Respiratory Therapy Development in Ghana

Kwami Ahlegbe, Dr. Audrey Forson, Michael Mensah, Lisa Trujillo

I am excited to share a few updates that involve the Weber State University Respiratory Therapy program and the development of the Respiratory Therapy profession in Ghana, W. Africa.  For the past 7 years, students from the WSU RT program have been going to Ghana to provide medical education, clinics in rural areas and community health education.  This has provided an amazing opportunity for our students to share their skills and expertise as well as to learn about healthcare in a developing nation.

This past March, 2012, with the assistance of Kwami Ahlegbe and Michael Mensah, Ghanaians living in the US that are also RRTs, we identified a pulmonary physician, Dr. Audrey Forson, as someone we encouraged to apply for the AARC International Fellowship.  During the March visit, meetings were held with key administrators at Korle Bu Teaching Hospital (KBTH), which is a 2000 bed teaching hospital in Accra, Ghana for the purpose of sharing information about the respiratory care profession.  We also met with the Dean of the School of Allied Health Sciences at the University of Ghana.

WSU team at Amoawi Clinic Out-Patient Department

In May/June 2012, a team of WSU students, faculty and local practitioners (left) traveled back to Ghana on a scheduled medical mission, some of which focused on meeting with Dr. Forson and delivering much needed respiratory supplies.

Ghana is a resource poor country and medical supplies and equipment are no exception.  We were able to deliver several single patient use items as well as devices such as the portable nebulizer (below) that will assist Dr. Forson in providing care to her many respiratory patients.  

During the May/June visit to KBTH, there were further discussions with Dr. Forson about her fellowship application and about respiratory therapy program development.  In August, Dr. Forson was contacted by the AARC and informed that she had received an International Fellowship.  This meant she would spend one week in Kansas with Karen Schell and one week in Utah with me as city hosts.

Our purpose in supporting Dr. Forson's application for the fellowship was to provide her the opportunity to observe respiratory therapy in the US. We had hoped the experience would give her an understanding of the scope of practice and how she could assist in implementing respiratory care in Ghana.  We needed a champion for the profession from Ghana before continuing to make steps in developing it.

Dr. Forson traveled to Kansas at the end of October and had a wonderful time with Karen visiting urban and rural hospitals while observing respiratory therapists at work.  Afterward, she traveled to Utah where she spent several days with RCPs in critical care settings throughout Northern Utah.  Dr. Forson also visited WSU and observed classroom lectures and simulation laboratory training.   

WSU Respiratory Therapy Dept

Dr. Forson observing NRP simulations

Pig lungs on HFOV

Utah Society for Respiratory Care

Dr. Paul Eberle, WSU RT Dept Chair

Medical donations collected for Ghana

Karen Schell, Audrey Forson, Lisa Trujillo, Janelle Gardiner

Following her visit to Kansas and Utah, we traveled with Dr. Forson to New Orleans for the AARC Conference where Dr. Forson had the opportunity to briefly address the House of Delegates and participate in other AARC and ICRC functions. 

By the end of her fellowship, Dr. Forson expressed her sincere interest in developing respiratory therapy in Ghana and committed her time and efforts to pursuing the necessary steps to move forward upon her return to Ghana.

Room full of donated supplies not being used

On November 21, Karen and I traveled to Ghana for a follow up visit with Dr. Forson and previously established contacts at KBTH and the University of Ghana.  These meetings went extremely well and we have outlined the next steps in developing an institutional collaborative agreement between WSU and the University of Ghana/KBTH.

RT supplies after being sorted and organized into bins

During our time there, we spent a great deal of time in the NICU.  I noticed there were several boxes of items we had donated in years past that were sitting in a room not being used.  They were not organized and it was clear that the staff had no idea what items they already had in their possession.

During a previous conversation with Dr. Nihad (pediatrician) in the NICU, she had requested supplies for NIV and we discussed the ease of setting up simple bubble CPAP.  We mentioned that these were items we could easily collect and bring with us during our next visit to Ghana.  While Karen and I were sorting and organizing items, we found nearly all supplies needed to set up bubble CPAP.

26-week baby on bubble CPAP at KBTH NICU

Resting comfortably with warm IV solution for heat

Within one hour, Dr. Nihad came to us with concerns for a new admit.  It was a 26-week neonate that was 2 hours old.  She was struggling to breath with a RR of >90 and marginal oxygen saturation on a simple oxygen mask.  She was also very cold (32 deg C) since the open warmers didn't work.

Karen and I were able to use some of the donated items we had located to set up bubble CPAP.  In the absence of an air flow meter (none available in the NICU or other departments we checked), I requested Dr. Forson bring us an air compressor that would generate the flow we needed.  The prongs were too big so we cut them off and placed the open holes against the baby's nose.  In order to help the baby warm up, we used hot water from the humidification chamber to heat IV bags.  Once heated, they were placed under the baby.  You can see we used lots of tape in order to make things fit, but ultimately it worked.  We even found a pressure manometer that allowed us to measure the pressure being delivered.

This was a great opportunity for KBTH staff to observe respiratory therapy at work.  The following morning we did the same for a 30-week c-sec with significant grunting, flaring and retracting.

Karen, Lisa, Dr. Nihad (Pediatrician), Michael

Our visit was a quick but very effective one.  We met with the Dean and the Provost from the School of Allied Health Sciences and the College of Health Science, respectively.  We also met with the Director of Medical Affairs and the CEO of KBTH, all of whom gave their support for developing the profession.  Additionally, we met with the Deputy Director of the Ministry of Health and received his support as well.  We are pleased with the progress and look forward to hosting a delegation from the university and the hospital early next year (2013) in order to provide them with the necessary understanding of respiratory care and the vision needed to gain additional support for program development.

Change in a developing nation requires significant time and follow-through.  Creating a new profession in a culture that is unaware of what respiratory therapists do is a difficult task, but one we are excited to embark on.  Thanks for allowing us to share our experiences.

If any of you are interested in joining one of our next missions to Ghana, which will include working at KBTH on program and profession development, please feel free to contact me in person.  We have two opportunities coming up in May and June 2013 and there are a few spots available for each trip.  (ltrujillo@weber.edu)

For those of you who are presently working on similar missions or RT program development in other countries, please take a moment to share what you are doing so we can all learn from your experiences. 

Happy Holidays!