Marj Ratel in Ghana – Blog Post 3

The final day of the conference was well received by an energized audience of doctors and nurses. The moderator was Dr. Vincent Hewitt, Head of the Radiology Dept. Beginning with an expert presentation on neuro-imaging and its impact on clinical care by Dr. Jocelyne Lapointe, Dr. Chris Honey followed with a riveting talk on functional neurosurgery and its impact on individuals suffering from essential tremors, Multiple Sclerosis, Parkinson, and other debilitating conditions. Dawn MacDonald discussed Palliative Care as a positive term, with quality of life the optimal outcome. Danny Moe resumed his Heart Power presentation, talking about greatness requiring us to “water the camels” – concluding the first day’s session.

In the afternoon, I discussed the management of behaviourally challenged neuro patients and Lisa presented the neuroscience research graduate program developments. Lisa also conducted an energized reflection session, where the participants got into groups of eight and discussed three questions. 1. What are the most critical health care issues in Ghana and West Africa at the moment? 2. What are the two most valuable concepts provided over the past two days? 3. What are the topics desired for next year?

A review of the answers by each group was quite revealing. Emergency transport needs were raised by almost every group as a top priority in West Africa. Deficiencies in resources including working equipment, education and training were also identified. One group raised the priority need for change of “attitude” among the health care team.

The second question revealed that the components of Heart Power took the prize! Each group singled out various concepts within Heart Power, including Solomon’s cap, going the extra mile, watering your “camels,” romancing every situation, giving out blessings to one another and to patients. They also appreciated Chris Honey’s discussion on Brain is Time (accepting the primary injury is complete however the secondary injury can be prevented with swift intervention), and Right Patient / Right Procedure / Right Time to improve quality of living. Discussion of the immediacy of intervention to preserve brain and choosing the right patient at the right time for the right reasons were valuable.

The topics desired included spinal cord care, management of spina bifida, emergency nursing, etc. Textbooks were gifted to four groups in attendance – ECG Manual to Dr. Rene Wulff, Neuro-anesthesiologist for the KBTH Recovery / ICU nurses; ACLS Manual to the Critical Care Nurses Association of Ghana; Critical Care Nursing textbook to the University of Benin Teaching Hospital neurosurgery nurses; and The Anatomy and Physiology Diagram textbook to a physician’s assistance school in Tema. We extend appreciation to Bruce Forrest for his generosity in providing the nursing textbooks. These resources will be used.

Danny wrapped up the conference, speaking on Heart Power’s – Dream maker’s help others fulfill THEIR dreams and by helping others, they fulfill their own dreams! Nii Otu Nartey, KBTH CEO Administrator and Mrs. Victoria Quaye, Director of Nursing joined the afternoon team as we wrapped up a very inspiring and successful conference. Prof Nartey shared that he is very excited by the wonderful response and wants to continue to build these neuroscience conferences at KBTH inviting the staff of all the hospitals around Ghana.

Evaluations have been submitted by each correspondent. We’re awaiting the formal results. Certificates were handed out for both days’ attendance. We brought 200 and we ran out at the end, having to combine two days onto one certificate. So over the two days, we enjoyed 100+ in attendance both days!! What a blessing.

I had a wonderful meeting with the KBTH Director of Nursing as the conference closed, discussing how my teaching in how to approach challenging situations hit a big chord with the attendees and this needs to be expanded and presented to the nursing administrators and staff throughout the hospital. As well, the chart documentation system is eagerly anticipated and we’ll be moving ahead on this Monday, using neurosurgery as a pilot unit.

The CME Conference continued in full force through Friday afternoon. KBNF team members including the nurses attended a luncheon on the Friday and we were eagerly received by the facilitator, Dr. Elijah Paintsil, Yale University. Our contributions in the neuroscience field were very much appreciated and Chris Honey received many calls to return to teach additional sessions. So you can imagine, we’re encouraging Chris to join us in future conferences. He’s very open. Paul King is also eager to continue to expand his role in Ghana and is pursuing various avenues to raise funds and meet critical needs. He was busy reviewing urgent pediatric cases that need neurosurgical intervention and determining if they could be managed at Korle-Bu or if they required transport to his Atlanta hospital in the U.S. for advanced care.

Jocelyne worked on education and training as well as radiology department assessment preparations during the day, as she prepares for next week’s programs.

Lisa met with Dr. Adjei, Deputy Provost, CHS, UG and they had a very rewarding discussion on research developments and student exchange program development. Lisa and Fred Addai, Chair of Anatomy, worked on the next steps for the research program and managed to connect with the collaborators. Regular international monthly meetings will now commence. The initial research into chart documentation development questionnaire has been prepared by Lisa and we will begin to implement this in the next few days.

