A game-changer: New fellowship expanding emergency care in Ghana

An Emergency Medicine program has produced its first fellowship graduates in Ghana, a major milestone in a 10-year U-M partnership to build emergency medical care capacity across that country.

Michigan Medicine's Dr. Rockefeller Oteng (left) and Ghanaian Emergency Medicine physician Maxwell Osei-Ampofo, one of the first eight doctors to complete a brand new Emergency Medicine fellowship program started with U-M assistance.

The Ghana Emergency Medical Collaborative is a teaching initiative to provide in-country training for emergency medicine nurses, physicians, and students. Having already graduated hundreds of nurses and dozens of attending specialists, the program’s first fellows – emergency medicine specialists trained to teach their skills to other doctors – graduated in December. The initial cohort included eight physicians, including Maxwell Osei-Ampofo.

“I realized that patients presenting with acute injuries and illnesses could have better outcomes if there were people trained to take care of them, and I wanted to be one of those trained to make a difference,” Osei-Ampofo said. “Training those who come after us is part of the succession planning. It’s going to be a wonderful thing to impart our knowledge to others.”

Leading the effort has been U-M emergency medicine physician Rockefeller Oteng, MD. Ghanaian by birth, Oteng has lived in the United States since he was nine. He grew up on near Washington, D.C., attended medical school in Ohio, and came to U-M for residency training in 2005. He was just starting his career – and didn’t have a specific interest in global health – when he was asked to join a series of meetings with Ghanaian health officials visiting Ann Arbor in 2007.

“I’m not even sure if the people who asked me to the meetings knew I was from Ghana, to be honest,” Oteng said. “But I believe things happen for a reason. I speak the languages. I was primed for the idea. Once it came up, it was like, ‘Ok, what can we do with this?’”

The resulting Ghana Emergency Medicine Collaborative is a partnership between U-M and several Ghanaian institutions, including medical schools, teaching hospitals, the Ministry of Health, and the National Ambulance Service. In Ghana, as in other lower-resource areas, there is a prevalence of injury-related deaths due to inadequate emergency care.

The Collaborative, funded initially by the U-M Emergency Medicine Department and later through an NIH grant, produced a three-year residency program and a subsequent two-year fellowship, coupled with a now two-year emergency medicine nursing degree program, all conducted in-country.

Program leaders worked with a non-profit organization already doing mission-style work to conduct the nurse training. The initial physician training was accomplished by supplementing  by Oteng’s six-week stints with scheduled short-term physician volunteers and other visiting U-M physicians.

To date, the partnership has produced more than 400 emergency medicine nurses and 37 resident specialists, 8 of whom are now qualified to supervise current trainees, meaning services will continue to expand.

“This training program has been a game-changer. Patients outcomes have improved in the areas impacted by the presence and training of emergency physicians and nurses,” said Osei-Ampofo. “The health care and emergency care landscape in Ghana will change significantly as the numbers of trained EM physicians and nurses increase. It’s about building a critical mass.”

But there’s also a matter of distribution. The training program – and the specialists and fellows to emerge from it – are largely concentrated at the Komfo Anokye Teaching Hospital, in Kumasi, although graduates are beginning to disburse to other hospitals around the country, Oteng said.

“Ministry of Health leaders want every region in Ghana to have a fully functional emergency department, so our next step is to have an assessment of each regional hospital and put together a five-year plan for each place that includes physical needs and human capacity,” Oteng said.

Nearly ten years on, program leaders have the numbers on their side; it will take about 70 emergency medicine physicians to adequately staff Ghana’s 10 regional hospitals, and the program has already produced 37 trained specialists, including the 8 new fellows.

“We are building something that I think forever will change the way medicine is practiced in West Africa, and I’m proud of that,” Oteng said. “The best thing you can do for someone is to respect them enough to expect the best of them. I’ve always felt like people deserve that chance.”