GLOBALHEALTH
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GHANA
Making a Difference 5,365 Miles from Durham
Fintan Hughes, MBBCh, BAO RESIDENCY CLASS OF 2024
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Simulated cardiac arrest training in the UGMC Intensive Care Unit; Demonstrating loss of resistance on a coconut.
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| DUKE ANESTHESIOLOGY
n September of 2023, we traveled to Accra, the capital city of Ghana in West Africa. Our main roles during the trip were to assist Dr. Adeyemi Olufolabi in establishing the use of labor analgesia and to teach local residents about neuromuscular monitoring and video laryngoscopy. We were primarily based at the newlyopened University of Ghana Medical Center (UGMC). We worked alongside Dr. Olufolabi, teaching UGMC residents the skills required to place epidural catheters. UGMC has a simulation center with an excellent model for neuraxial placement, but to facilitate widespread access to simulation we experimented with a variety of items from a local market. After much trial and error, we found that a coconut with holes drilled through the outer husk provides a crisp loss of resistance as a Touhy passes from the white flesh into the hollow liquid filled inner space. Pineapples were a close second when the Touhy was advanced from the base, but became much less consistent as the fruit ripened. We delivered lectures to the anesthesia residents on the monitoring of neuromuscular blockade. Additionally, we gave tutorials on emergency airway management to the residents and nurses. Day-to-day in the operating room, we demonstrated the practical use of both train-of-four monitoring and video laryngoscopy.
A highlight for me was the simulated cardiac arrest sessions that we ran in the Intensive Care Unit. Navigating the culture’s differences while practicing closedloop communication led to a lot of laughter all around. This was all made a little more exciting as we used a live defibrillator at 4 joules rather than a training unit. It was fascinating to see two very different approaches to global health work being undertaken in Ghana. During our time at the hospital, we met a cardiac team from another US academic center. The primary aim of this group was to complete a large volume of surgeries in their time in the hospital. While this well-oiled machine provided excellent care to many patients, their work was met by local staff with varied responses. This is a completely different philosophy to Dr. Olufolabi’s capacity building model. Capacity building in global health seeks to develop long-running partnerships with local doctors and nurses. Listening and responding to the needs of local health care workers, both sides collaborate to develop sustainable solutions, and in time, the local teams become independent. This trip was an inspiring window into the vast need for effective global health work that exists even in the more developed countries of the global south. BP