In part one of this story, we chronicled how The Fourth Estate uncovered a frightening case of ‘Matron Gaga’, an unlicensed midwife whose 30-year history of practice has resulted in the death of at least two babies within a year, and the maiming of another. Today’s focus is on the owners/supervisors of two places Francisca Quaye worked during the course of our investigations.
June 27, 2021: It was a Sunday. The clock read 2.15 pm.
Dr Ralph Obeng Owusu, the Medical Director of the New Generation Medical Centre, paced the compound of the one-storey building housing his clinic and home. For years, the downstairs had been the clinic, and the top, his home.
The grey-haired bespectacled family health doctor appeared rattled and angry.
The Fourth Estate’s eyes and ears at the clinic reported that the veteran doctor had been moody all day.
It was unusual. Although reserved, he is hardly sulky around his staff.
For decades, Dr Owusu had anticipated a quiet retirement—handing over his clinic to his two sons—both medical doctors. But now, all he felt was dread and a vague, formless panic.
After today, a lot in his well-ordered practice, at least, that was what he thought, would change. He is not the type who liked the strident, jagged edges of change. His preference is for his affairs to run smoothly, down the middle of the road.
But one person was about to alter it.
“Was matron at work on Friday?” He asked no one in particular, as he walked to the reception area of the clinic.
The nurses at the front desk responded “Yes” in a chorus.
“Why doesn’t she listen when I talk to her?”
The question was not one that demanded an answer.
So, they went mute.
“Who was with her during the last delivery?”
He walked away. His pace was faster than usual. His arms across his chest, folded when he entered his office, which shares a wall with the reception-cum triage.
The last delivery in question was the near-death experience of Esther Baker. Esther nearly bled to death after she popped a 3.5-kg baby.
By matron, he was referring to his assistant of almost 30 years. A boisterous character who has no midwifery qualifications but had done all midwives do—attend to pregnant women, deliver babies, cut and stitch the cervix of women in labour when their babies were too big to come out of the opening.
For the first time, Dr Owusu thought of terminating the appointment of the matron, Francisca Quaye.
There was no appointment letter when he hired her verbally almost 30 years ago.
She’ll lose her job without a dismissal letter.
When he entered his office, he took the most difficult decisions he had been contemplating for days. He had to end it.
He made a call.
When he said “hello” to the person on the other side of the line, the entire front desk went shush.
The call was to Francisca Quaye. With pleasantries out of the way, Dr Owusu, with a little hesitation told Francisca not to report to work until he called her.
But it appeared his sidekick for almost 30 years did not get the memo.
When Dr Owusu graduated from medical school in 1980 and completed his housemanship a year later, he didn’t see himself surviving in an economy that imposed hardship on everyone, even doctors. Rawlings had just overthrown President Dr Hilla Limann. The economy was in shambles.
Dr Owusu fled with his stethoscope, joining the brain drain. There were no guns to his head. Hunger had a gun on his stomach.
It was a time Nigeria was fulfilling the dreams of the economically disadvantaged from Ghana and other parts of Africa. It was enough reason to look elsewhere. The lure of oil money won.
He laboured in Nigeria for seven years. Six of those at the Health Centre of the Obafemi Awolowo University in the ancient city of Ille-Ife in Nigeria’s Southwestern state of Osun. The last year of his stay in Africa’s biggest oil producer was in Lagos.
By 1988, Ghana’s economy was beginning to see some revival. So, the 27-year-old doctor who had left for greener pastures returned to a 34-year-old man with a renewed sense of patriotism.
He worked briefly for Cocoa Clinic before joining the Susan Clinic as its head. For five years, he worked with Francisca Quaye at the Susan Clinic. He admired her work.
By 1993, he decided to answer to himself, not another boss.
So, they (Dr. Owusu and Francisca) left to start the New Generation Medical Centre in one of the quietest neigbourhooods in Accra—the South Odorkor Estate.
That relationship carried them through 28 years until that phone call on June 27, 2021.
The day she was asked not to report for work, Francisca arrived before 9 am.
The 67-year-old doctor was flustered. He ordered the clinic’s cleaner to call his beleaguered matron to his office.
