Of training and dust

So we are back in Ghana! After an unfortunate and long delay at Heathrow Amelia flew into Accra on Tuesday 29th May – just – it was heading to 30th by the time the plane landed. Brilliant to see Kodwo and be whisked off to the luxury of Dean’s.

It was lovely to walk back on the ward to see all the old faces and the hustle and bustle of stroke care going on as normal at Korle Bu. I did not have time to even sit down before I was in the back of a car and on my way to Ridge (now Greater Accra General Hospital) to observe the Korle Bu team delivering the well-established communication and continence teaching.

Having spent the rest of the week catching up on the project progress to date it was great to have Keri and Liz arrive on Saturday night. Following my own experience I was not at all jealous that they had both been bumped to business class!!

Back to hard work on Sunday – in a taxi to Labadi Beach Hotel to do some serious debriefing and preparation for the week ahead – along with a bit of R&R!!

Accra has been particularly dusty – but this was relieved by torrential rain on Sunday and then again on Thursday – but this has only briefly disrupted the wonderful sunshine.

It has been a wonderful week spending time with the Korle Bu team and supporting them to spread the word of high quality stroke care across Accra. The training that has been undertaken with staff at Ridge and La General Hospitals is bearing fruit with improved care and positioning noted at both hospitals. The most notable element of the week has been the enthusiasm and drive of all the staff involved in the project.

Along with some administrative work to ensure that the project is on track all of us have enjoyed catching up with old colleagues as well as meeting new friends all in the pursuit of top class stroke care.

Calling all Stroke partnerships!

As part of our current Health Partnership Scheme Grant, we are planning a UK based 'networking and sharing event'; specifically aimed at UK partners who are part of stroke-related projects with low or middle income countries.  The exact programme is in progress - but we are increasingly aware of a number of projects that are focussing on stroke care, and are sure that there is a lot we could learn (and possibly take forward) together.

The event is likely to be in the Winchester area (to be confirmed very soon), with a provisional date of Sat 30th June.

If you are interested in attending or would like more information please contact Julia at jnm1g12@soton.ac.uk or Tweet/DM us on @WGStroke!

End of January/February 2018 visit

The positivity of the first few days continued into our second full week.  Firstly we had a very friendly and enthusiastic welcome at La Hospital, who are really looking forward to upskilling the staff who treat their busy throughput of stroke patients.  Back at Korle Bu we had a fantastic time with the team filming and audio recording all the content we needed for the training videos.  It was great to do something a bit out of the ordinary for all of us, and the enthusiasm and acting skills of everyone who took part blew us away!  Thank you so much to all the patients, staff, relatives and members of the public who agreed to be filmed.  Also thank you to the photographer Andy Rapkins, who fitted in so well on his first time in Ghana.  We will look forward to sharing the videos as they are completed over the next few months.

January 2018 visit - first post

Sarah and Julia are delighted to be writing this blog post from our guest house in Accra, following the first couple of days of our first visit of 2018!  Everyone has been very enthusiastic about the new project, and it has been lovely to catch up with the team at Korle Bu.  We have already been to meet some of the team at Greater Accra Regional (Ridge) Hospital, one of the two hospitals who will be working with the Korle Bu team over the next year to develop new stroke-skilled clinical leads.  We were impressed with the facilities at the newly-built hospital, and were pleased that the staff were so engaged and keen to get started.  We are looking forward to visiting La Hospital next week and meeting the team there.

We are off to the airport tonight to collect Louise and Andy (a videographer), as the other focus of the next week will be working with the Korle Bu team to film footage and audio for our new short stroke education videos.  These videos will be accessible to anyone via the internet, and aim to reinforce the key messages for each of the 8 Core Skills.  It should be a fun week; some of the team are getting ready for their close-up…and others will spend most of the week in hiding! 

Dean's Guest House
KBTH and Ridge team

New THET Grantees Announced

We are delighted to announce that the WGSP has been awarded a further Health Partnership Scheme Grant from THET.  The award will support a further 13 months of collaboration, beginning in Dec 2017.  The project will focus on the KBTH team training stroke care leads in two partner hospitals in Accra.  We are hugely excited about branching out beyond KBTH - increasing knowledge and skill more widely will ultimately bring benefit to more people with stroke in Ghana, so is an important step for the partnership.

We're busy planning our first visit for early 2018.  Watch this space! 


Two pieces of exciting news.....

