Egnatia FC’s Demrozi Stadium in the tiny Albanian town of Rrogozhine is a modest stadium, with just one side open for spectators.
It was here on Saturday, November 11 that Raphael Dwamena, the league’s most decorated player and top scorer with nine goals, collapsed and died during a match against FK Partizani.
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Twenty-four minutes in, a video shows the referee and players from both sides rushing to help and medical staff attending to Dwamena on the grass. An ambulance enters the pitch within a minute of him falling to the ground as distressed players look away with their heads in their hands.
Dwamena was taken to Kavaje hospital, 20 minutes’ drive away, with his wife of six years, Ama, but was pronounced dead before he got there.
His death, aged only 28, shocked the football community and tributes poured in from around the world. Yet it also throws up difficult and troubling questions.
Dwamena had repeatedly been warned by doctors and friends to stop playing football because of issues with his heart. He did not pass a medical at Brighton & Hove Albion in 2017 after a £10million (now $12.4m) fee had been agreed, had collapsed during a match in October 2021, while contracts at clubs across Europe were ended early because of his heart condition.
He had an implantable cardioverter-defibrillator (ICD; a small battery-powered device) fitted in his chest in January 2020, but then had it removed in early 2022.
Antonio Asso, the cardiologist who fitted Dwamena’s defibrillator, is convinced the player’s decision to remove the device resulted in his death.
He said: “Unfortunately, what happened last Saturday was easy to predict. Two years ago, he suffered ventricular fibrillation (a chaotic rhythm in the heart that equals death if an electric discharge is not applied to the chest in the first 10 minutes). Fortunately enough, as the defibrillator implanted was operative, it resuscitated him. He later asked for his device to be taken out and when that malignant arrhythmia recurred last Saturday, no defibrillator was in his chest.
“He has died as a consequence of a respectable personal decision, but if the defibrillator had not been removed, Raphael would still be alive. It is the end of a sad and foreseeable story.”
Dwamena, a deeply religious man, was determined to continue doing what he loved best. “God is the one who takes care of my heart,” he once said.
Egnatia’s general director, Klejdi Zenelaj, insisted the club had carried out proper medical checks on Dwamena and followed the Albanian Football Federation’s protocols, adding the club had done three medical checks on Dwamena since his arrival in December 2022.
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“In the end, he decided to play; it’s his life,” Zenelaj said. “He can decide so long as all the tests were done by the club… and everything was OK.”
This is the story of a talented footballer who could not face giving up the game he loved.
Dwamena grew up in Nkawkaw, in the south of Ghana. He had no contact with his parents during his childhood and was raised by his very religious grandmother, a headmistress at a local school. He finally met his parents for the first time at the age of 18. This left a lasting impression on him — in an interview, he once said: “You can’t really trust anyone.”
As a boy, he used to sell granita (shaved ice) and had to sneak out to play football as his grandmother disapproved of his favourite hobby and stopped him from going to trials as they clashed with school commitments. However, an uncle gifted him a pair of yellow Diadora football boots and he eventually joined up with the now defunct Red Bull academy in Ghana, where he was paid €100 (£87.50; $109) a month, before moving to Europe with Red Bull Salzburg aged 18.
Red Bull Salzburg said there were no health issues flagged during his time there from 2014-16. His first taste of senior football came when he was loaned to Salzburg’s feeder club, FC Liefering, where he played 27 matches. But it was at Austria Lustenau, in the country’s second tier, where his career really took off during the 2016-2017 season. Dwamena scored 30 goals in 38 matches.
“You could see straight away he was a special player with special ability,” his former team-mate Pius Grabher told The Athletic. “He was the best striker I ever played with. It was the start of a great career.”
Grabher said he heard the news of his friend’s death two hours before Lustenau’s home match on Saturday, where he still plays.
“It was a punch in the stomach,” he said. “He was one of the most impressive people. He had so much energy. When we played together we were top of the league, he was a great person and also a brilliant player.
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“The fans here loved him even though he only played one season, but that tells you everything about him and his character.”
Grabher said Dwamena had no issues with his heart during his time at Lustenau, but they later talked about it when he moved on from the club.
“He always talked about this issue,” he said. “Two years ago, he told me he wanted to get the defibrillator out of his heart because it was God’s plan. He took that out. It was against the doctor’s advice.
“He was really religious; it was his whole life. A normal person can’t understand this decision because there are so many bigger things than football. I always told him there is more to life than football.”
Dwamena joined FC Zurich in January 2017 in the Swiss Super League. It was here that his heart issues were first detected.