The conversation went from murmuring to a shouting match.
“You always cause problems. When we talk, you don’t listen, if it’s not a mother, it’s a baby. I said go home until I call you.”
“Is it a suspension or what?” she asked at the top of her voice.
“Three months, just go home, until I call you,” he replied.
She walked out angrily but kept in touch with some of the staff for a daily run down.
In October 2021, Francisca called to announce that she was reporting to work because her three-month suspension had ended. She indeed returned to work, but Dr Owusu sent her home again.
A day after she was asked to go home, she came to the hospital in the company of her brother and an unidentified man.
Their mission was to beg Dr. Owusu to accept her back.
If she was hoping the two men would make her case, they failed. The soft-spoken doctor didn’t budge. The Rubicon has been crossed.
He insisted he didn’t ask her to return in three months when he sent her home in June but rather when he needed her.
Determined to shoo her out, he handed her an envelope—compensation. That in addition to a three-month salary from June was meant to end it all.
Francisca threw it back at him, storming out of the office. She entered the nurses’ lounge, packed her belongings, threw them into a waiting taxi, and left.
It would be her last day in the clinic she saw the sunset, almost every day for almost 30 years.
But it wouldn’t be her last day watching women navigate the pangs of labour.
I’m sorry—Francisca Quaye
That is how long it took for Francisca Quaye to get a new job.
Her experience in the labour ward counted. Due diligence into her past didn’t count, The Fourth Estate would later learn from her new boss.
On February 2, 2022, Francisca received two unexpected guests at her new workplace, Adam Specialists Clinic, where that day, health workers outnumbered patients.
Her guests—two members of The Fourth Estate team—had been at the facility at least six times. Two of those days were with an undercover agent, whose story of miscarriage Francisca had ears for and even offered to buy medication for her.
“I told her she took care of me at New Generation, and that I had a miscarriage with a recent pregnancy. She consoled me and advised me to take folic acid. She offered to buy me medication for conception which I would pay for when I return to see her.
“She asked that I come back when I menstruate,” the undercover agent reported her encounter with Francisca.
On the day she met The Fourth Estate team, she was on a bench outside a newly constructed building that towers over the clinic’s administrative block and consulting room. Her palms were cusped on her lap.
For a uniform, she wore a cream scrub dotted with maps, dogs, and flowers on the top and spotless pair of purple trousers. On her feet was a pair of black sandals. Her hair was neatly tied into a blend of ash and a sky-blue shower cap. For facial expression, she wore a smile. A face mask would have hidden the fast transition from cheerfulness to sad-puppy face when the team broached her work at the New Generation Medical Centre.
“Let’s talk in private,” a team member of The Fourth Estate suggested. It was an attempt to escape the glare and ears of an old man who shared the bench with her and a carpenter nailing a board very close.
But there is no privacy in the narrow compound, where even whispers could be heard.
She opened the glass doors into a narrow corridor that led into wards. A patient was lying in one of the rooms.
With the formalities out of the way, she nodded to the idea that it wouldn’t have been fair to go to town without her side of the story.
“Are you a qualified midwife?” we asked her.
“No,” she responded without hesitation.
“But how long have you been practicing?”
“For 34 years.”
She then went on to give a history of how she became a midwife.
“My grandmother was a midwife at the Dora Quaye Maternity Home. When I was schooling, I had an interest [in it]. When I graduated from Form Four, I worked there as a receptionist. While working, I got more interested. When they’re working, I’d be in the room.”
When the team asked her permission to allow filming.
She ducked behind ill health.
“I have gone through hell. Because of this, I have been through a lot. I see myself like your daughter, that is why I want to talk to you,” she said.
“Do you remember Kate—?”
“The names are a lot. This issue is making me sleepless. My blood pressure is up,” she said in an attempt to kill the conversation.
It made no impact.
A nurse carrying a syringe and medications walked in. Francisca went hush.
She pleaded the conversation should continue outside.
That outside is a dingy space behind the new building. Debris and mortar from the construction work were splashed everywhere. Refuse bins lined up neatly. The clinic’s cranky water pump occasionally burst to life, disturbing the tranquility of the backyard.
The questioning continued.
