Ghana: 2014 Field Report

Published on April 26, 2014
West Africa’s largest A&E has become a regional hub for emergency medicine education.

Trainees take part in a one week EM course in Kumasi, leaving them better prepared to respond to events like the tragic shopping mall collapse.

On November 7, 2012, a multi-story shopping complex collapsed in the capital of Ghana, turning the city’s Achimota neighborhood into a disaster zone. Tragically, 18 people were killed and many more injured. As horrifying as the event was, as I watched it unfold on the news I had to marvel at the timing. I was in Ghana with a team from Irish-based non-profit Global Emergency Care Skills (GECS) and we had just then completed a week-long training course in emergency medicine. I was heart-broken thinking of the lost lives, but encouraged knowing that the first-responders were a little more equipped than they’d been a few days prior.

Our course, which took place at Komfo Anokye Teaching Hospital (KATH) in Kumasi, showcased the exciting developments at what has become West Africa’s premier emergency medicine training facility. During our visit, our team was brought to the A&E resuscitation room where we saw a young lady who had been knocked over by a truck over the previous weekend. She had been immobilized for a cervical spine injury, a flail chest and disruption of the pelvic ring. She had already spent 24 hours in the A&E with her chest drain and pelvic binding in place while waiting for a bed to become available within the hospital. I noted certain similarities in the A&E of KATH and many emergency departments in my home in Ireland. Severe overcrowding and long waiting times are accepted as a routine occurrence. Many patients with serious limb injuries were boarding in the ED corridors making it impossible to assess any other patients due to exit block. However these patients and their families were most thankful for the excellent care they received from the overworked doctors and nurses at the KATH A&E.

KATH is one of three university teaching hospitals in Ghana. Today, it is a 1200-bed hospital facility, having begun life on this current site in 1952 as Kumasi General Hospital. It was renamed Komfo Anokye Hospital in honour of the 17th century powerful local magician and Ashanti priest Komfo Anokye, and his famous sword is still housed on the hospital premises. The hospital was granted teaching hospital status in 1975, when it was affiliated with the medical school of Kwame Nkrumah University of Science and Technology (KNUST). In 2009, the 200-bed Accident and Emergency Medicine Unit was built with the aid of government funding and opened in May of that year. The Accident and Emergency unit of KATH, located on the ground floor of the new hospital wing is the largest Accident and Emergency center in the West African region. It houses a 4-bed resuscitation room, major and minor cubicles, operating theatres, radiology rooms, a burns unit and an intensive care unit. There is a designated hospital helipad for emergency aeromedical transfers to and from KATH. The unit cares for between 50 to 95 new patients daily (35,000 per annum). The hospital admission rate from the Accident and Emergency unit approaches 80% partly due to the fact that minor injuries and illnesses are diverted to the KATH Polyclinic, an outpatient facility, also located on the grounds of the hospital. A full range of in-house specialists are available, from surgery to dental to oncology services.

Emergency Medicine (EM) in Ghana is a young, emerging specialty. Postgraduate training is growing and is at a very exciting junction. With ongoing collaboration and mentorship from healthcare organizations and specialists in emergency medicine from around the world, Ghana is poised to take a leadership role in the development of EM across Africa.

Mortality and morbidity relates mostly to trauma and sepsis. The main causes of death include HIV/AIDS, respiratory infections, malaria, diarrheal disease, tuberculosis and road traffic accidents. Barriers to effective healthcare provision are the same in Ghana as across the continent of Africa, namely, infectious diseases, rural-urban migration with consequent slum formation, natural and man-made disasters and the increase in frequency and severity of road traffic accidents. By the year 2020, it is forecast that vehicle ownership in Ghana will double. Treatment of the victims of road traffic accidents currently accounts for almost 3% of the national gross domestic product. Prehospital emergency medical care is in the early stages of development in Ghana and there is a need for standardization of service provision across the country.

Additional challenges relate to the geographic diversity and limited infrastructure within and between regions of Ghana making patient transportation to higher levels of care a continued challenge.

