What's New February 15, Gary Faerber and John Park GHANA

Transcription

1 The University of Michigan Department of Urology 3875 Taubman Center, 1500 E. Medical Center Drive, SPC 5330, Ann Arbor, Michigan Academic Office: (734) FAX: (734) What's New February 15, 2013 Gary Faerber and John Park GHANA Michigan Urology Faculty, Fellows, and Residents 16 Items, 10 Minutes 1. In December 2012, Gary Faerber, Humphrey Atiemo and I traveled to Accra, Ghana, to learn more about collaboration opportunities with the Ghanaian urologists. Because of Humphrey s personal ties with Ghana and the existing institutional relationship between the University of Ghana and the University of Michigan Medical School, we looked forward to many intriguing possibilities. 2. Why look for global outreach opportunities? Many of the current urology faculty enjoyed the opportunities to travel abroad to share our knowledge and skills as urologists in third world countries. When Dr. McGuire was the Section Head of Urology in the 80 s, he made multiple trips to the Albert Schweizer Hospital in Haiti, and Gary Faerber and Julian Wan still recall those trips fondly (along with some amazing stories!). For several years, Stu Wolf and I made trips to the Hopital Lumiere (Hospital of Light) in Haiti, following the visits

2 established by Dr. Jim Montie. Cheryl Lee and I first accompanied Dr. and Mrs. Montie back in 1996 as fellows, and Stu and I made few more visits with residents (including Jeff Montgomery twice!). These trips were special for many reasons. It opened our eyes to the world that we do not normally see. Making friendships with local Haitian physicians, nurses, patients, and their families was priceless. Both faculty and residents came back changed for the better. It broadened our sense of purpose, not only as providers to relieve the human suffering caused by urologic diseases in the midst of unimaginable poverty but also as leaders to make the whole world a better place. When the Hopital Lumiere closed several years ago, we longed for a similar opportunity. 3. We stayed at the Ghana College of Physicians and Surgeons hotel. The accommodation was not luxurious but extremely clean and comfortable. We enjoyed breakfast and dinner at the hotel, including some really spicy stuff (Thank God for the beer!). Humphrey did a great job researching the best accommodation for us. It was very close to two hospitals we visited: the 37 Military Hospital and the Korlebu Teaching Hospital. 4. On our first day, we made a visit to the 37 Military Hospital and were greeted by Dr. Mensa and Dr. Adusei, two attending urologists. They were very interested in Gary s world-renowned expertise in stone disease. They already had several patients who were admitted waiting for us. We made rounds and made plans to tackle the stones using ureteroscopic approach. We were surprised by the outstanding quality of equipment. Dr. Mensa opened up a never-been-used semi-rigid Storz ureteroscope as well as a flexible ureteroscope. There was also a holmium laser, although the maximal power output was set rather low. The fluoroscopic equipment was also superb in quality. Humphrey,

3 having been at Ghana before, helped us to come prepared with laser fibers, ureteral access catheters, stents, and wires. We also learned that Storz had been very interested in further expansion of endourology market in Ghana and was very much willing to support any additional supplies and equipment at a discount. The 37 Military Hospital, being supported by the United Nations, had much up-to-date equipment, and we were informed by Dr. Mensa, who is the Associate Director of the Hospital, that additional purchase of supplies and equipment would not be a problem. What they lacked were skills, education, and quality improvement processes. 5. The next day, we visited the Korlebu Teaching Hospital. The level of activity was unbelievably high and chaotic. The ward was packed with beds lying side-by-side with barely adequate curtains in-between. We attended the teaching conference where a lecture was given by one of the senior residents and a medical

4 student. This was followed by a modest Morbidity and Mortality (M&M) Conference led by the chief residents. The health economics in Ghana is obviously different than the US. It is very cheap to be admitted to the hospital about 1-2 dollars per day with food included, but the medications are not included; the patients and families must come up with money to buy the treatments. Thus, if a patient is admitted for pyelonephritis, they often end up waiting trying to come up with money to buy antibiotics. One of the complications was a mortality of a patient who could not buy the drugs in time. 6. The operating rooms at the Korlebu Teaching Hospital were bustling and chaotic. It was clear that the Joint Commission did not have any impact on the operational logistics. We observed urethroplasty for pelvic fracture membranous urethral stricture, performed by a senior resident and a young faculty, and palliative cystectomy for an inoperable bladder cancer in a woman who presented with severe hematuria. 7. I was asked to perform a reconstruction in a young man who likely had 46 XY partial androgen insensitivity. He was initially raised as a female and in fact was a member of a female soccer team. He then gender converted to male and now asked for masculinizing reconstruction. He had a good length phallus, perineal hypospadias, severe chordee, and bilateral inguinal testicles. My

5 plan was to perform either a 1 st stage reconstruction or do the whole thing using oral mucosa. The case was, however, canceled because of no room at the recovery room. There is no separate intensive care unit, and when patients do not recover well from previous surgeries or if there are emergent admissions through the ER, then the PACU becomes full, and no elective cases can proceed. It is not unusual for elective cases to wait for weeks and months. 8. I also caught up with a genitourinary focused pediatric surgeon, Dr. Appeadu-Mensa, and visited the pediatric ward and the newly renovated pediatric surgical suites. The ward was similarly crowded, but the OR was amazingly clean with the state-of-theart equipment. Apparently, the pediatric surgical specialty center was approved by the government (it helped that the hospital director was a pediatric surgeon). It turns out that many specialties are advocating for their own such centers within the hospital to gain independence and efficiency of care delivery, including urology. The decision for a urology center was approved by the previous administration, but given its political nature, the recently elected new president and the parliament will soon determine whether this becomes a reality.