“Why did you continue to work as a trained midwife even though you know you are not a trained midwife?”
“Mostly I direct them (other midwives) to work on the cases.”
“Why do you supervise trained midwives even though you are not trained?”
She stared at the floor and said nothing.
Turning to Kate’s case, she admitted that Kate’s baby died.
But she couldn’t tell her because Kate’s parents and fiancé’ advised that it could take a mental toll on the 27-year-old.
“The father, the mother, and the husband all said we should not tell her. They all said that she can go off if she’s told immediately.”
She said that informed the cooked story about the baby being sent to the Neonatal Intensive Care Unit (NICU) at the Korle Bu Teaching Hospital.
But there were contradictions in her story.
While she claimed it was Dr. Owusu who delivered the baby, both Kate and Dr. Owusu said the doctor wasn’t present until the baby was born.
When the conversation turned to Zekiya’s baby, whose shoulder joint got dislocated and her elbow twisted backward, Francisca became elusive with her answers.
She claimed two of those cases happened in the hospital. And on both occasions, she was not involved. The closest she came to Zekiya’s was when she returned to work and the baby’s mother brought her for postnatal care.
“I came to work on Monday. The doctor said if the baby did not recover, then we could refer her to the Korle Bu Teaching Hospital. But when the mother came back, I realised that she had applied herbal medicine and a bandage on the arm and I said. ‘Oh Maa, the doctor said if it’s up to 40 days and we haven’t seen any change, then we refer her to Korle-Bu, but what you have done now, even if we refer you to Korle-Bu, they may not be able to find where exactly the fault is.’”
However, both Zekiya and Dr. Owusu confirmed that Francisca only called in Dr. Owusu when she was struggling to deliver the 3.7-kg baby
In the case of Esther, who nearly bled to death, she absolved herself of any blame. But admitted inducing her with a birth inducement pill, Cytotec.
Medical professionals at the Ridge Hospital questioned certain medications Esther was given after delivery, but Francisca disagreed with them saying, “I didn’t give her any other drug which shouldn’t have been given.”
For Bernice, who had a pad left in her vagina and had to return for its removal and re-stitching, Francisca had an excuse— it was not deliberate.
“Sometimes when the patient continues to bleed even after suture[restitching], we have had to leave the pad in there and we make sure that we inform them of it. We do that and remind them to remove it when they visit the restroom. I am sure she did not hear us speak about it probably because of the pain she might have been going through when we told her,” she explained.
Some midwives who worked with her insisted she interfered and dictated what should be done, although some of her practices were alien to best midwifery practices.
Away from dead babies and maimed patients, she couldn’t justify what went into the extra fees, except to say she sold nightgowns and other items and some of the women came to the hospital without those items.
Under Ghana’s free maternal care policy, pregnant women are entitled to free registration with the National Health Insurance Scheme (NHIS), free of cost health services and drugs up to the time of childbirth and 90 days after birth.
But this is often abused by some healthcare providers (both public and private) who demand out-of-pocket- payments from pregnant women during their most critical moments.
A study published in the Health Economics Review in 2017 revealed that 69.4 % of the sampled women in rural Northern Ghana who gave birth perceived that the NHIS did not cover all the expenses incurred during childbirth. According to the report, the women indicated that they had made out-of-pocket payments for drugs and other supplies during childbirth even though the costs were covered by the NHIS.
The women The Fourth Estate spoke to said they paid the hospitals GH₵100 prior to going into labour only to be confronted with extra bills between GH₵ 300 to GH₵ 700, for which receipts were not issued. These payments were allegedly engineered by Francisca Quaye despite the fact that they were covered under the NHIS.
The findings from the study and Francisca’s out-of-pocket-payment demands on women due for delivery undermines Ghana’s drive to meet the United Nation’s Sustainable Development Goal 3. This goal places priority on high-quality, evidence-based obstetric and neonatal care as a way to reduce maternal and infant mortalities.
For each woman that paid extra fees, she developed selective amnesia.
“It’s been long so, I can’t remember,” she said when The Fourth Estate put the allegations of illegal fees and the detention of newly-delivered mothers who couldn’t afford to pay until their relatives came to bail them.