The Wessex-Ghana Stroke Partnership has reached the final of the Health Service Journal Annual Awards, International Health Partnership category.  The application we submitted has been shortlisted and 3 of the partnership, Louise Johnson, Claire Spice and Liz Cullen, are presenting to the judges on Thursday 12th October.  The results will be announced at an award ceremony on 22nd November, so fingers crossed and “good luck” to Louise, Claire and Liz.

The second piece of news is that we are waiting to hear whether we have been successful with a further grant application.  The closing date for applications to THET was 1st October, and we expect a response any day, as the one year grant period begins on 1st November 2017.   Again, fingers crossed and watch this space!

Sarah Easton

Sharing our work - Dr Lucy Sykes attends ESC in Berlin.

On 24-26th May 2017 I attended the European Stroke Conference in Berlin. This was a fascinating and stimulating event bringing together Stroke clinicians not just from many European countries but also the Americas, Asia, North Africa, the Middle East, Australia...but none from sub-Saharan Africa this year so I was proud to be flying the flag for Ghana by presenting our WGSP poster. I had only 3-4 minutes to speak, so it was challenging task compressing 8 years' progress into a clear overview of what the Partnership has achieved. Afterwards there were several questions and the audience were all impressed with the depth and quality of our work. I hope we will have future opportunities to present WGSP achievements to raise the profile of this and similar work throughout the Stroke community.

Celebrations and Farewell…….for now?


Liz and I have just returned from another busy and hot week in Accra.  As usual, everyone made us welcome and we were proud to see the unit working so well.  Everyone was happily working together for the good of the patient.  The 8 weeks that Amelia and Debbie spent on the unit was certainly evident and everyone spoke highly of their time there and misses them. 

We took the opportunity to take slide-sheets and bedpans out to Ghana and whilst there we bought 2 wheeled commodes…. It was fun seeing Dorothy squeezed into a taxi with them to get back to the unit!!  After much searching we have found a way of getting a new transfer aid out to Ghana, which will hopefully arrive at the end of June.

The main purpose of our week was to collect the final observational evidence and data to enable us to quantify the huge development which has taken place over the past 3 years.  Ruth and Jude had the various spreadsheets prepared and 12 of the team received certificates and badges for completing all 8 competencies!  This group includes nurses, doctors, physiotherapists, pharmacists   and occupational therapists, which shows the true multi-disciplinary team work taking place within the stroke unit.  Many other members of the team have so nearly completed their competencies …..  hopefully they will be signed off very soon.  Please don’t forget!!!

WGSP Stroke Celebration

Liz and I presented the team with a montage of photographs taken since 2014, which brought back lots of happy memories. Our final evening in Accra was spent at the Noble Chinese restaurant, where many an hour has previously been spent.  As our visit was short, we did not have time to go to the beach, however we did manage 2 hours in the market, and returned back to Dean’s Guest House with no money!

It is sad to think that this could be our last visit to our friends at Korle-Bu Teaching Hospital.  The grant has come to an end and the project plan is completed; thoughts must now turn to potential areas for further partnership, hopefully with the Ghanaian team taking the lead and the UK team supporting!      

Good luck and thank you to everyone involved in the partnership, Sarah  

Church, beaches, monkeys and a bit of work too!

Well it all started with an unexpected but very pleasant trip to church with Dr Adjelolo – a really charismatic church with wonderful singing and music and a very enthusiastic preacher. It was way fuller than any church in the UK would be and this was the second service of the day! Dr A then took us on a drive round Accra – mainly round the other hospitals! The new out-patient wing at Ridge looks very nice but pales into insignificance compared to the amazing new hospital at Legon, attached to the University. This will be quite something when it opens – I am not sure how it will be staffed but I think (quite rightly) there is a bit of concern that it will be major competition for Korle Bu. Although from what I understand it will not have a Stroke Unit.

On the unit at Korle Bu the brilliant work continues. A busy week with several female admissions and several challenging male patients! The staff delivers the most amazing basic care to these patients and I do hope that this can continue to roll out across the hospital. The staff are continuing to complete their competency log books with at least 8 members of staff having fully completed the required competencies. The multidisciplinary team meeting was great again, with really meaningful discussion involving all the team members. Special praise to the OTs this week who came with some truly insightful information in regards to discharge planning for all the patients. The hoist is back working – even if the switches are all the wrong way round – we now have to press the buttons that open and close the legs of the hoist to make the hoist go up and down, and vice versa! Also a prototype chair raiser arrived this week – just what is wanted and we hope the other seven will follow shortly.