I met with Head Sister Charity, KBTH Neurosurgery Unit, and she has conducted meetings with her staff determining what they would like to hear from me in the next couple of weeks. The priority for Monday and Tuesday will be Glasgow Coma Scale reviews and practice sessions. I met briefly with George Wepeba and Patrick Banka, KBTH neurosurgeons. They were delighted to hear of the automated doctors orders that I am preparing for their review, revisions and acceptance.

Chris and his son Michael toured the neurosurgery unit and the operating and recovery rooms, escorted by Thomas Dakurah, Head of the Neurosurgery Dept. Chris was so pleased to visit the various areas.

Our team headed to the Fair and Marketplace to purchase gifts for family at home. Bartering was vastly conducted by Justina, our Nigerian neuro nurse. Dr. Honey watched Justina’s skills in amazement, as she bartered for each item. Most of the team purchased beautiful quality cloth so their families could make outfits or in Chris’s case, a tablecloth, at home.

Our day concluded with a relaxing dinner and reflection over the past week’s visit and activities. It was spirited, encouraging and rewarding, as we heard of the wonderful impact of the teaching conferences and the quality time together as a neuroscience family. Chris mentioned that the twice daily visits on the bus, sometimes taking two hours, was a wonderful time of getting to know each other. We challenged each other in neurosurgery management issues and dug deeper and deeper into the challenges of decision-making and confidence to make right choices. We discussed issues of life and death, the challenges of patients with a GCS of three and ventilated for weeks and months with no appearance of improvement and yet other patients are denied ventilator support because there are no other mechanical resources available. We discussed reducing length of patient stay, thereby freeing up beds for the eight patients in emergency or clinic urgently awaiting a bed in neurosurgery.

Our practice in Canada of preoperative patients arriving the day of surgery does not appear to be an option at this time with the Nigerian team. Why? Because patients would not likely be able to fulfill the preop instructions independent of the nurses. As for discharge, they would like to try to achieve reducing their postop stay. Mobilizing day one postop is being practiced now, where it is feasible. Having a subacute unit for patients that need supervision, but are almost ready for discharge was another concept that may work.

Our KBNF family continues to grow and deepen. We are indeed blessed.

Marj Ratel in Ghana – Blog Post 2

Sunday was a wonderful day!  Attending Rev. Prof. Seth Ayettey’s Shiashie Presbyterian church in the morning, I listened to sermons in Ga, Twi and English.  The congregation was most welcoming and Danny Moe gave an encouraging introductory message on Heart Power and Dare to Dream-Dare to Do. It was very well received. Our Nigerian team arrived at the service and we all celebrated two Ayettey birthdays that afternoon. We toured the Shiashie School and visited the well project at the back of the property. Presently, the water is not consumable; so as funding is available, preparations are underway to develop a filtering system. They appreciate the financial commitment of members of our KBNF family towards this project.

The rest of our KBNF mission members arrived over the weekend, with Lisa Cain coming in last on Monday afternoon. The youngest member of our team is four . . . Caleb Udoh! He’s a very bright and lively little Nigerian boy and keeps his parents hopping.

Jocelyne Lapointe and Paul King, along with Chris Honey and his son, headed over to the CME conference first thing Monday morning, presenting neuroscience talks to approximately 240 attendees from across West Africa, including our Nigerian team doctors. Jocelyne and Paul have been working for months as members of the CME planning team, arranging the neuroscience speakers, so this was an exciting day for them.

Our Nigerian neurosurgery team, led by Prof. David Udoh, is so very inspiring and full of love and passion for the advancement of neurosurgery care for their people. Monday morning, the nurses and I headed over to Korle-Bu Teaching Hospital, to work on chart documentation upgrades for West African hospitals. We were joined by critical care nurses and educators. A review of critical care pathway development, automated doctors’ orders and various protocol and assessment sheets was positive and we are now working on the draft documents that will be trialed. The purpose of these revised documents is: 1. Time saver 2. Reduces errors 3. Accountability. David Udoh is prepared to begin using automated doctors’ orders “within 1 week,” so I need to work swiftly to ensure I have the first installment ready for his return home on Friday. I understand that Military 37 are willing to participate in a trial run, so that is exciting as well. My dream is to contemporize the documentation system so that West Africa is on the cutting edge of development.

Tuesday saw a day of multitasking, while the doctors headed to the CME Conference, with the focus primarily on neuroscience while the nurses headed to Korle-Bu to attend Danny’s Dare to Dream-Dare to Do Academy in the KBTH Boardroom. 7 Ghanaian and Nigerian nurses expressed they would never be the same after the very inspiring day, with all of them identifying many of their life dreams and how they would achieve them. They also learned that impossible dreams = God dreams, and we are dream carriers in these dreams. The outcome is well beyond anything that we could imagine and the details for realizing these dreams is out of our control . . . so much excitement was generated by the day.