“I can only apologise to them. To all of them, I am sorry. They should forgive me. I am really sorry for whatever happened. They should forgive me.”
When we pressed further, she could only beg.
“Daddy[referring to one of The Fourth Estate reporters], please, I am pleading with you. What’s going on with me can even cause me to take some poison,” she said.
“Uncle[referring to one of The Fourth Estate reporters], please, forgive me. I am taking care of an abandoned child who was left by the roadside by her mother. Anytime I remember what I am going through, then I feel like committing suicide. Daddy, Uncle, please, take me as your mother and forgive me. Please,” she pleaded grabbing the arm of a member of the team when she saw a letter addressed to the Medical Director of the Adam Specialists Clinic.
When The Fourth Estate put the issues of medical errors to her, she apologised.
“I can only apologise to them. To all of them, I am sorry. They should forgive me. I am really sorry for whatever happened. They should forgive me,” she said in what could be her first apology to any of the victims of her unlicensed practice.
Although the head of the New Generation Medicial Centre said he had fired her, Francisca Quaye told The Fourth Estate she left of her own volition, especially because of the many allegations
“I lost interest in the job when these issues started coming in. This got me thinking for some days. I went on hunger strike for two days just to understand the issues I was alleged to have been involved in.”
I was naïve –Dr Owusu
The Fourth Estate team’s first meeting with Dr. Owusu was on October 27, 2021.
He was brutally honest about his work with Francisca, with whom he started the New Generation Medical Centre.
“Who is your matron?”
“At the moment, we don’t have a matron, we have three midwives who help in the deliveries.”
“Have you ever had a matron before?”
“Yes, we did, but she is no longer here. There were a few issues and I realised that probably she wasn’t qualified for the work she was doing so we asked her to stop coming.”
“But you employed her, knowing her qualifications?”
“This is a difficult thing for me. I have known her for quite a while. She was under my tutelage. But I realised that there were a few issues with the management of some of the patients. We’ve had some supervisorial sort of enquiries about some of the problems. After that, I realised that it will be in the best interest of everybody for her to do proper licensing. It will not be professionally good for her to be doing what she was doing.”
“She was the one supervising the delivery of babies?”
“There were midwives here. I always have midwives here. She was doing general administration because she was helping me with running the place and then of course she was also supervising the midwives. I was supervising it.”
“How does someone who has not trained as a midwife supervise midwives?”
“I have tried very much to be directly involved with whatever happens here. Most times when there are problems or complications, they call me and I try to see what I can do. If it is beyond what I can do, then we refer to a higher authority. I have been responsible for manning the place and making sure things go well.”
He denied ever promising to deliver Kate’s baby saying, “I don’t do the babies directly. Maybe it’s her interpretation of how things are done that when the time comes, I’ll deliver her.”
“I think I’m in trouble. Am I not in trouble? …And that is my life. That is my life, and if this thing gets out of hand, I’m gone. I’m gone. And if it happens, who knows, I may put a knife on my throat.”
But The Fourth Estate would return for the answers to the questions of what happened on another day.
On Bernice, who had her vagina allegedly restitched terribly and a pad left in her without her knowledge, Dr. Owusu expressed shock that Bernice had not been told that she needed to remove the pad.
“In a case like that, she is [supposed to be] told that we packed it just to prevent bleeding and once she is here, we supervise it. If she goes home, we tell her there is a pad there when you get home remove it.”
Bernice was never told. She had to live with a skunk-like scent and pains for a week.
“Was it not dangerous to keep her [Francisca Quaye] here to even deliver babies?” The Fourth Estate asked Dr. Owusu.
“I agree with you. It was probably a little bit of naivety on my part. That is the truth. We were not doing too badly. There was always a midwife with her. But the thing with her is she was a little boisterous when it comes things of that nature. Anytime there is a problem, I used to talk to her. It was supervision, I didn’t know there would be so many problems.”
“What we’ve gathered here is that she didn’t even give the midwives the chance to operate”
Probably feeling overwhelmed, he paused.
“Hmmmm!” He let out an exasperation, before launching into an explanation “I don’t know, but I cannot explain that. Partly, I’ll take the blame because she has been under my tutelage for quite a while. I always try to impress upon the midwives that ‘I’m around. If there is any problem call me.’”
