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During his visit to the 37th Military Hospital, Robert P. Dunbar, MD, (front) toured the facility with Dr. Sunny Mante (far left) and Dr. Samuel Offei Awuku (far right). They were joined by the hospital’s CEO, staff from RehaMedical, and Ms. Juliana Cudjoe, local AAOS program coordinator.
Courtesy of Robert P. Dunbar, MD

AAOS Now

Published 2/1/2009
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Lynne Dowling

AAOS, OTA bring trauma education to Ghana

Program whets appetites of attendants “hungry for education”

During the past several years, AAOS has been developing a curriculum and planning for a major educational venture in the West Africa region. Although the Africa Cooperative Education (ACE) Program—originally targeted for launch in November 2008—did not achieve an appropriate level of initial outside funding, AAOS made the commitment to conduct an education program in the West Africa region before the end of 2008.

The Academy approached the Ghana College of Physicians and Surgeons (GCPS) requesting time for a trauma symposium in conjunction with the GCPS annual meeting in December 2008. The answer was a quick and resounding “yes.” The Orthopaedic Trauma Association (OTA), which had been involved in developing much of the syllabus materials for the original ACE Program, spearheaded the planned trauma program by identifying an OTA member to serve as program chairman.

That honor went to Robert P. Dunbar, MD, from Seattle. Joining Dr. Dunbar as faculty were Jaqueline J. Krumrey, MD, traumatologist from Washington state, and Oheneba Boachie-Adjei, MD, a spine surgeon from New York who is originally from Ghana.

No one left early
The full-day trauma program was held at the GCPS Headquarters building in Accra, Ghana. More than 100 physicians, nurses, and allied healthcare personnel attended. Physician members of the Ghanaian Local Organizing Committee were stunned and delighted to see that no program participants left the afternoon sessions early. Instead, participants stayed from 9 a.m. to 6 p.m., a rarity in West African medical seminars.

“It shows how deeply interested and hungry for education our local people are,” said Emmanuel K. Osei, MD, chief of Orthopaedics at Korle Bu Teaching Hospital in Accra, and an original project team member for the ACE Program. Drs. Dunbar and Krumrey both noted that the morning sessions—which focused on local physicians talking about the state of trauma care and the challenges to adequate care confronting them in West Africa—were of particular interest.

While in Accra, Dr. Dunbar visited the United Nations Classified Level IV care center 37th Military Hospital and Dr. Krumrey visited Korle Bu Teaching Hospital. They found that open fractures, particularly of the tibia and femur, are major trauma problems in Ghana. Until recently, more than half of these wounds developed infections. With the introduction of external fixation for treatment within the past few years, infection rates have dropped to about 10 percent.

“In general, acetabular fractures are too complex for the surgeons, and patients don’t have the income to afford the required plates and screws,” said Dr. Krumrey. As a result, traction is the primary mode of treatment. When discussing pelvic fractures with the only orthopaedic surgeon on staff at the 37th Military Hospital, Dr. Dunbar learned that the hospital, although it has a 60-bed orthopaedic ward, had no reconstruction plates.

Perfect scores from attendees
Upon their return from Ghana, the three U.S. faculty learned that 84 percent of the program participants responded to the postprogram assessment—and 100 percent rated the program of the highest quality, saying that they would definitely participate in another AAOS program. Participants agreed that the program met their learning objectives and educational needs, and asked for a minimum of two trauma programs per year.

AAOS and OTA look forward to on-going collaborations with the GCPS, the Ghana Orthopaedic Association, and others involved in the provision of health care throughout the West Africa region to develop and deliver much needed trauma education and care on a more regular basis.

Lynne Dowling is director of the AAOS international department. She can be reached at dowling@aaos.org

What happened to ACE?
The African Cooperative Education (ACE) program was designed as a multiyear, multimillion-dollar education program that would use a “train-the-trainers” approach to educate local surgeons and create a self-sustaining program to improve patient care throughout West Africa. The AAOS initiative was supported by several specialty society partners, including the Orthopaedic Trauma Association, the Pediatric Orthopaedic Society of North America, the Scoliosis Research Society, and the American Academy of Physical Medicine and Rehabilitation. The Ghana College of Physicians and Surgeons and the Ghana Orthopaedic Association were also active in planning the program.

Despite the endorsement of the World Health Organization, the Academy was unable to achieve the necessary degree of outside funding within the project’s timetable. By mutual agreement among the International Committee, the Council on Education, and the AAOS Board of Directors, the program’s launch was postponed. The program is currently being redesigned to be somewhat less ambitious in scope and considerably less costly.

The three U.S. faculty members who participated in the Ghana trauma program agree that a concerted effort to continue to try to bring quality basic trauma education to the region would provide a much needed service and improve overall patient care and trauma management.