Lisa and I met with Prof. Fred Addai, Chair of Anatomy, University of Ghana, for the morning as plans for the launching of the neuroscience research graduate program were confirmed. Lisa will share on the developments in a blog post. It was so exciting to feel the enthusiasm generated by our efforts. Fred shared that this is so very timely and now that he has two new anatomy professors along with two more young professors returning in a year, there is the expectation that this can be the beginning of a very productive research program. The key areas that are being pursued concomitantly include spinal, cerebral malaria (vast majority of deaths in children), and stroke research. We believe that these three areas alone will inspire much collaboration and interest around the world.

Fred, Lisa and I met with Provost Aaron Lawson and reviewed the plans for the establishment of the neuroscience research program. Many details were discussed and a press release was forwarded by the Provost after our visit. We also discussed the upcoming construction of the CHS hospital in East Legon, University of Ghana campus. These are exciting times, as Parliament has now approved the loan for this project. Rev. Prof. Seth Ayettey is Chair of the project and is also fully engaged in preparations for the upcoming construction, expected in September.

To close out a full day, the nurses worked with Lisa Cain and me on documentation, identifying that we need two pilot projects in order to effectively transition these documents throughout the region. UBTH’s neurosurgery team is very committed to this project. A Ghanaian unit will also be seconded for a trial run. Lisa Cain, Research Chair, is preparing a research study for the project that will determine the effectiveness of these new documents and their value to nurses and doctors.

In the evening, our team met for dinner and games were enjoyed during the meal. Asking medical questions for gifts was much more successful than asking geography questions about Canada! Education about the capital of Canada ensued, as well as several other lessons. Lots of fun! Afterwards, five remained in the dining room to watch The King’s Speech, my favourite movie, on my laptop.

Wednesday again was a full and exciting day for the team, as we held the first KBTH-KBNF Neuroscience two-day Conference at KBTH. Seth Ayettey and Afua Hesse opened the conference with me. As Chairman, Seth gave greetings on behalf of the KBTH Board and the President that appointed them, and opened the conference in prayer. 100 attendees from various regions of Ghana, as well as Nigeria, are in attendance through to tomorrow. Dr. Thomas Dakurah ably moderated the 1^st session. Chris Honey gave a riveting power point on head injury management – maximizing outcomes, identifying that while primary head injury is not in our power to prevent, secondary head injury is. Paul followed with a beautiful power point presentation on stroke management and intracerebral hematomas. The audience avidly questioned the speakers on their presentations and related material, challenging them with questions including how to handle neurosurgical crises when essential equipment such as a CT Scanner or a ventilator are not available. Chris’s response was that there is usually something that can be tried based on the history and exam alone – including lateralizing signs, without a CT scan, to definitively identify the source of deterioration. He said you do your best with what you have and sleep well at night. The first session was rounded off by Danny Moe, commencing his lively and motivational Heart Power Academy seminar. He is delivering the seminar in four phases over the two-day conference. Many expressed a desire to hear his complete seminars. On Saturday, there is a full Academy Day at the hospital for anyone who would like to attend. The sign-up sheet was filling up fast, last time I looked.

In the afternoon, we split into two groups, with Lisa and me teaching the nurses and Paul and Chris teaching the physicians. Cranial nerves and raised intracranial pressure were expertly covered by Lisa, whose background is in neuro-anatomy; while a neuro nurse and I reviewed neurovital sign assessment, followed by behavioural challenges in the neuro patient and coping mechanisms for the nurses. There was much laughter in the midst of learning. Michael Honey spent hours writing up all the attendees’ names on conference certificates, taking such care and attention to get the names spelled right. Jocelyne taught neuroradiology at the CME conference, while Paul and Chris continued their teaching at our KBTH-KBNF conference, teaching trigeminal neuralgia diagnosis and treatment options and spine injury management. The day’s conference sessions concluded with Danny giving part two of Heart Power – attitude is gratitude! Following the final session, a wonderful reception was provided for all the attendees. Prof. Nii Otu Nartey attended and greeted the guests, while Prof. Afua Hesse was busy signing the lovely conference certificates.

With no time to spare, our team headed over to the Department of Anatomy at 6 p.m., for the special event of celebrating the commencement of the neuroscience research graduate program. Neurosurgeons, anatomists, KBTH hospital administrator, Afua Hesse, and KBNF members were in attendance, while Lisa gave a wonderful power point talk on the development of the international research collaborative. A reception, graciously hosted by Fred Addai and his department, concluded the evening. Exhaustion set in as our team called it a day and peacefully headed home to the hotel, led by our expert KBTH driver.