On the two occasions that Dr. Owusu spoke with The Fourth Estate, he insisted that forced labour was not done only on women who had gone beyond their expected date of delivery or had a weak contraction.
In an ideal situation, pregnancy should last for 40 weeks. So, The Fourth Estate sought to know why there were repeated cases of inducing pregnant women, some of whom were asked to go home and come back without any special care as best practice requires.
Dr. Owusu said, “If you have to induce labour to the extent that labour has not started at all, that has to happen when the patient has crossed 40 weeks. Pregnancy for a baby is 40 weeks. Maximum 42 weeks, their period in the womb is finished and the placenta’s ability to maintain the health of the baby goes down. So, the baby has to come out. The induction is done on post-term [pregnancy]”.
The conversation revealed that Francisca allegedly abused labour inducement drugs.
“At what point will you insert a medication in a pregnant woman and ask her to go home and come back?”
“No no no. That one, I don’t think is something that is …”
“Francisca Quaye’s processes involved that. It became a norm for medications to be inserted into women to enhance delivery, as she puts it. Did the hospital sanction that?”
At this point, he stammers.
“No! No! I didn’t sanction that.”
Asked about inducing pregnant women during their first stage of labour, especially when they had not passed their expected date of delivery, he said it was wrong, a wrong that Francisca allegedly perpetuated on many women.
When The Fourth Estate met Dr. Owusu for the second time on February 11, 2022, he wanted to cut the conversation short as he accepted that Francisca was not qualified for the job.
But he maintained that at all times, there were midwives around.
However, his attention was drawn to an earlier promise he made to clarify some claims including those his former employee made about him.
He admitted that Esther Baker was induced with Cytotec, a medication for inducing labour, but could not tell if she needed it at the time she was given.
He said it was possible for the nurses that accompanied her after the referral not to know the details of the event that got Esther referred to the Ridge Hospital because “some of the people who accompanied her may not even be midwives. They could be nursing assistants.”
Asked if the protocols permitted nursing assistants to accompany a postpartum bleeding patient, he said, “It’s not a perfect scenario.”
“I think I’m in trouble. Am I not in trouble? …And that is my life. That is my life, and if this thing gets out of hand, I’m gone. I’m gone. And if it happens, who knows, I may put a knife on my throat.”
Kate’s Stillbirth: allegations and Responses
Kate complained that when her baby’s head emerged, the midwife left her to her fate because she was cooking.
Dr. Owusu was of the view that while he didn’t encourage interference in the labour process, the time between when the head popped out and delivery was crucial.
“Once the cervix is fully dilated to the time the baby finally comes out of the womb, there is a time limit. You’re looking at that particular time limit. It should not go beyond that time limit. Once it goes beyond that time, then you’re looking at possible complications that are not making the baby come out,” he said.
Again, he said once the baby’s head emerged, the right thing to do was to encourage the mother to push because the contractions help with the baby coming out and at the same time gently rotate the head for the anterior shoulder to come with it.
“It is not a difficult thing, of course, [but] you have to be experienced and you have to be trained,” he said.
But he was also quick to add that it would also depend on the weight of the baby and the size of the mother’s cervix.
He pointed out that episiotomy—the cut in the cervix to allow the baby to come out— would be needed if the baby is bigger than the cervix.
When The Fourth Estate asked if Francisca was qualified to use the knife to expand the cervix, he said, “Francisca was not qualified to deliver a baby. The only thing is that we’ve been together for quite a while and she has learned on the job under my tutelage.”
“She was doing quite okay. Even with the deliveries, it was not too long ago that she started because I wasn’t allowing her. We’ve always had midwives here. She is a little domineering. The midwives she was working with; she was pushing them around,” he said.
On Kate’s delivery, Dr. Owusu admitted that he wasn’t around, but he was called and informed that she delivered a stillbirth.
“Did the hospital officially communicate to her that her baby had died?
“That one, I’m not sure.”
“What is the protocol around that?”