Ancillo Canepa, the club’s president, said: “Before we sign a new player, we always do medical checks. We detected some heart irregularities with Raphael. We discussed them with the player and with different medical specialists and cardiologists. After further medical tests, we were informed by these specialists that Raphael could continue his career as a professional football player.”
Zurich always had a mobile defibrillator by the pitch when Dwamena was playing, but he never had any heart problems in Switzerland and his impressive form helped him to break into the Ghana national side.
“He was not only an excellent striker but also an outstanding person,” added Canepa. “Raphael is a player and person that I will never forget.”
With his stock rising, Brighton turned to Dwamena as the player to score the goals to keep them in the Premier League after promotion from the Championship.
A £10million fee was agreed with Zurich and he signed a four-year contract, only for the deal to fall through when his heart problem was flagged during his medical. Brighton use MRI scans once a problem is highlighted by initial testing and then get a top specialist to review the results — a process that is far more in-depth than at many other clubs.
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Zurich said they were “very surprised” by the results and had carried out their own medical checks before the move. Canepa branded the English club “amateurish and unprofessional” and claimed Brighton had leaked the information to the media before informing him, which promoted anger at the Premier League side.
On Dwamena’s return to Zurich, he had further tests and then a heart-reading chip implanted in his chest.
Chris Hughton was Brighton’s manager at the time and is now in charge of Ghana’s national side. “Our very good recruitment team (at Brighton) identified that he was a quality player and they brought him to my attention,” he said.
“Having been at Brighton at that time, the first thoughts are ‘how can it happen in this day and age’? Now that I am the Black Stars coach, it resonates even more.
“It’s incredibly sad for everyone associated with the player. Being here in Ghana, surrounded by players and staff members that knew him, it’s very sad.”
In 2018, however, Dwamena finally arrived in one of the world’s top leagues — signing a four-year deal with Levante in La Liga. He came off the bench against Real Madrid and played a full match against Atletico Madrid but failed to score a league goal. He was loaned out to Real Zaragoza in the second division the next season.
After nine appearances for the club, they detected a heart problem during a routine medical check in October 2019. It showed Dwamena had a heart condition that caused an irregular and fast heart rate. He didn’t play for the club again.
Alberto Soro, a former team-mate at Zaragoza, recalled: “He was very powerful physically and also had a lot of quality. As a person, he was a very quiet guy, but he was always laughing. And on the pitch, too, he worked for the team.
“We knew about his health problems because it was at Zaragoza where they found the problem. I distinctly remember that at half-time of a match, he was unwell. He didn’t say anything, but they did tests and the next day they gave us the news that he would be sidelined for a while because he had a health problem with his heart.”
Dwamena had an ICD fitted in January 2020 by Asso, a cardiology specialist in Zaragoza.
“Mr Dwamena suffered from a heart condition in his heart muscle that made him prone to suffer very fast and risky ventricular arrhythmias (abnormal heartbeats), especially associated with exercising,” said Asso.
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“We indicated implanting a defibrillator as the first part of his treatment and, in case of recurrences later on, to consider an intervention called catheter ablation (passing tubes through blood vessels to the heart). He accepted only the defibrillator.
“It took pains to convince him to have the implant because he believed his condition was God’s desire. He moved to Denmark and we lost contact.”
With his defibrillator in, Dwamena returned to football in August 2020 with Vejle Boldklub in Denmark’s top league.
Players are allowed to play with a defibrillator in Denmark, but the rules vary in different countries. In Italy, for example, they do not allow footballers to play with a defibrillator. Christian Eriksen was stopped from playing for Inter Milan in Serie A after having an ICD fitted following his cardiac arrest at Euro 2020. However, he was then allowed to play for Brentford and Manchester United in England. In the Netherlands, Daley Blind continued playing with an ICD after being diagnosed with heart muscle inflammation.
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Jacob Kruger, Vejle’s sporting director at the time, travelled with Dwamena to a doctor in Switzerland to make sure he was allowed to play, and every week his heart was monitored by the club’s doctor. Players observed how Dwamena played with a Pulse watch, which checks your heart rate.
After one match, the club found his heart limit values were very high and the defibrillator was close to kicking in. They arranged a meeting with Dwamena and told him they wanted to avoid having a situation where he might collapse and decided to terminate his contract after just two months.
In the next match, against Randers FC, the team’s players wore shirts with his name on the back as a show of support and Vejle kept Dwamena on for seven months in a coaching capacity.
Morten Pelch, the club’s spokesperson, said: “He was a role model for our African players. He had experience and a good insight into football. He scored three goals in six matches when he played. You could see he had that X-Factor, he was a Premier League player.”
But rather than pursue a career in coaching, Dwamena was determined to play.
