GECS in Ghana

November 2012

Five members of the GECS faculty (Dr Jean O’Sullivan, Dr Richard Lynch, Dr Ciara Martin and Dr Neil Reddy and Dr Gerard O’Connor) travelled to Accra, Ghana on Tuesday 30th October to participate in the African Conference on Emergency Medicine (AfCEM) held in the Ghanaian capital. A GECS workshop was run over 3 days at the conference. The curriculum included teaching a systematic approach to trauma care, Major incident training and a “Train the Trainer” skills module. Delegates and trainees in Emergency Medicine from Kenya, Uganda, Zimbabwe, USA, Botswana, Nigeria, Ghana and South Africa attended the GECS workshop.
It was a wonderful opportunity to share experiences of developing emergency medicine training with international colleagues. GECS made commitments to assist emergency medicine training in Botswana and Uganda going forward.

Three other members of the GECS faculty (Dr Shirley Potter, Dr Cian McDermott and Ms Eilis Fitzgerald) arrived in Accra, Ghana on Wednesday 1st November. Whilst in Accra the GECS team witnessed the remnants of the Cape Coast castle, the main slave-trading centre of West Africa for hundreds of years. It was a shocking reminder of human cruelty. It encouraged each of us to strive to enshrine in the GECS teaching curriculum a clear focus on maintaining dignity of patients and of advocating for the human rights of the patients we treat.
Following the conference we travelled inland to the Ghana’s second largest city, Kumasi, to begin the next stage of our GECS course.

Kumasi is the largest city in the Ashanti region of Ghana. Home to almost 2 million inhabitants, it is known in Ghana as “The Garden City” owing to its lush tropical rainforest climate. Kumasi is a royal city and has been the ceremonial seat of the Ashanti Empire since the 17th century. King Otumfuo Nana Osei Tutu II, the 16th monarch of the Ashanti people, resides in the Manhiya Palace in Kumasi. Kofi Annan, seventh Secretary-General of the the United Nations and 2001 Nobel Peace prize recipient also lists among the notable people from the Ashanti region of Ghana.

This article was published in the Emergency Physicians International in April, 2014.

Dr Cian McDermott

Dr Cian McDermott

Dr Cian McDermott – Consultant in Emergency Medicine

Komfo Anokye Teaching Hospital (KATH) in Kumasi

6356The Komfo Anokye Teaching Hospital (KATH) in Kumasi 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 to the medical school of Kwame Nkrumah University of Science and Technology. 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 centre 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 roughly 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. The in-house specialties include General Medicine, Surgery, Anaesthesia and Intensive Care Medicine, Obstetrics and Gynaecology, Dental, Eye, Ear, Nose and Throat (Ophthalmology and Otolaryngology), Diagnostic Radiology, Paediatric Medicine, Oncology and Pathology.

Emergency Medicine in Ghana

Dr Jean O'Sullivan&Dr George Odoru (KATH)

Emergency Medicine (EM) in Ghana, similar to Ireland, is a young and emerging speciality. Postgraduate training is growing and is at a very exciting junction. It is for this reason that GECS responded to an invitation to come to Kumasi and run a full GECS training programme.

Mortality and morbidity relates mostly to trauma and sepsis1,3. The main causes of death include HIV/ AIDS, respiratory infections, malaria, diarrheal disease, tuberculosis and road traffic accidents.

Dr George Odoru is the Director of Emergency Medicine training in KATH and head of the Accident and Emergency department. Having left Ghana in the 1980s, he specialised in emergency medicine in the United Kingdom. He returned to Ghana in 2011 on a full-time basis, to take up his current post and he also holds a staff position on the board of the University of Michigan Hospital, USA. Dr Odoru is responsible for 21 emergency medicine residents in training, thus representing the largest African EM residency training programme outside of South Africa. 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 November during the GECS visit. Dr Odoru delivered a keynote address at this conference regarding the current status and future of EM in Ghana. His plans for the future include increasing the number of senior EM faculty at KATH, with a view to sending EM specialists to co-ordinate care in rural hospitals throughout Ghana. He also aspires to collaborate with other West African countries and continue to train residents in Emergency Medicine.