“The protocol is that you have to tell the mother that the baby did not survive. But sometimes because of emotional things, if she wasn’t told I won’t be surprised. Because of the initial emotional attachment, you want things to calm down a bit before you break the news to her. After a while, if she hasn’t seen the baby or heard the baby cry and all that, they’re in a better position to appreciate what has happened.”
“Is it a normal practice to tell the mother of a [dead baby] that you sent the baby to a NICU in another hospital?
“No! No! If the baby has died, I wouldn’t think that is the right thing to do.”
“That is what was done here.”
“I don’t know about that, honestly.”
“In the case of Kate, do you think you followed the procedure from birth to announcing to the parents that your child is dead?
“I’m not sure, probably we did it. I just left things for the midwives. They carry on with … so I’m not really sure,” he said.
“But I talked with her husband. We had a long chat with the husband. He brought out certain issues. There was something about Francisca cooking and all that,” he said.
Seeking to deflect the allegation, he said it was possible she had not fully dilated at the time she claimed Francisca was cooking.
Dr. Owusu also said it was impossible for Kate to see the baby’s head while lying down and that it was also impossible for the nurses to be laughing while Kate was in pain.
“I’m not perfect. This facility is far from perfect but look at the psychology of somebody who has lost a baby. I don’t think you can believe everything she says. She is bitter. She has lost a baby…Before they are fully dilated, they’re not even on the chair in the theatre, they’re in the bed. Hardly would you find anybody delivering on the bed,” he explained.
“There is a possibility that during the course of her contraction and pain, some of the nurses may be giggling and doing their own thing. We’re human. It doesn’t mean nobody cared for her. I will not agree with that one. It’s just the circumstances [under which] she lost the baby.”
He also confirmed that he was angry when he saw the outcome of the re-stitching of Kate’s vagina done by Francisca.
“There’s a way we do the stitching. If you don’t do it well, it can give in. When I saw it, I said no, no, this is not the right thing. It wasn’t properly done. I had to put her on some medication so that the wound will heal much faster without much complication.”
Dr. Owusu was honest about his failure to tame his employee. But he has fears about the consequence.
“I think I’m in trouble. Am I not in trouble? …And that is my life. That is my life, and if this thing gets out of hand, I’m gone. I’m gone. And if it happens, who knows, I may put a knife on my throat”
Francisca Quaye’s next stop
On February 1, 2022, The Fourth Estate wrote to the Medical Director of the Adam Family Specialist Clinic, Dr. Nana Oduro Essuman, requesting an interview.
By February 3, 2022, The Fourth Estate met the Medical Director of the clinic, Dr Nana Oduro Essuman.
He admitted that the clinic employed Francisca Quaye as a midwife assistant. He described her as highly experienced but was quick to add that she wasn’t employed as a midwife because she lacked the qualifications.
Section 58(4) of the Health Profession Regulatory Bodies Act, 2013 (Part 3), requires that even nursing assistants must be trained by accredited institutions and licensed by the Nursing and Midwifery Council (N&MC). Where there is an exemption, it has to be granted by the board of the N&MC.
Francisca didn’t have that exemption.
However, halfway through the conversation on February 3, 2022, Dr. Essuman requested that he should be allowed to consult shareholders and lawyers of the clinic.
“After that you can even bring your cameras for a full interview.”
However, On February 11, 2022, he reached out to The Fourth Estate with a letter dated February 9, 2022.
The letter said, “We wish to state that there has not been in the employ of our facility any midwife named Francisca Quaye. To this end, we are not in a position to grant you an interview as requested.
It went on: “We are by this bringing to your attention that our facility has no association with any midwife by name Francisca and should not in any way be associated with any publication concerning and or/involving the said Francisca Quaye.” Dr. Essuman, the man who had told The Fourth Estate team that the woman worked there, signed the letter.
Further, the clinic threatened legal action should The Fourth Estate fail to adhere to the caveat.
Interestingly, Dr. Essuman said he would only grant The Fourth Estate an interview if the media house had a court order.
The Fourth Estate wrote to the Greater Accra Regional Health Directorate in March 2022, asking for the clinic’s five-year child and maternal mortality statistics.
Its revelation was astonishing and will be in part three of this story to be published on Thursday, May 25, 2023.