Dr George Oduro is the director of emergency medicine training in KATH and clinical head of the A&E department. Having left Ghana in the 1980s, he undertook specialist training in emergency medicine in the United Kingdom. He returned full time to Ghana in 2011 to take up his current post. He also holds an honorary staff position on the board of the University of Michigan Hospital in the United States. In 2009, the University of Michigan and KNUST joined forces to establish Ghana’s first emergency medicine post-graduate EM training program for physicians. Dr Oduro is responsible for 21 emergency medicine residents in training, which is the largest sub-Saharan EM residency training program outside of South Africa. The first six specialists graduated from this program in October 2012. The importance and influence of KATH on EM training in Africa was clearly visible by the number and quality of research posters from this unit at the inaugural African Conference on Emergency Medicine in Accra. In addition, the Ghanaian Society of Emergency Medicine (GEMS) was established in 2012.

Dr Oduro delivered a keynote address at this conference regarding the current status and future of EM in Ghana. He accurately described the challenges that face EM systems in Ghana today. These include financial and economic constraints combined with a lack of governmental support for EM. The physician to population ratio is 0.9 doctors per 10,000 compared with Ghana’s closest neighbor, Nigeria, which boasts a total of 4.0 per 10,000 population. On occasion also, there is a barrier to intellectual information exchange in the form of limited access to internet, textbooks and journals. There are common misconceptions regarding emergency care in Ghana. In particular, all physicians, by definition, are assumed to be qualified to practice emergency medicine. In general, specialists focus on diagnoses rather than emergency presentations, processes of care and treatments, a problem that has its roots in medical school training in Ghana. In the hospital in KATH, there is perceived to be an institutional reluctance to invest long-term in EM. Start-up and fixed investment costs are expensive. Inertia is prevalent especially regarding the attitude to ongoing ED overcrowding. There is a general resistance to the concept that EM care is important for the entire population and especially for time sensitive conditions.

Planning for the future of EM in Ghana is necessary to develop the specialty. Dr Oduro is keen to identify and address priority areas for training. It is necessary to train more specialist doctors in emergency medicine because they are ideally placed to carry out roles as leaders and educators and to form alliances with public health policy advocates. There are also plans to work closely with all levels of pre-hospital and hospital-based emergency care personnel and to institute community outreach training programs that will train future trainers to rapidly scale up capacity in emergency care practice.

Dr. Oduro is keen to accept established care protocols for common conditions but also to tailor these guidelines to suit local resources and disease burdens. Also it will be necessary to design EDs that are locally fit for purpose that will allow community participation.

On a broader scale, Oduro will continue to work with international partners such as the University of Michigan and Global Emergency Care Skills. But there is also a need for national EM coordination in Ghana with increased collaboration. The use of telemedicine has not yet been explored in Ghana and this is an exciting opportunity for EM to make maximum use of online training resources and widen networks of emergency care to remote and deprived areas. Technology transfer and EM-specific medical education and research are vital to the ongoing development of the specialty. These new technologies have the potential to improve the collection, management, analysis, interpretation and dissemination of emergency care data. This will serve to address data gaps in the system and to ensure evidence-based decision making in Ghana.

Reflections on our Journey to Ghana

As I sat in the hotel lobby in Kumasi, early Wednesday morning in the middle of this lush countryside, watching CNN and listening to US President Barack Obama’s re-election speech, I thought about our journey to Ghana. This country reminds me of an adrenaline-fuelled, intensified version of life at home in Ireland. The colors are deep and intense from the red earth to the bright clothes of Ghanaian people. Smells, sounds and sights confuse and excite the limbic system. Inhabitants are open and honest, ambitious for the future yet realistic about the present. The heat of the sun is ever-present and governs the pace of everyday life. Typical Ghanaian food is spicy and filling, never dull or predictable to the Western palate. It is the wonderful combination of all these senses that make up the complete experience that is Ghanaian life.

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