Oheneba Boachie-Adjei, MD, will soon fulfill a long-awaited dream. Having built a career as an expert in spine reconstruction and the treatment of scoliosis and kyphosis at the Hospital for Special Surgery (HSS) in New York City, Dr. Boachie-Adjei will leave the United States and return to his homeland of Ghana.
Once there, he will devote himself full-time to running the orthopaedic hospital built by his nonprofit organization, the Foundation of Orthopedics and Complex Spine (FOCOS), a group he established in 1998 to provide orthopaedic and spine care to underserved populations in Ghana and other countries. This work will be a continuation of the volunteerism that has marked the career of Dr. Boachie-Adjei, who received the AAOS Humanitarian Award in 2004.
Growing up in Ghana
As an 8-year-old in Ghana, Dr. Boachie-Adjei had a severe gastric illness that nearly claimed his life.
“In those days, there were very few doctors,” he said. “My family didn’t have a lot of money, so we could only afford to visit traditional healers.”
Treatments using herbs and other natural medicines did nothing to alleviate Dr. Boachie-Adjei’s extreme dehydration and other symptoms. He thought it was just a matter of time before he succumbed to the illness.
“Finally, my grandmother found a pediatrician who had just come back from training in the United Kingdom,” he said. “The doctor agreed to take care of me without charging.”
Dr. Boachie-Adjei’s recovery, thanks to the physician’s treatment, seemed like a miracle to the boy.
“That doctor became the first male figure of significance in my life,” said Dr. Boachie-Adjei. “I really admired him—he was like an idol.”
Coming to the United States
That early experience with western medicine fueled Dr. Boachie-Adjei’s desire to come to the United States and become a physician, with the ultimate goal of returning home to practice in Ghana. When he was 21 years old, with just $12 in his pocket, Dr. Boachie-Adjei arrived in New York, where he enrolled in Brooklyn College and found minimum-wage factory work. After graduating summa cum laude with a bachelor’s degree of science in 1976, Dr. Boachie-Adjei received his doctor of medicine degree from Columbia University’s College of Physicians and Surgeons.
“By 1980, I had achieved my goal of earning a medical degree—that was step one of my plan to return to Ghana to provide medical care,” said Dr. Boachie-Adjei. “Step two was to pursue a specialty practice and raise funds. I knew if I was going to go back and provide care to underserved patients, it would require a great deal of money, and Ghana’s government was in no position to provide it.”
While still deciding which surgical specialty to pursue, Dr. Boachie-Adjei completed a general surgery internship at the now-closed St. Vincent’s Hospital in Manhattan.
“I realized that orthopaedics was the best choice for me because of my interest in medicine as well as in engineering,” he said.
Dr. Boachie-Adjei soon obtained a position as an orthopedic pathology fellow at HSS.
“I was responsible for collecting specimens in the operating room; cleaning, sectioning, dissecting, and fixing them under the microscope; looking at them with the pathology attending physician; making the diagnosis; and putting the report in the patient’s chart,” he said. “I really became a pathologist, which was very good, because I learned the basics of orthopaedic diseases.” It was also during this year that Dr. Boachie-Adjei coauthored the Atlas of Spinal Diseases, a seminal medical text based on anatomic dissection of 100 full human spines obtained at autopsy.
After completing the fellowship, Dr. Boachie-Adjei completed an orthopaedic surgery residency at HSS, followed by a spine fellowship at the Twin Cities Scoliosis Center and the Minnesota Spine Center.
By 1989, Dr. Boachie-Adjei had started going back to Ghana once or twice a year to visit hospitals, give lectures, and begin plans for creating a nonprofit orthopaedic organization. He and his wife soon bought land in Ghana to build a residence for themselves and a guest house for orthopaedists and other volunteer healthcare personnel.
In 1995, Dr. Boachie-Adjei, who had become chief of the scoliosis service at HSS, continued to develop his plans for creating a nonprofit organization. He used $100,000 of his own money to found FOCOS 3 years later, with the goal of providing much-needed orthopaedic care to patients in Ghana and other developing nations and creating educational programs for local surgeons and caregivers.
“I wanted to build something permanent—a program that would enable me to bring volunteers as well as equipment, because there is so little medical equipment available in Ghana,” he explained. “Going there to treat patients is like going to dinner with your own utensils—the surgeon must bring all of his own equipment.”
For 8 years, whenever Dr. Boachie-Adjei and other volunteers traveled to Ghana and other countries to provide care, they stored their medical equipment in a truck they brought along and parked nearby. They would retrieve equipment from the truck to perform surgery and then store the truck in a warehouse until they needed it again.
“It was difficult to work out of other people’s offices, so we knew we needed our own facility,” said Dr. Boachie-Adjei. “So, we built an outpatient clinic where we could see patients, store medical records, and have a small staff to provide continuous care to the patients. The clinic made it feasible to provide a high level of care.”
Over the years, Dr. Boachie-Adjei led dozens of teams of orthopaedic surgeons and ancillary personnel to Ghana as well as other parts of Africa and Barbados.
