Utah doctors, nurses go global to teach, heal and learn

By Alyson Heyrend

For the Deseret News

Published: Thursday, Sept. 6 2012 4:09 p.m. MDT

Children sell food at a highway rest stop outside of Accra, Ghana

Alyson Heyrend

I recently traveled to Ghana with a group of pediatric doctors and nurses from the University of Utah Medical Center. I’d heard of the planned trip from my daughter, a pharmacy student who has done lab research for, among others, Dr. Krow Ampofo, a Ghanaian native and an infectious disease doctor at Primary Children’s Medical Center.

As did all members of the group, I paid my own way. Unlike the medical team, my motives were somewhat selfish. In the aftermath of an emotionally charged, often divisive debate over health care reform in this country, I wanted to go where some positive energy was being directed.

The group, which visited Ghana from May 3-13, consisted of 18 people, including 12 doctors/nurses, as well as two pharmacy students and other family members.

The experience was uplifting beyond my expectations. What I saw was an extraordinary collaboration between medical teaching professionals that has evolved through carefully nurtured relationships over 16 years. It is not a case of a richer country showing a poorer one how to treat patients. Rather, it’s medical colleagues sharing knowledge and skills, building capacity and learning from each other how to strengthen preventive care.

“Money and expertise do not justify someone’s presence in a Third World country,” says Dr. Stephen Alder, chief of the University of Utah's Division of Public Health. “Experience proves that ‘drop-in medicine’ is simply not sustainable.”

Alder has been travelling to Ghana for a dozen years, laying the groundwork for his division’s Global Health Initiative there and in other countries. It is one of the offshoots that grew from the U.’s first forays overseas.

Dr. Devon Hale, assistant dean of International Medical Education, is one of the first supporters. But he says the beginnings were a happy accident. In the 1990s, he was looking for an opportunity for medical students seeking international rotations. His colleagues at the U.’s ophthalmology department — Dr. Alan Crandall and Dr. Robert Hoffman — had been to Africa since the mid-1990s, performing cataract surgery and reversing blindness. To Hale, Ghana looked promising.

But it got off to a rough start.

“On our first trip, we took 89 boxes of supplies — and it was a disaster,” says Hale. “We quickly realized that we were more productive if our goal was centered on an exchange of education and teaching, not providing supplies, equipment or direct patient care.”

He and Dean David Bjorkman looked at U.S. schools working abroad for an existing model. They first partnered with Indiana University at the Moi Medical School in Kenya. Soon after, they started working at Komfo Anokye Teaching Hospital (KATH) in Kumasi, a city of 1.5 million people. It is Ghana’s second largest city, after the capital of Accra, and the modern capital of the country’s Ashanti region.

A medical student named Erin Hinrich was among the first group of 10 students who traveled to Kumasi in 2003. (She was making her third trip in May, as an anesthesiologist with this pediatric group.) On our trip, she was in high demand, assisting pediatric ophthalmologist Dr. Bob Hoffman and Ghanaian surgeons and nurses in the operating room as their pediatric anesthesiologist.

In a bare-bones operating room, minus the latest machines and gleaming fixtures of an American surgical suite, I watched as children had eye muscles repaired and vision restored under Hoffman’s steady, deft movements and Hinrich’s watchful eye, guiding and encouraging their African colleagues.

“For me, it’s not about coming for a short period of time, doing a lot of procedures and then leaving. The reward is in being part of something better that remains here as a result of education and training,” Hinrich says.

Hoffman — accompanied by his wife Carolyn and daughter Andrea — either screened patients or operated every day in Kumasi. He began visiting at least a decade ago. KATH’s current day administrator — Dr. Baffour Awuah — credits him and the other ophthalmologists from Utah with training Ghanaians not just to operate but to diagnose and treat disease before it causes blindness.

“The Utah doctors are helping me with training that fits the context of our local culture and conditions on the ground,” said Awuah. “For example, we must ask, can our patients afford it?”

Dr. Robert Bolte, a pediatric emergency doctor, and his colleagues from Primary Children’s Medical Center’s emergency room staff, ICU, orthopedics, gastroenterology, ophthalmology and infectious disease units, teamed with doctors from Kumasi at the 10th annual KATH Children’s Health Conference at the U. of U. Medical Center. Originally, only doctors attended. Now medical students and residents also participate. This year’s keynote speaker said “the number of pediatric subspecialties is growing and is benefiting the children of Ghana.”

Bacterial infections and malaria are the biggest causes of childhood deaths in Ghana. The country has high infant mortality in the range of 75 per 1,000.

According to the World Health Organization, malaria caused an estimated 700,000 deaths in 2010, mostly in African children. It is preventable and curable, if diagnosed and treated early.

Ampofo, who spoke at the conference on neonatal infections, said that as in the U.S., antimicrobial resistance is increasing in Ghana. He said the main source of infection is the mother as 10 percent of pregnant women have MRSA — a super germ that has developed resistance to most antibiotics.

Another conference presenter, Dr. Daniel Ansong, is a malaria specialist and one of the first doctors at KATH to welcome the U. of U. medical providers to Kumasi. Ansong said there are 800,000 deaths annually from complications due to malaria, but when treated, mortality drops to less than 20 percent.