A discussion about a Ghanaian woman that is in desperate need of a craniotomy, for removal of a difficult brain tumour, was broached today. This woman’s husband found KBNF during an Internet search and sent a heart wrenching email asking for help. Afua Hesse and Patrick Banka, KBTH neurosurgeon, are collaborating with Paul and Chris in determining if they can help this woman and her distraught husband before the end of the week. Expert support from our team could perhaps give her a chance at a future.

We’re ready for day two of our conference. I am so thrilled that of all the participants today, only one confirmed he would not be back and we understand more will be joining us tomorrow. So I’m hoping we have enough certificates for everyone. . .

Marj Ratel in Ghana – Blog Post 1

Well, my brother Danny Moe, VP KBF and I arrived in Accra yesterday evening, and were greeted by balmy weather. In fact, it was so lovely, that air conditioning was simply not needed. It was a light moment when upon touchdown, cheers erupted from throughout the plane. Considering there were 480 passengers, it was quite a cheer! Once disembarked, we were greeted by a wonderful group of friends, including Prof’s Afua and Adukwei Hesse, Samuel Ampen-Asare, Dr. Hannah Ayettey and a police escort. Our bags packed in vehicles, I was quickly on my way to visit the Ayettey’s, as Cecilia celebrated her birthday. So I arrived to a wonderful meal prepared for us all!

Naakai Ayettey, Seth and Cecilia’s 8-year-old daughter is particularly excited, as her aunty Marjorie has brought a load of things to transform her bedroom into a princess room. Included in my suitcases are paint rollers, brushes, and castle mural. So we’ll be sure to have lots of fun towards the end of the visit, decorating her room.

Our Nigerian contingent arrived this evening from Lagos, and are now settled into the Crystal Palm Hotel. Included are Priscilla Uabor, Head Sister of the University of Benin Teaching Hospital’s Neurosurgery Unit, Christine and Justina, neurosurgery nurses, along with Drs. Dsazuwa and Sampson, anesthesiologist and neurosurgery resident. We will expect UBTH Neurosurgeon Prof. David Udoh and his family Monday, along with KBNF Research Chair Prof. Lisa Cain, from Galveston, Texas.

Today, Profs. Paul King, KBNF neurosurgeon, from Atlanta, Georgia and Education and Training Chair Jocelyne Lapointe, KBNF neuroradiologist, arrive along with VGH neurosurgeon Chris Honey and his son Michael. Others arriving include KBNF member Prof. Bill Galloway, conducting research on KBNF proposed Guggisberg film as well as seeing many Ghanaian sites with his sister. Bill’s granddad worked with Gov. Gordon Guggisberg, as a construction owner/developer in the 1920′s and had a part in Korle-Bu. We are also expecting Dawn MacDonald from Coquitlam, President of the Palliative Care Association, who will be joining our conference and various meetings and introducing palliative care initiatives set for Ghana.

Much of our mission work this visit involves teaching and workshops. We are part of the CME Conference August 1 – 5 for West African doctors, providing the neuroscience teaching for the conference, as well as co-hosting our first KBTH-KBNF Neuroscience Conference for Ghanaian doctors and nurses at KBTH August 3 & 4. We are so very excited by this opportunity and hope it will only be the beginning of great things to come. We have many presentations being given by our team, including Chris Honey and Paul King, teaching on various aspects of neurosurgery care and management, Jocelyne teaching on neuroradiology issues, and Lisa Cain introducing the neuro research developments. We also have Danny Moe teaching on personal and professional growth, something that I am sure, will be transformative for many.

I am also working with members of the Critical Care Association of Ghana, our Nigerian neurosurgery team, and others, in developing the first computerized documentation system for health care delivery. Included in this will be flowsheets such as neurovital sign assessment, other assessment tools as well as critical care flow pathways, automated doctors orders, standards and protocols. It will be a wonderful opportunity to introduce standardized charting to West African hospitals. I understand from Prof. Hesse that Internet access is being introduced in many nursing units, so we will help in anyway we can to leapfrog our teams in West Africa to North American standards in the years to come. I anticipate that we will have a trial period with one or two units including UBTH’s neurosurgery unit, trialing these documents, so we can determine what works best for their staff and patient population. I’ll keep you all posted. Suffice to say, there’s much enthusiasm for chart documentation developments.

Much more to tell, but I must close for now and get some rest, before beginning a full Sunday. Trust you are all well!

Marj