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Emergency Care Comes into Focus in Ghana

Dr. Eno Biney is an emergency medicine specialist at the Komfo Anokye Teaching Hospital in Kumasi, the second-largest city in Ghana. She’s part of a new cohort of health workers that are changing the way emergency care happens in the country.See Dr. Eno Biney on the cover of Impact magazine. This issue is all about health workers.“I chose to specialize in emergency medicine because I realized that it was one of the most lacking specialties in our country,” Eno says. “There wasn’t any form of organized emergency treatment of patients.” Instead, Ghanaians injured in accidents or suffering from medical, surgical, or obstetric emergencies were rushed to feebly equipped emergency care centers that didn’t have specially trained health workers or triaging systems in place. During her medical training, Eno saw the resulting delays in diagnosis and treatment—and lost lives.“The patients or their families would have to determine the kinds of medical needs they had,” she explains. “They would be tossed between the emergency ward and the surgery ward. We lost a lot of patients through that tossing around.”

There wasn’t any form of organized emergency treatment of patients.

Ghana has a serious shortage of health workers. According to an article in the African Journal of Emergency Medicine, in 2009 there was only one doctor for every 11,929 people. With such limited access, people would often wait until their medical needs had escalated to emergency levels before seeking care. Someone in Ghana with a life-threatening but salvageable injury was six times more likely to die than someone here in the US.  The political will to establish a formal emergency care system in Ghana took hold after a tragic accident in 2001, when the Accra Sports Stadium collapsed—126 people died and many more were injured. That’s when the government established the National Ambulance Service and built a national Accident and Emergency Center at Eno’s hospital, laying the groundwork to start a training program in emergency medicine.The Ghana Emergency Medical Collaborative Training ProgramLast year, Eno graduated from the Ghana College of Physicians and Surgeons as part of the country’s first class of emergency medicine specialists. The college partnered with Eno’s hospital, the Ministry of Health, the Kwame Nkrumah University of Science and Technology (KNUST), and the University of Michigan’s Department of Emergency Medicine to start the Ghana Emergency Medical Collaborative Training Program. It’s the first of its kind in West Africa.The program is funded by a five-year grant as part of the PEPFAR Medical Education Partnership Initiative (MEPI) and trains physicians, nurses, and medical students in acute medical illness management, handling emergencies in a systematic way, and research and leadership skills.The IntraHealth-led and USAID-funded CapacityPlus project is collaborating with MEPI-funded medical schools in 12 African countries to strengthen their capacity in eLearning, community-based education, and graduate tracking. One of these medical schools is KNUST in Ghana.Now Eno trains medical students in emergency medicine and organizes emergency care teams for national events. She also conducts research. Her recent article in the African Journal for Emergency Medicine showed that road traffic accidents account for a high percentage of the injuries she sees at her emergency care department and urged policy-makers to make road safety a priority.

The integrated approach to patient management is saving people’s lives.

So far, 11 emergency medicine specialists have graduated from the program. Eight are practicing alongside Eno at Komfo Anokye Teaching Hospital and two more are practicing in other regions in Ghana where they plan to start new emergency care departments.The Life She SavedA 56 year-old woman had arrived in Eno’s emergency ward the previous day. She was suffering from pulmonary edema caused by heart failure. She was struggling to breathe.An emergency nurse performed an ABCDE assessment—airway, breathing, circulation, disability, exposure—just as he’d been trained to do. He shared the results with Eno, who immediately intubated the woman and put her on a ventilator.“The integrated approach to patient management is saving people’s lives,” Eno says. “In the past, if you wanted to secure a patient’s airway you’d have to look for an anesthesiologist, or an anesthetist. Sometimes by the time you found them, the patient was already dead.”But thanks to Eno and her team’s specialized training, the woman survived.“She has been extubated, she’s doing better, she’s talking,” Eno says. “She has been sent to the medicine ward. So I’ll say that I saved one life.”The new emergency ward and program have brought more clients to the hospital and expanded the catchment area.But imagine the ripple effect the program will have. The goal is to train 100 residents, 100 nurses, and 900 undergraduate medical students during MEPI’s five-year period. The program will dramatically increase the number of health workers who can effectively treat emergencies—and decrease preventable deaths in Ghana.Meet over 60 more amazing health workers around the world in our “I’m a Health Worker” video series. 

Photos

Dr. Eno Biney is part of a new cohort of emergency specialists in Ghana. She posed for this portrait in the nurses’ station in the middle of her emergency ward at the Komfo Anokye Teaching Hospital. Her photo appears on the cover of the new issue of PSI’s Impact magazine, which is all about focusing on health workers to increase access to quality health care.

Dr. Eno Biney is part of a new cohort of emergency specialists in Ghana. She posed for this portrait in the nurses’ station in the middle of her emergency ward at the Komfo Anokye Teaching Hospital. Her photo appears on the cover of the new issue of PSI’s Impact magazine, which is all about focusing on health workers to increase access to quality health care.

Professor Peter Donkor is the principal investigator for the MEPI grant that funds the emergency training program. He’s also a surgeon and the coordinator for KNUST’s Grants and Research Office. Prof. Donkor recently shared information about the program with other schools that are part of the MEPI community. “One of the wonderful effects of our emergency medicine program is that, because of the awareness of our successes, Zambia has decided to also start an emergency medicine training program,” he says. Read the journal article he coauthored about emergency medicine in Ghana: http://www.afjem.org/article/S2211-419X(12)00122-X/pdf.

Professor Peter Donkor is the principal investigator for the MEPI grant that funds the emergency training program. He’s also a surgeon and the coordinator for KNUST’s Grants and Research Office. Prof. Donkor recently shared information about the program with other schools that are part of the MEPI community. “One of the wonderful effects of our emergency medicine program is that, because of the awareness of our successes, Zambia has decided to also start an emergency medicine training program,” he says. Read the journal article he coauthored about emergency medicine in Ghana: http://www.afjem.org/article/S2211-419X(12)00122-X/pdf.

Abeo Uthman Aszab Mohamed is the emergency nurse who helped Eno save the woman suffering from pulmonary edema.

Abeo Uthman Aszab Mohamed is the emergency nurse who helped Eno save the woman suffering from pulmonary edema.

Dr. Rockefeller Oteng (middle) is one of Eno’s mentors. He’s a clinical instructor in the program and an emergency physician on faculty at University of Michigan. “There were a lot of traumas and a lot of people were dying in the emergency departments,” he says. “I'm doing some research to see if we can quantify how things have changed. It's hard to say, because there are so many confounders to patient outcomes. We have seen an increase in the patient volume that we have here—the catchment area, the places that patients are coming from, has completely changed since we started.“ Read the journal article he coauthored about emergency medicine in Ghana: http://www.afjem.org/article/S2211-419X(12)00122-X/pdf.

Dr. Rockefeller Oteng (middle) is one of Eno’s mentors. He’s a clinical instructor in the program and an emergency physician on faculty at University of Michigan. “There were a lot of traumas and a lot of people were dying in the emergency departments,” he says. “I'm doing some research to see if we can quantify how things have changed. It's hard to say, because there are so many confounders to patient outcomes. We have seen an increase in the patient volume that we have here—the catchment area, the places that patients are coming from, has completely changed since we started.“ Read the journal article he coauthored about emergency medicine in Ghana: http://www.afjem.org/article/S2211-419X(12)00122-X/pdf.