CLINICAL ROTATION IN GHANA Sterling Braun| Plastic Surgery Unit|

CLINICAL ROTATION IN GHANA Sterling Braun Plastic Surgery Unit Komfo Anokye Teaching Hospital Kumasi, Ashanti Region, Ghana

GHANA Population of 25.9 million Language: English, Asante Twi Tropical Climate First to gain Independence in Africa (6 March 1957) Formerly British Gold Coast

KUMASI 2nd most populous city in Ghana (2.1 million) Capital of the Ashanti Region Major producer of gold and cocoa Kumasi Central Market (Pictured below) Largest market in Africa with 45,000 shops

GHANAIAN HEALTHCARE SYSTEM Overseen by Ghana Health Service National Health Insurance Three Hospital Tiers: 110 District Hospitals First point of contact for patients Typically 50-100 beds Serves populations of 100,000-200,000 10 Regional Referral Hospitals (one per region) 4 Teaching Hospitals Komfo Anokye Teaching Hospital (Ashanti) Korle Bu Teaching Hospital (Greater Accra) Cape Coast Teaching Hospital (Central) Tamale (Northern) Source: Ghana Health Service (2009)

KOMFO ANOKYE TEACHING HOSPITAL (KATH) Originally built in 1954 1,200 beds (2nd largest in Ghana) Receives referrals from many regions in Ghana

SURGICAL ACCESS IN GHANA Lancet Global Surgery 2030 Recognizes economic and health impact of unmet surgical need Aims to increase surgical workforce 0.49 Surgeons per 100,000 population in Ghana 0.03 Plastic Surgeons per 100,000 population in Ghana (World Bank, 2017) 2.42 Plastic Surgeons per 100,000 in US (Bauder 2016) Meara, et al. (2015).

PLASTIC SURGERY AT KATH Five Plastic Surgeon Faculty Three Residents Scope of practice Acute and Chronic Burn Care Congenital Deformity/Malformation Hand Trauma Craniofacial trauma Wounds Cleft lip and palate, hand Pressure ulcers, infectious ulcers, Oncologic reconstruction Photo credit: John Evarts

PLASTIC SURGERY TEAM Three Plastic Surgery residents (Right) Three Plastic Surgery Faculty (Left) Visiting Surgeons and Hand Therapists (Right and Left) Two House Officers (Right) Photo credit: John Evarts

OPERATING THEATRE 8 operating theatres in the Accident & Emergency Building 2 beds per room Additional operating spaces in the OB-GYN and Main Theatre Buildings Photo credit: John Evarts

CONSULTANT ROOMS (CLINIC) Patients arrive to waiting room in the morning Physicians see patients in consultant room Rooms are often congested and patients may wait all day to be seen Photo credit: John Evarts

VISITING SURGEONS International support to strengthen plastic surgery training in Ghana Dr. LaLonde (Canada) taught “Wide Awake” hand surgery Dr. Kozin (US) taught pediatric congenital hand surgery Telecommunications maintain education after the visit Photo credit: John Evarts

PLASTIC SURGERY TRAINING IN GHANA Scarcity of Plastic Surgeons relative to surgical need Plastic Surgery Residency established at KATH to increase workforce Critics note indirect and lengthy nature of current model (below) Alternative models under consideration by West African College of Surgeons CURRENT PLASTIC SURGERY TRAINING MODEL Primary Education Age 18 Medical school House Officership Attend District Hospital General Surgery Residency 7 years 2 years 1-2 years 5 years 5 years of mostly coursework with 2 years of clinicals Four six-month rotations: Surgery, OBGYN, Pediatrics, and Medicine Serve as attending medical officer at a district hospital assigned by the GHS. Five year training in general surgery required before subspecializaion Age 25 Age 27 Age 28-29 Age 33-34 Plastic Surgery Residenc y 3 years Consulta nt Plastic Surgeon Age 36-37 Personal communication, Dr. Farhat, 2017

MY EXCELLENT HOSTS Host: Dr. Aidoo’s and his wonderful family! (pictured below) Housing: Doctor’s Flats Conveniently located within KATH compound

CULTURE

REFERENCES Bauder, A. R., Sarik, J. R., Butler, P. D., Noone, R. B., Fischer, J. P., Serletti, J. M., . & Fox, J. P. (2016). Geographic variation in access to plastic surgeons. Annals of plastic surgery, 76(2), 238-243. Ghana Health Service (2009) Ghana Health Services, Retrieved from: http://ghanahealthservice.org/ghs-subcategory.php?cid 2&scid 43 Interview with Dr. Boutros Farhat, personal communication, March 1, 2017 Meara, J. G., Leather, A. J., Hagander, L., Alkire, B. C., Alonso, N., Ameh, E. A., . & Mérisier, E. D. (2015). Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. The Lancet, 386(9993), 569-624. The World Bank (2017). Population of Ghana, total [data file]. Retrieved from: http://data.worldbank.org/indicator/SP.POP.TOTL?cid GPD 1