Ways to Improve Our African Hospital

For eleven years I have worked in a four hundred bed Sub-Sahara hospital where needed improvements can only come about through outside funding. The developing country in which the hospital is located cannot afford the cost for these basic improvements. Three main problems are lack of water, lack of oxygen and the cost to the patients for treatment.

The hospital does not have a consistent water supply which causes the inability to sterilize instruments and wash gowns, thereby shutting down surgery. Lack of water prevents laundering of sheets and towels making it impossible to treat patients with diarrhea and prevents patients from bathing and using the toilets, all of which break and are rarely repaired.

Oxygen supply is irregular. After weekends, during which many accident cases occur, oxygen is never available. Surgical cases, even life threatening emergencies, are cancelled. I have bought my own tank of oxygen which I keep to use when needed.

Many times the hospital does not have medications or the patient does not have insurance and the patient’s family has to go to town to purchase the drugs. X-rays, ultrasounds, lab tests, Foley catheters and plates for fracture stabilization must be paid for prior to a procedure being done. Frequently family members contact their village for money which takes critical time and results in delay of care.

This emergency patient had a possible injury to his blood vessels. Because his family could afford to pay for a computer tomography x-ray which did not reveal any injury he was able to avoid surgery.

Muslim custom unfortunate liability with the use of motorcycles.

Having been here ten years in a referral hospital, many interesting cases come to us. Sadly, several are in the late stages of their diseases and only palliation can be provided. The patients are poor and they first try to obtain a cure from a local healer. Only when in their final stages do they come to the hospital.

 A malnourished child was brought in with his left cheek and jaw necrotic. After being fed he looked and acted stronger. However, he needs the dead cheek and jaw to be removed and his rehabilitation will be far from perfect.

The traditional Muslim custom of the woman wearing a long scarf can become an unfortunate liability with the use of motorcycles. We are seeing accidents in which the scarf gets caught in the wheel and results in strangulation. Such a case presented recently in a woman with a total transection of her trachea from her larynx. Only an emergency tracheostomy saved her life. Her trachea was sewn back to her larynx and now she has a fair air passage. However, both vocal cords are not moving and her nerves may have also been transected with her injury. We are hoping at least one vocal cord will recover.

Because there is minimal dental care, we continue to see many cases of deep neck abscesses from infected teeth.

The custom of drying out groundnuts and corn (maize) on the compound floor allows crawling infants to swallow such items and these young children present choking with food stuck in their trachea.

 We have used our donated facial reconstruction plates on several patients with multiple rib fractures and they did well.

Malnourished child with necrosis of left cheek and jaw.

New form of Transportation

Tamale Teaching Hospital Doctors traveling for Awards

Poor, recovered child whose care was paid for by her doctors

Reflections and Recommendations After Eleven Years as an Otolaryngologist in Northern Ghana

After eleven years of working in the Northern Region of Ghana, a poor and largely rural area, I ask myself if the experience has been worth it? For the patients whose lives were helped and saved, yes. For my family enduring long separations, each of those members would have to comment. Personally, I have gained immeasurably in appreciating a different culture, enjoying other countries on home visits and improving immensely my surgical skills and medical knowledge.

While strongly encouraging foreign healthcare workers to live and practice in northern Ghana, the following  recommendations may improve upon one’s goals. If worthwhile things are to be accomplished, come with strong financial and administrative support to allow you to remain on site for many years. My days are spent with clinical cases, administration and teaching - all of which require more time than exists.  I spend a good portion of my time  purchasing supplies, clearing items through customs and repairing equipment. This is not what these people need from a medical surgical specialist. Too often after surgery, the physician, himself,  has to supply the antibiotics needed to keep his patient alive and this requires funds. A developing country can truly benefit from a specialist who will come for several years with modern equipment and teach the in country physicians new techniques. Medical training in Ghana lacks the availability of such tools and often does not include the instruction of more current methodology. As a result, Ghanaian doctors continue to do surgical procedures which could be better performed if the proper instruments were available.

The value of short-term visiting teams is questionable. One group came to teach a week-long course on middle ear surgery which requires certain microscopes and drills. However, if the visiting team does not leave the equipment necessary to do what they are teaching, little is accomplished because those instruments are not available here. The visiting cleft lip and palate teams come to correct patients’ deformities, but they do not allow the Ghanaian physicians to do the procedures under their supervision. Surgeons do not learn how to do an operation by observing.

Neck trauma causing a collapsed lung and airway obstruction.
This patient's life was saved.

Mosquito net. The mosquito bites are the most annoyance.