Monday, February 22, 2016

Kumasi, Ghana

By: R. Bruce Canham, MD

In August 2015, thanks to the support of the Washington University Department of Orthopedics, I traveled to Kumasi, Ghana in West Africa to work with the surgeons in the Directorate of Trauma and Orthopaedics at Komfo Anochie Teaching Hospital (KATH). I was especially fortunate to be accompanied by my brother, Colin, who is also a chief resident in orthopedic surgery in Rochester, New York.

Kumasi is a city of over 2 million people, approximately 120 miles north of the Atlantic coast. It is the second largest city in Ghana. KATH is the second largest hospital in Ghana. Originally built in the 1950's, it consists of 1000 beds, though most of these are situated in large open wards holding 20-80 patients as well as a new Accident and Emergency center (A&E) built in 2009. Given its location and size it is a major referral center for the entire northern region of Ghana.

Ghana is better off than many of the other nations in Africa, however it is still a developing country, and as a result it must struggle with providing healthcare for its citizens in the face of limited resources. It was in this setting that my brother and I found ourselves arriving in the middle of a doctors' strike. The doctors whose main source of income was from the government including those at KATH were striking with the goal of obtaining "conditions of service" which included things similar to workman's compensation, pension and reimbursement for work expenses. As an example, under the current situation if they contract a disease such as HIV or Tuberculosis while on the job they are on their own to pay for the costs of treatment and disability. The strike was very unpopular with many of the rest of the population as obtaining health care was very difficult. However the doctors' situation was also a difficult one as they did not have any alternative constructive avenues for advocating for themselves. It was certainly a thought provoking situation. While I couldn't fathom the notion of doctors in the United States going on strike, we are also much better reimbursed compared to our Ghanaian colleagues. In fact, it is not uncommon for the government not to pay the doctors for many months at a time.

The doctors were still working in a limited capacity, though were not taking new patients. Similarly we were able to be involved in the care of some patients that had come to the hospital prior to the strike, or that somehow got admitted despite the strike. We were however, grateful when the doctors voted to return to work at the end of our first week despite not receiving the conditions of service from the government.

Our second week at KATH was much different. Many patients returned to the hospital seeking care. The orthopaedics teams frequently see 50-60 patients daily in the OPD (outpatient department). Also there are many patients who arrive daily in the A&E. The orthopedic surgeons at KATH are swamped with trauma patients to care for, mostly from motorcycle and automobile accidents as well as pedestrians who are struck by moving vehicles. The volume of trauma is at times overwhelming, but the orthopaedic surgeons take it in stride. We saw and treated many open fractures while at KATH. Large open wounds are a significant problem.

While they have limited resources, I was impressed by the things that they are able to do there to care for their patients. The A&E is a new and relatively modern facility, similar to a level one trauma center in the United States, also with 4 operating theaters. The equipment that they have to work with in the OR's however is quite old, often making treating patients challenging. Problem solving and creativity are constantly required in order to treat the patients. The trauma and orthopaedics directive consists of 5 attending orthopaedic surgeons, 4 orthopaedics residents as well as other surgery residents and house officers. I worked most closely with Dr. Victor Ativor and Dr. Ralph Kumah, as well as with some of the residents such as Godwin and Robert, pictured with my brother Colin and myself. They do an incredible job caring for the people of Ghana. It was invaluable being able to work together with them, sharing some of my knowledge but also learning so much more from them as well.

My trip to Ghana gave me a new appreciation for how orthopaedics can be practiced with far less resources than we have in the United States while still striving to provide the best possible care for patients given the situation. The individuals that I encountered there are an inspiration to me to provide the best care that I can to my patients now and in the future. The Washington University Department of Orthopedic Surgery in St. Louis made this experience possible for me in so many ways, and I will always be grateful for this life-changing experience.

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