect of the project was particularly novel. Studies on the prevalence of COVID among providers in limited-resource settings are rare. Those that also examine the emotional toll of the pandemic in such places are rarer still.

“In my experience, we don’t often think about the doctor perspective in LMICs—just the day-to-day challenges they face and how they cope,” Lawrence said. “This project got me more interested in the physician experience, and has opened up areas of study for me along those lines.”