In the early days of the Utah staff’s visits, Ansong and other KATH doctors — including hospital administrator Dr. Patrick Karikari and pediatrician Justice Sylverken, had only one request at the end of each visit: “Just please come back.”

But soon they identified more specific needs. Karikari — who in 2010 stepped down as KATH administrator to establish a dental program within the school — told me that “70 percent of the doctors trained in Ghana were leaving to practice in foreign countries.” (Hale says that figure now is probably more like 30 percent.)

“For years,” Karikari said, “this hospital had a single pathologist.” That doctor’s primary focus was running the morgue.

Pathology is the study and diagnosis of disease through the examination of organs, tissues and fluids. The vast majority of cancer diagnoses are made by pathologists. Analyzing blood samples from an annual checkup alerts a doctor to any changes in health early — when successful treatment is most likely.

“By 2004-2005, the turnaround time on lab results at KATH was so long as to be almost useless to the doctors,” Karikari said.

So a request was made to the U. of U. colleagues for help with establishing a training program for pathologists. An assist from Hale and a significant commitment by Dr. Tom Coppin, a retired pathologist, and his colleagues by way of the Pathologist Overseas group produced a rotation of temporary volunteers to KATH, while a university in Norway trained two Ghanaian pathologists (over four years). Today, there are five Ghanaian pathologists on the faculty, completing timely test findings that aid in diagnosis and treatment.

According to Karikari, the collaboration with the U. of U. medical providers has “opened a lot of boxes for us, including dentistry, public health and child health in the areas of ophthalmology, pediatric infectious disease, orthopedics and emergency treatment.”

A new eye center — built with support from USAID and The Church of Jesus Christ of Latter-day Saints — is scheduled to open at KATH perhaps as early as this year.

But the greatest health improvements may not arise in Kumasi or its teaching hospital. They may come from 15 miles away, in the subdistrict surrounding Barekuma.

The relationship that links the two locales involves Ansong. After he treated and saved the life of a severely ill infant suffering from a secondary infection due to malaria, the grateful chief made him an honorary village member. When Hale’s students arrived in Ghana in 2003 and 2004, Barekuma was a place that Ansong wanted them to visit.

For Ghana’s Ministry of Health, places like Barekuma are where the rubber meets the road. Facing daunting challenges to rapidly improve maternal and child health, the government is prioritizing efforts that produce the biggest return.

As Alder puts it, this is where visitors work “to unlock human capacity in order to make a lasting difference in people’s lives.”

The community approach involves economics, agriculture, education, sanitation and public health. By collecting data through annual child health assessments, health care providers chart progress.

Geographic information systems mapping makes it possible to plot the home of every family, comprising roughly 30,000 individuals. Researchers can overlay malaria cases to determine if kids living closer to a river get more malaria than elsewhere. They can even monitor and factor in the use of bed nets (used to block mosquitoes from biting) and gauge effectiveness. Annual child health checkups — just as in America — provide data on how immunizations, diet and access to clean water contribute to better health.

Providing community health care requires community health workers. The Barekuma project and others identified the need for a training program for medical assistants — akin to the physicians’ assistants now so widely used in American health care delivery. Again, the U. medical providers are assisting.

“Collaborations like this are transforming the landscape of how health care delivery is even thought of in Ghana,” says Alder. “If we let it, the rebound will transform how we do health care delivery in the U.S. as well.”

KATH administrator Awuah calls the Barekuma effort “a really big boost to our efforts. We want to spread this project as an effective way of preventing the diseases that are killing women and children in our country.”

How does he see the future?

“Brighter and brighter, as long as we here in Ghana follow what I believe is the most important rule: tell the truth about the way you see things.”

At the U. medical school, Hale is not resting on his laurels. Building on the lesson of “don’t tell us what you’ll do for us, let us tell you what we need,” he is already expanding relationships in Lima, Peru; Hainan, China; Bangkok, Thailand; and Baroda, India. Each year, there are more overseas opportunities for University of Utah medical students, residents, doctors and nurses.

As impressive as the global outcome may be in the future, it can’t mean any more to these Utah health care providers than just one incident I observed at KATH.

I was standing with Dr. Daniel Jackson, a gastroenterologist, and Mary Jo Grant, a pediatric ICU nurse, outside an old wing of the hospital. They were waiting for a doctor to meet them and take them to see a patient.

Jackson and Grant have perfected a way to provide nutrition to a very ill baby or young child without having to deliver it through an I.V., which can be difficult and dangerous to do in Third World facilities.

They thread a soft, slim tube through the patient’s nose, down into the stomach, through the pylorus valve directly into the intestine, allowing the delivery of liquid nutrients. The day before, they’d shown the ICU staff how to do it for a sick baby. Afterwards, Grant placed a small teddy bear, taken from her backpack of toys, next to the child’s head.

As we stood on the hospital walkway, a young Ghanaian couple approached. The man, smiling broadly, identified himself as the father. He thanked the doctor and nurse profusely. He had just been to see his much-improved baby. He promised to cherish and preserve the teddy bear so that when his child was older, he could tell him how “the kind white lady had come to his aid and helped make him well.”

It was low-cost medicine with a priceless outcome.

Alyson Heyrend is a Utah native, who studied music and journalism at Utah State University, interning at the Deseret News while in college. She has two grown daughters who are both studying medicine. She's worked since 2001 for Rep. Jim Matheson.

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