Emergency Medicine Partners with Ghanaian Hospital for Training, Education

With a new international partnership, two University of Cincinnati emergency medicine physicians are working to improve the training and provision of emergency medical care in Ghana, and provide new opportunities for UC trainees at home.

Assistant professors of emergency medicine Jason McMullan, MD, and Dustin Calhoun, MD, spent a week in Ghana this spring learning about the emergency medicine and EMS systems and training in the West African country.

The trip arose from a link with the University of Michigan department of emergency medicine, which has worked with the Ghana College of Physicians and Surgeons since 2007 to train Ghanaian physicians in a new

residency program

.

The country sought to develop its emergency medicine specialty in 2001, after crowd violence and stampede in a football stadium killed 127 people and revealed gaps in its medical infrastructure.

To further develop the emergency medical services (EMS or prehospital services), Ghanian and University of Michigan program leaders reached out to UC.

Home to the first emergency medicine residency program, UC also houses an EMS fellowship program, among the first of such programs in the country to be

accredited

by the ACGME. McMullan directs the UC EMS fellowship program, which Calhoun completed in 2012.

With the support of department chair Art Pancioli, MD, McMullan and Calhoun traveled to the capital city of Accra and to the

Komfo Anokye Teaching Hospital

, or KATH, in the city of Kumasi in May.

While they were there, they saw firsthand how the National Ambulance Service (NAS) has developed and how the existing emergency medicine residency program at KATH operates—and what the country needs to fulfill the potential of delivering excellent emergency care to its citizens and visitors.

Built from the ground up over the past ten years by its director, Professor Ahmed Zakariah, MD and, more recently, his deputy Joseph Akamah, MD, who hosted McMullan and Calhoun during their visit, NAS uses about 140 ambulance to provide both the 911-equivalent emergency response system and inter-facility transports for ill and injured patients requiring higher levels of care. NAS currently uses emergency medical technicians (EMTs), but is looking to expand to a paramedic system.

"They have done remarkably well to get a functioning infrastructure there in such a short time,” says McMullan. "Now the question is, what do they do next—and how can we impart the hard lessons learned over time here to accelerate their growth in Ghana?  How can they learn from our mistakes?”

Those growth opportunities include training providers in advanced, paramedic-level care and optimizing the dispatch system—as well as more fundamental challenges, such as dealing with a country where street signs and addresses are not universal and where people aren’t accustomed to calling 193 (the Ghanaian 911) in event of an emergency.

"The big things that we take for granted are obstacles they need to overcome, but these obstacles represent great opportunities for exploration,” says McMullan.

He adds that there are exciting options: "For example, most people don’t have addresses, but they have cellphones. Could you use GPS technology to locate them? The challenges for us are to come up with creative solutions—not necessarily recreating what we know from the U.S., but simple, novel solutions that will work in Ghana.”

The ambulance service work will be paired with the development of an EMS fellowship program in Ghana, in order to train the future emergency medicine-trained physician leaders of the country’s EMS program. Both McMullan and Calhoun are focused on creating sustainable programs that can move on without them.

"It’s a fun role,” says Calhoun, "where, hopefully, we’ll be able to assist in the development of the EMS system itself and the transition to that service, but we’ll also be helping to develop a set of replacements for ourselves.”

He says they expect the first class of Ghanaian EMS fellows to start in early 2015, to train at both KATH and UC. For UC fellows, the partnership can offer international teaching and training experiences.

"What they are doing now to develop their medical system in Ghana is absolutely wonderful,” says McMullan. "They have a perfect vision of where they want to go—hopefully we can play some small part in helping them to achieve those goals.”