Better Health For All

Unlike most visits to Ghana, this trip was particularly special and a “mission” rather than a reunion with friends and family. My yearning to make this a success had me constantly refreshing myself on the terms of reference and action plans for the trip, which, I guess, was the culmination of a partnership ‘journey’ that started in the latter part of 2018 involving various emails, teleconferences, text messages and phone calls!

My first day (and first time) at LEKMA hospital, started with some personal observations (and to have a moment to myself).  Afterwards, on the way to see the Medical Superintendent, Dr. Ameh, I saw one of the pharmacists that I recognised from one video conference call. I called him by his ‘English’ rather than Ghanaian name, thereby giving away who I was, but more reassuring was when he mentioned they were expecting me (as did Dr. Ameh when we met).  This bode well for the visiting team.  With initial introductions over, I went into planning times for the Global Point Prevalence Survey (GPPS) which took place over subsequent days with two Pharmacist colleagues.

Samantha arrived a few days later. The rest of the team arrived after Samantha, but the excitement made me go to the airport. Waiting like it was Christmas!  The next morning, we all met for the first time and were driven to LEKMA Hospital.

Our first day LEKMA was extremely pleasant with the usual warm Ghanaian hospitality.  The enthusiasm was apparent from the get-go.  We ran through the agenda for that day and duration of the visit followed by ward/departmental visits.

FPH Africa SIG Ghana Visiting Team (left to right)

• Mr Edwin Panford-Quainoo, Public Health Pharmacist, Liverpool School of Tropical Medicine
• Dr Rajesh Rajendran, Consultant Microbiologist, East Cheshire NHS Trust
• Dr Valérie Decraene, Consultant Epidemiologist, PHE Field Service
• Dr Sam Ghebrehewet, Head of Health Protection, Public Health England, North West (FPH Ghana Visiting Team and Partnership Project Lead)
• Dr Saran Shantikumar, Clinical Lecturer in Public Health, University of Warwick
• Ms Samantha Walker, Lead Nurse – Infection Prevention and Control, Countess of Chester Hospital NHS Foundation Trust
• Mrs Indu Das, Antimicrobial Specialist Pharmacist, East Cheshire NHS Trust

The second day had workshops on Antimicrobial Resistance (AMR), Antimicrobial Stewardship (AMS) and Infection Prevention and Control (IPC), with a fully engaged hospital team who gave frank and honest opinions about their hospital IPC practices and improvements needed. Workshop evaluation provided invaluable information that was consistent with observations.

On the Saturday, we visited the hospital to get a sense of the out-of-hours services [accident and emergency and out-patient departments (OPD)]. We used this opportunity to review OPD antibiotic prescriptions of the day (revealing interesting findings).  We visited three community pharmacies within walking distance of LEKMA Hospital who had been informed of the project and were fully engaged in completing a knowledge, attitude and practice survey.

We spent the Sunday recapping and reflecting on the previous days’ events in the idyllic setting of Sogakope. Even on our day off, the team could not help but be productive and were able to record a podcast, prepare a WHO grant application for implementing delayed/back-up prescribing at LEKMA Hospital and learn about Ghanaian music.

Monday was the advisory committee meeting, chaired by Prof. Afari. The morning of Tuesday 18th June, was feedback session with the LEKMA management and Ghana Public Health Association (GPHA).

In summary we were able to deliver:

1. Agreed and signed off a Memorandum of Understanding and ToR;
2. Established an AMS Advisory Committee;
3. Completed a Global Point Prevalence Survey;
4. Completed a healthcare workers Knowledge, Attitude and Practice survey;
5. Initiated IPC guidelines review based on the WHO infection prevention control and hand hygiene assessment tools;
6. Initiated discussion around prescribing guidelines (national) with the view of having simpler and more accessible local prescribing guidelines, i.e. within the context of the National AMR Plan and Prescribing Guidelines;
7. Initiated the discussion around laboratory data surveillance processes and regular production surveillance outputs, with a focus on drug-resistant organisms;
8. Agreed to implement delayed/back-up prescribing in the out-patient department of LEKMA Hospital.

We left Ghana with nothing but fond memories of a magnitude that we could not put into words and look forward to our next visit to Ghana.

Blog written by Edwin Panford-Quainoo, Liverpool School of Tropical Medicine