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In the summer of 2021, he signed for FC Blau Linz in Austria’s second tier. In a press release marking his signing, the club insisted stringent medical tests had been conducted but, just four months after joining, he collapsed on the pitch 20 minutes into an Austrian Cup match against TSV Hartberg. Dwamena was conscious the entire time and treated by a medical team on the pitch before being taken to hospital.
Speaking at the time, sports director Tino Wawra said: “It’s a grave situation and he’s aware of that. He’s realistic about the future. The medics said his life was never in acute danger because of the defibrillator. It corrected his heartbeat four times. He’ll have a few more check-ups and will then be allowed home either tonight or tomorrow morning. There’s no danger any more if he avoids strenuous exercise.”
His contract at the club was ended in December 2021. Then, against the advice of numerous doctors and friends, Dwamena had his ICD removed in Switzerland.
In an interview with Neue Zurcher Zeitung in October last year, Dwamena said: “I went to many doctors, they all say different things. But only the Lord can tell me when it’s time to stop. It’s God’s will if I die. People around me will be sad for a few hours or maybe for a few days, but they will get over it. I don’t live to please people. Only God. I believe that God is the one who takes care of my heart… I am never afraid.”
“I remember talking to him (Dwamena) with some of the Ghana boys,” said Didi Dramani, Ghana’s assistant coach. “He had a human touch, connecting with people. He was a very humble, cool-headed person. It’s very sad.
“We are very religious. If medically you are being supported by a gadget to help sustain your life, you can sign documents to ask for it to be taken out and then you can live and then accept your destiny.”
Despite pleas to quit football, he started training and playing with BSC Boys in the fifth tier of Swiss football in August 2022.
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One close former friend remembered begging Dwamena to stop playing. “I told him, ‘You are more important as a person than as a footballer’. But he wouldn’t listen.”
At BSC Boys, it was reported that Dwamena signed a risk waiver but there was no medical. He scored eight goals in 11 games before departing in December.
Club chair Christian Schmid said: “Raphael was a positive, cheerful young man and an excellent football player who made many friends with us in a short time. We knew about his problems and we also sent him to a doctor who warned him and us. We wanted to convince him to have a defibrillator inserted again, but unfortunately, he didn’t do that.”
In December 2022, Dwamena joined FC Egnatia in Albania, a club which played in the first qualifying round of the Europa Conference League this season.
In Albania, Dwamena lived in a hotel arranged by the club with Ama, then an apartment in Kavaje.
Given his medical history, why was Dwamena permitted to play for Egnatia?
The club insisted Dwamena had passed all the necessary medical checks. They said there was no need for him to sign a risk waiver as “doctors said he’d passed all the medical tests”.
Egnatia’s general director, Klejdi Zenelaj, told The Athletic: “He was very good, we had the perfect relationship. We are sad but life will continue. Everyone is shocked, the whole community is.
“He passed everything medically before he came to the club. He came here in January, now we are in November and we did three checks and everything was good.
“Everywhere he passed the tests. In Levante, Zaragoza, Denmark. But after that, he has the problems. He took out the defibrillator. We talked to him about it but he said it caused problems for him. He believed that was the problem.”
Zenelaj added the club would now be stronger with their testing.
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Dwamena’s agent in Albania said the player had “double, triple medical checks for everything” and could have passed a medical “everywhere in the world… because his heart doesn’t have problems to pass the medicals, this is the truth”.
He added: “I checked his medical history several times, even with doctors. He believed a lot in God. He was fighting against the medical things. This was his personal decision.
“He said many times, ‘If my destiny will be to die on the pitch, then it doesn’t matter. This is my life and I want to decide’. None of the doctors could force him to stop playing football.”
Both the club and agent claimed plans were in place for him to sign for another club in January, with offers from clubs in Eastern Europe, Dubai, Qatar and Saudi Arabia. The Albanian Football Federation did not respond to multiple requests for comment.
Dwamena’s body is now being flown back to Ghana. Ama returned to the country early on Wednesday morning via Turkey and Dwamena’s playing shirt is also going back to Ghana, where it will be gifted to his family.
His father, Amoako Sefa, told Peace FM in Ghana: “We’ve been crying since we heard the news, but we trust in the Lord to keep us strong.”
Zenelaj described Dwamena as “the inspiration for the entire team”.
“His team-mates are very sad,” he added. “It’s going to be a difficult job to pick them up, but we need to play for him.”
Additional contributors: Andy Naylor, Mario Cortegana, Sebastian Stafford-Bloor
(Top photos: Getty Images, Tom Burrows/The Athletic; design: Eamonn Dalton)