Patient Planning on KBTH Stroke Unit
Training Resources

We said goodbye to Dr Nortey who is now on leave for three weeks, but expect Freda back on Monday. Aunty Dorothy is off to Kumansi to assist with nursing exams next week and as it is the end of the month, we will say good bye to the interns and house offices (physios and Drs) that will hopefully all be replaced on Wednesday. We have a hello too with a new dietician – welcome Andy.

Had a wonderful day at Bojo Beach with a few members of the team; an absolutely stunning beach that is accessed by a canoe with an outboard motor – we crossed a lagoon about 50m in width before spending the day chatting, relaxing, enjoying the sun and sea. It was a great way for Eunice to spend her 30th birthday. Church with Cynthia was a different experience to that last week. It was a smaller more local church with only one service, but the music, singing and charismatic preaching were still in abundance – certainly no lack of enthusiasm! Back in for week seven.

Another busy and heavy week on the stroke unit at Korle Bu. We now have 12 functioning chair raisers – so most patients should be able to sit at a comfortable height. This is a minor aside to the major work of the week which the nursing staff completed tirelessly – nursing for some really unwell patients. Unfortunately we lost three patients this week – most of them unacceptably young – but all had had what can only be called massive strokes. I have not seen too many CTs showing that a patient had lost their entire right hemisphere to an infarct.

On a happier note it was good to see Dr Freda back and we welcomed new medical officers David and Sani.

After being let down by a travel company our planned expedition to Mole did not happen so we made do with a trip to Shai Hills Reserve instead, and managed to see Kobs, Baboons, several bird species and some amazing butterflies – a good day out.

Next week is our last week – we will be so sad to leave the unit and the wonderful staff there – but have some amazing memories to take home with us. I hope that we will also be able to keep in touch with the good friends that we have made here and we both hope to visit again in the future.

Improving Global Health Fellows. Week 5: Blood Pressures, Learning and all that Jazz!

The hard work continues on the Stroke Unit at Korle Bu. After a relatively quiet week with all the doctors on IMPACT training, the unit is now much busier and the patients are certainly keeping all the staff on their toes. I’ve never seen Aunty Faustina move so fast as when one of the patient’s got himself out of the chair and had a slight wobble on his way to his bed! Most are doing really well and engaging in the early stages of rehabilitation whilst preparing for discharge home.

The high percentage of haemorrhagic strokes continues – 6 of the eight patients most recently admitted have had a haemorrhage; and even one with an infarct has had a haemorrhagic transformation – so the doctors are busy working out the best forms of treatment. This week it has not been unusual to see blood pressures of 220/110, which would explain some of the bleeds!

The highlight last week was the really constructive multidisciplinary team (MDT) meeting we attended. The structured format allowed all members of the team to give feedback and be involved in the debate, leading to effective decisions being made about patient care. But it was not all about the clinicians – the thoughts, feelings and circumstances of the patients and their families were central to the discussion and led to some really patient centred care. This excellent MDT working continued afterwards as it expanded into a more managerial meeting and consensus was reached on how best to move forward a few things on the unit – again everyone had their say and contributed to the conversation.

It has also been good to see some really constructive discussion on the ward around a few topics that keep cropping up and this has led to some peer learning and therefore better patient care. One of the hot topics at the moment is cognition - how to assess it and how to differentiate a cognitive problem from a communication problem.  It would appear that as the Ghanaian population ages these cognitive problems (stroke related or not) are becoming more prevalent.

We ventured out to Akosombo this week too – we explored the Volta Dam – amazing scenery and quite a feat of engineering too!

Volta Region

After our weekend trip it was back to the Stroke Unit on Monday and a busy week with an average of 9 patients on the ward most days.  The variety of patients is as great as would be expected on a stroke unit in the UK, ranging from those with mild weakness and good rehabilitation potential to those who are very unwell and requiring nasogastric (artificial) feeding.

Nasogastric Feeding

It is good to see how many of the staff have now completed their competency logbooks and how many are nearly there. The willingness of the staff to learn new information is inspiring and hopefully our presence here is helping to consolidate some of the learning.

The weekly trips out continue! After an evening of live Jazz with Dr Akpalu and Dr Nkromah on Friday, we headed to the beautifully tranquil Botanical Gardens in Aburi on Saturday – a welcome change from the hustle and bustle of Accra.

Amelia Shaw and Debbie Bartlett (IGH Fellows)