GECS Workshop in Action

6488Thirty-five students had enrolled including doctors, nurses and medical students from Kumasi and further afield. The morning began with a set of adult and paediatric trauma skills stations that were designed to guide each student through a typical trauma scenario. Students were taught to approach trauma victims in a systematic approach, learning life savings skills in a hands- on approach. Team leadership and team management were also taught through simulation training.

Day One

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We were taken on a tour of the hospital at lunchtime in the hot sun. Local legend tells us that Komfo Anokye, a powerful local magician, is reputed to have buried a magical sword in the grounds of the hospital over 300 years ago. Reminiscent of King Arthur’s Excalibur, many men have tried and failed to remove this sword. Mohammed Ali visited the site in 1964 and even this mighty man failed to extract the sword from its resting place. During the 1970s when the hospital was under construction, heavy digging machinery was forced to this negotiate around the unmovable sword. It now occupies a place of pride in the hospital grounds and serves as a tourist attraction.

We were shown to the A&E resuscitation room where we saw a young lady who was knocked over by a truck over the previous weekend. Her case was remarkably similar to the trauma scenarios that we had just simulated with our students that morning. She had been immobilised for a cervical spine injury, a flail chest and disruption of her 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 at home in Ireland. Severe overcrowding and long waiting times are accepted as a routine occurrence with many patients with severe limb injuries boarding in the corridors making it impossible to assess any other patient due to exit block. However, these patients and their families had been most thankful of the excellent care they received from the overworked doctors and nurses in KATH A&E.

That afternoon, GECS Plastic Surgeon, Dr Shirley Potter delivered a lecture regarding the critical life-saving and holistic management of burns patients in a resource deficient system.

Day Two

14.51.26Day two opened with a series of lectures on the “ABCDEFGH” approach to sick adults, children and sepsis management delivered by Dr Jean O Sullivan, Dr Richard Lynch and Dr Cian McDermott. Students were then given the opportunity to apply these principles in a set of adult and paediatric simulation scenarios.

Ms Eilis Fitzgerald delivered a multidisciplinary workshop on the emergency management of complex wounds to a classroom of students from backgrounds as diverse as family medicine to doctors working the KATH polyclinic. Later that afternoon, we introduced our GECS Major Incident workshop to the students. We simulated a tro-tro (local bus) crash on the highway and asked each group of students to triage 25 seriously injured patients at the scene using a basic triage sieve tool. This exercise provoked much debate among the students as to who should receive priority treatment. It was a challenging experience also for the faculty as everyone voiced their individual opinions out loud! It gave us an insight into Ghanaian culture and attitudes as we watched this live debate unfold. The workshop also highlighted to us and the participants that the GECS principles of emergency care management can be applied across cultures and communities.

Day Three

6506On our final day, Dr Richard Lynch led with a workshop on advanced interpretation of ECGs based on his soon to be published ECG book. This section was particularly well received by all students and even the faculty members learned new concepts during this lecture. In the afternoon all faculty members joined to teach the principles of the GECS “Train the Trainer” module – this aspect of the course is specifically designed to make the GECS model sustainable in the future for the host hospital. It consists of a general discussion of personal learning styles, aspects of teaching and presentation skills followed by critiqued examples of a good and bad lecture delivered by the GECS faculty. This segment of the course is always popular among students and serves to highlight different approaches to group learning. Using this approach, students were divided into groups to practice a stepwise approach to teaching a skill station and delivering a lecture. We learned from our Ghanaian hosts how to make a mother’s papoose to carry a newborn baby and how to cook Oto, a yam-based local dish. Participants learned to apply the same simple principles to teaching complex medical skills as they would to teach activities of daily living such as these.

Following a discussion of these new skills, we closed the GECS course after a feedback session from participants with the presentation of course certificates to each participating student.

Disaster Strikes

On Wednesday November 7th 2012, disaster struck in downtown Accra, Ghana. The roof of a large shopping complex, Melcom, collapsed killing 18 people and injuring many more. The GECS team had taught many of the doctors and nurses involved in the care of the injured and dying at the AfCEM GECS workshop in Accra one week previously. We felt that our teaching workshop was timely and successful as our direct involvement was put into practice to help care for the victims of this tragedy.

Reflection

As I sat in the hotel lobby in Kumasi, early Wednesday morning in the middle of this lush countryside, watching CNN live 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 colours 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 controls 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.