6 9. We performed additional stone procedures the next 2 days. We were able to treat and teach various stone pathologies, including renal pelvic stone, ureteral stone (distal and proximal), ureterocele stone, and calyceal diverticulum stone. Clearly having a more powerful laser would have been helpful. 10. We were treated to a great banquet style dinner at a Chinese Restaurant on our last day. There are many Chinese nationals living and working in Ghana, and I would have to say it was one of the nicest Chinese meals I have had. The next day, before we got on the plane back home, we toured the rest of Accra. Ghana is a thriving country with many rich natural resources and foreign investment opportunities, including gold, timber, and petroleum. There are many Asian and European investors coming in to Ghana everyday to take advantage of its political stability. During the week we were there, there was a presidential election, and we were impressed about how smooth and orderly the whole thing

7 went. The University of Ghana campus is amazingly beautiful. We all thought how much fun it would be to be an exchange student here for a few months. Gary already picked a home set aside for visiting faculty where he and Kathy could stay if they ever wanted him to stay for a longer period of time. (And yes there are golf courses not far away.) 11. Why should we pursue Ghana opportunities? One of the key components of our departmental mission is to train the future leaders in urology. Gary and I came away convinced that Ghana represented an outstanding opportunity to expand and build on this mission. The next generation of leaders coming out of Michigan should not only be leaders in American urology but for the entire world. Creating a mission-centric commitment to expand our own faculty s, residents and fellows sense of purpose in embracing the improvement of care world-wide would provide an extraordinary distinction for our program. It would provide an additional opportunity to attract outstanding medical students and residents looking for training opportunities in a global sense. In some specialties, such as pediatric urology, many of the complex congenital index cases (like bladder exstrophy) are becoming rare in Michigan due to falling birth rates. I am quite confident that this collaborative partnership with our Ghanaian colleagues would provide an invaluable resource for education and collaboration. 12. Why Ghana? There are many reasons why the Ghana-Michigan partnership is attractive. Unlike other potential countries (such as Haiti) which need medical assistance, Ghana is very stable politically and economically. As an emerging economic investment opportunity for many other countries, the proximity to high quality health care, such as stone disease management, is as important as other infrastructures such as roads, electricity, and

8 sanitation. It is a critical resource for managing the Human resources. The long-standing academic relationship between Ghana and University of Michigan is another strength of this opportunity. The RRC has relaxed their view of trainees participating in global initiatives such that trainees can count these cases in their individual official ACGME surgical logs. Humphrey s familiarity and relationship with Ghanaian urologists is also a huge asset. The Ghanaian urology faculties at both hospitals share an outstanding culture of collaboration and commitment to education and excellent care, similar to our own mission. Their leadership is outstanding, and they are highly respected in both hospital systems. Collaboration with Michigan will strengthen the political argument for funding the much needed urology center at the Korlebu Teaching Hospital. Finally, the existing corporate interest by Storz is another intriguing partnership opportunity. 13. Where do we go from here? Our vision is to establish the Michigan-Ghana Urologic Educational Collaborative. At first, we will propose a 5-year plan to establish the Michigan-West Africa Endourological Center. We will make an annual trip of 7-8 days in December each year for a focused surgical workshop in both stone disease and pediatric reconstructions (mostly complex hypospadias, disorders of sex development and exstrophy). The goal is to gradually introduce additional skill sets to a select group of urologists which would include percutaneous stone management, SWL, laser TURP and laparoscopy. We would remain in contact with the Ghanaian urologists to establish a patient registry and perform quality assurance assessments (including M&M s) to systematically identify improvement needs.

9 14. We are tentatively planning to return to Ghana on December 7, Along with Gary, Humphrey, and I, we envision including an additional faculty with each trip, along with 2 senior level residents or fellows. During a 7-day trip, we will perform 4 days of surgical workshop at the 37 Military Hospital, 1 day of didactic and case discussion type of teaching (where our residents will give lectures), and 1 day at the Korlebu Teaching Hospital clinic and OR. Our residents will have an opportunity to participate and learn in cases such as open prostatectomy for several hundred gram BPH. 15. We will seek philanthropy as the primary means of establishing the necessary funds for these trips. We will work with Global REACH initiative of the Medical School, our development officers, as well as sharing our vision at the upcoming Nesbit Meetings with friends and alumni of Michigan urology. 16. This is an exciting opportunity for Michigan Urology for taking our brand globally. The innovation and the next breakthrough outof-the-box thinking can come most unexpectedly. I believe that this partnership has the potential to create an extraordinary context for such an inflection point. - John Park