“We have had about 500 volunteers stay at our guest house,” said Dr. Boachie-Adjei. “I’ve been going back at least 3 times a year for the last 16 years. And this year alone I’ve been there three times.”
FOCOS Orthopedic Hospital
This fall, Dr. Boachie-Adjei will, in his words, assume the roles of “president, CEO, surgeon-in-chief, medical director, and janitor” of the FOCOS Orthopedic Hospital in Accra, Ghana’s capital city. Built in 2012 and financed by $10 million in donations and a grant from the Ghanaian government, the hospital provides comprehensive orthopaedic services, including diagnostic imaging and laboratory, rehabilitation, pharmacy, outpatient consultation, and surgical care. Thus far, more than 1,500 corrective general orthopaedic spine and joint procedures have been performed on children and adults at the hospital, and more than 30,000 patients have visited the hospital for care.
Dr. Boachie-Adjei is undaunted by the many challenges he and his 175 staff members face in a country with 26 million people and only 20 orthopaedic surgeons.
“Healthcare personnel are inundated with trauma because of the insufficient road systems and other factors,” he said, noting that ambulance services and access to emergency medical care are inadequate.
Yet another challenge is that many patients who seek treatment at the FOCOS clinic in Ghana have end-stage orthopaedic diseases. Dr. Boachie-Adjei and his colleagues frequently see children with advanced cases of spinal deformities.
“Here in the United States, I will commonly see patients with 50- to 80-degree curves, but in Ghana, children come to us with as much as 180-degee curves,” he explained. “In West Africa, people just live with their conditions. They limp around with a bit of a deformity until they can’t breathe or can’t get out of bed or walk around anymore.
“Elective surgery is also lacking—and that’s where FOCOS is making a big difference. We are performing elective orthopaedic procedures, such as joint arthroplasty and spine surgery. Eventually we will get into other areas, such as sports medicine, upper extremity, foot and ankle, and pediatric orthopaedics.”
Besides the challenges of treating advanced and end-stage diseases, Dr. Boachie-Adjei and his staff members must also contend with unreliable or nonexistent utilities. Three generators provide back-up power to the hospital, and wells provide 3,000 gallons of purified water to the hospital each day.
“Equipment maintenance is a challenge, because Ghana has few technicians and engineers,” said Dr. Boachie-Adjei. “There may be only one engineer or representative from a given medical device company serving the entire country.
Yet another problem is that many patients can only pay a portion of their healthcare costs, while others cannot afford to pay at all.
“To date, we’ve spent $16 million, and it’s all come from fundraising,” said Dr. Boachie-Adjei. “Only about half of patients can make a contribution toward their care.”
Education is key
Despite the myriad obstacles, problems, and challenges involved, Dr. Boachie-Adjei remains steadfast in his goal of providing state-of-the-art orthopaedic and spine care in Africa, as well as training local healthcare personnel. To help accomplish the latter, FOCOS has sponsored AAOS International Scholarship programs for surgeons from West African countries since 2009, providing scholarships for surgeons from Ghana, Sierra Leone, and Nigeria.
“We will continue to support that because by working together, FOCOS and the AAOS can give young orthopaedic surgeons the opportunity to see how things are done differently in the United States,” said Dr. Boachie-Adjei.
Helping to train the next generation of orthopaedic surgeons is central to the FOCOS mission.
“Educating others is the main reason I’m going back to Ghana,” he said. “I could continue working in the United States for another 10 or 15 years, but I would like to spend those years in Ghana instead.”
Dreams for the future
Dr. Boachie-Adjei plans to return to the United States periodically to help with fundraising efforts and oversee the FOCOS office in New York City. He will not only retain admitting privileges at HSS to enable him to assist with special cases, but will also remain involved in HSS’ program to enable nurses, physical therapists, orthopaedic residents, fellows, and other physicians to travel to Ghana and provide volunteer medical services, as well as the reciprocal program whereby staff from the FOCOS Orthopedic Hospital travel to HSS for fellowships, observerships, and other educational programs.
“I have several dreams for the future,” said Dr. Boachie-Adjei. “One is to build a FOCOS institute to provide continuing medical education and training to surgeons from Ghana and other parts of Africa. I also want to partner with international institutions to get our surgeons access to ongoing eLearning programs. Another goal is to build additional facilities so that we can take care of more patients.”
“We want the FOCOS Orthopaedic Hospital to become the premier orthopaedic teaching hospital in sub-Saharan Africa,” he added.
Dr. Boachie-Adjei is hopeful that an endowment fund can be established to help FOCOS continue to grow and serve patients.
“Help has always come from somewhere to keep FOCOS going,” said Dr. Boachie-Adjei. “Where there’s a will, there’s a way.”
Jennie McKee is a senior science writer for AAOS Now. She can be reached at email@example.com
Learn more about FOCOS
To read more about Dr. Boachie-Adjei’s nonprofit organization and ways to help it achieve its goals, visit FOCOS online at http://www.orthofocos.org