Orthopaedic residents make rounds at the National Accident and Emergency Center, affiliated with the Komfo Anokye Teaching Hospital in Kumasi, Ghana.


Published 10/1/2012
Richard C. Fisher, MD; Peter G. Trafton, MD

Orthopaedic Training in Ghana

Two years ago, Orthopaedics Overseas (OO), a division of Health Volunteers Overseas (HVO), launched a program for orthopaedic volunteers in Ghana at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana’s second largest city. A joint effort by HVO/OO and the AAOS led to an agreement with the Ghana College of Physicians and Surgeons for the establishment and development of Ghana’s second orthopaedic specialty training program.

Although Ghana’s population exceeds 25 million people, fewer than 20 orthopaedic surgeons provide care for the entire country, which is rapidly developing economically. Like most developing countries, Ghana is experiencing an epidemic of serious road traffic crashes, so the new orthopaedic training program, which began shortly after the opening of KATH’s modern National Accident and Emergency Center (NAEC), is indeed timely.

KATH’s new training program follows the British tradition of combining trauma and orthopaedics. In addition to HVO/OO and the AAOS, the Orthopaedic Trauma Association, the Pediatric Orthopaedic Society of North America, and the University of Utah Orthopaedic Department are active in this project. The Institute for Global Orthopaedics & Traumatology (IGOT), which is based at the University of California–San Francisco, oversees the research component. Several projects—including some nearing completion—are in process.

Educational resources
KATH is one of Ghana’s two major independent teaching hospitals; the other is located in Accra, Ghana’s capital city. KATH is affiliated with the Medical School of Kwame Nkrumah University of Science and Technology, located on a separate, suburban campus.

The NAEC, adjoining the 1,000-bed teaching hospital, is a busy, modern facility; 15 to 20 patients with significant orthopaedic injuries are treated each day. It includes a triage area, minor and major treatment facilities, a plaster room with C-arm fluoroscope, a resuscitation ward, three subacute wards (for men, women, and children), an intensive care unit, four operating rooms, and a helipad. It also includes office space, conference rooms, and classrooms.

The orthopaedic library, which is staffed by a research assistant, has three computers with Internet access. One computer contains numerous texts, reference articles, and teaching materials supplied by AAOS and IGOT, all of which serve as a core curriculum. The Journal of Bone and Joint Surgery is available in both online and print versions.

Although this listing sounds similar to the resources typically found in a North American or European trauma center, significant limitations remain. Instruments and implants are more like those used in North America several decades ago. The CT scanner is rarely used, due to the cost of operation. Radiographs are obtained sparingly and often printed in small-scale to conserve film. The blood bank cannot fill every request. Modern wound management techniques are rarely available. Operating schedules may be abbreviated because anesthesia or nursing personnel are lacking. The trauma/orthopaedics staff and trainees do their best to overcome these limitations and provide excellent care for their patients.

Teaching opportunities
KATH receives referrals from much of the country. Typically, about 200 adult and pediatric orthopaedic patients are seen on rounds. The heavy burden of trauma patients tends to overwhelm the staff and facilities and to interfere with the care and teaching of nontraumatic orthopaedics. The program’s goal, however, is to prepare well-rounded orthopaedic specialists who are competent to deliver and teach the full spectrum of orthopaedics and traumatology.

The program has made great strides in its first 2 years and offers excellent teaching opportunities. In addition to the seven faculty members in trauma/orthopaedics, seven residents, and 12 house officers, groups of 15 medical students serve 2-week rotations at KATH. The residents are either in orthopaedics or on several-month rotations from general surgery.

The trauma/orthopaedics department cares for all musculoskeletal problems except for those of the spine (covered by neurosurgery) and hand (covered by plastic surgery). A newly arrived orthopaedic hand surgeon, however, is expected to expand the department’s efforts in hand surgery.

The department is divided into three services. These teams—each led by an attending physician—rotate through the operating room, ward rounds, and outpatient clinic, depending on the day. The call schedule has a similar rotation. Volunteers accompany one of the teams during the course of their daily activities.

Each morning starts with a conference to review new admissions, with several in-depth presentations. Twice a week, this conference finishes with a didactic presentation by the residents or house officers. The HVO/OO volunteer typically contributes to the ongoing curriculum.

The center has a dynamic energy, with a growing and enthusiastic department and training program. The University of Michigan is running an emergency medicine residency program alongside the orthopaedic training program. Potential projects being developed include pediatric orthopaedics, joint replacement, arthroscopy and sports medicine, prosthetics, and emergency trauma training for the district hospitals in the KATH referral area.

Consider Volunteering
Kumasi, with 1.7 million inhabitants, is the capital of Ghana’s historic Ashanti Region, as well as the home of the reigning Ashanti King. Approximately 100 miles from Ghana’s southern coast, it is a culturally rich tropical city. Ghana’s official language is English, which is widely spoken and is used for teaching and medical discussions. Although some patients may speak English, others use one of the many local languages.

OO volunteers must be board-certified or board-eligible and are expected to teach and to participate in live surgeries throughout their 2- to 4-week assignments. KATH has a guesthouse for volunteers in a walled compound about a 10-minute drive away. Transportation to and from the hospital is provided.

Orthopaedic surgeon volunteers need to be aware of the constraints of healthcare systems, in the developing world and in Ghana. Collaborating with colleagues, helps maximize the current quality of care and improves future care.

This is an excellent opportunity for AAOS members to share their skills and knowledge and to participate in furthering the orthopaedic profession in Ghana. More information on volunteering for this program can be found at www.hvousa.org

Richard C. Fisher, MD, has been an OO volunteer for more than 30 years; Peter G. Trafton, MD, is the OO program director for West African residency training.