Chronic and non-communicable diseases, for example hypertension, stroke and diabetes, have become significant health problems in Ghana. Indeed, stroke disease is now in the top five causes of death in nationally (6% of all deaths; preceded by HIV/AIDS, malaria, lower respiratory infections and perinatal conditions). In the Greater Accra region, it is believed that stroke is now the second largest cause of death, preceded only by malaria.  Stroke therefore causes significant burden to patients, their families, healthcare professionals, health services and wider society.

Having previously worked in Ghana and experienced such problems first hand, Dr Claire Spice (Portsmouth Hospital NHS Trust) and Dr Hetty Asare (Ridge Hospital, Accra) planned the first stage of a co-operative developmental initiative between Ghanaian and UK health services. Over the past 2 years, a project group within the Wessex Region has been established, and in March 2009 a multidisciplinary team from this group made an initial visit to Ghana.  During this visit the team collaborated with colleagues in Accra to review local services for people with stroke, assist with service planning and provide multidisciplinary education and training through both formal workshops and practical case-based problem solving.  The various meetings and workshops resulted in an agreement by senior staff to establish West Africa’s first stroke unit. 

It is hoped that ongoing collaboration, including further visits and reciprocal visits by Ghanaian professionals to the UK, will help to support future developments and lead to sustained change.

Fields of work

Nursing
Therapies

Current Activities

The Link is currently planning a second visit to Accra – it is hoped that this will take place in Autumn 2010.  During the first year of this project (2008/09), activities focused on laying the foundations for establishing the Link, including an initial scoping visit to Accra.  In the coming year, we hope to take this forward with a second follow up visit to Accra. The main aim of this second visit is to identify the priority needs for core stroke care development and to jointly agree a written action plan, including formalisation and agreement of responsibilities of each project partner.

It is also hoped that one member of the group (the therapist) will remain in Ghana for an extended period of time, during which she will work within the hospital and therapy departments to support the development of care in these priority areas.

 We have been awarded an International Health Links Funding Scheme Small Grant (£3000) as well as a British Medical Association Humanitarian Fund Grant (£1800) which will support this visit, and are in the process of exploring other avenues for further funding. 

In addition, we are building publicity and awareness of the Link both locally and nationally.  This has included the sharing of our experiences so far at various forums, including the Wessex International Group and the UK Stroke Forum (poster presentation in December 2009). 

Link Requests

Financial support for future visits.

Contact Details

UK

Dr Claire Spice
Consultant Physician, Medicine for Older People

Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Southwick Hill, Cosham, PO6 3LY
02392 286 923
claire.spice@porthosp.nhs.uk

Ghana

Dr Hetty Asare
Physician Specialist

Ridge Regional Hospital
Castle Road
Ridge
Accra, GHANA

Dr Albert Akpalu
Consultant Neurologist

Korle Bu Teaching Hospital
Guggisberg Ave
Korle Gonno
Accra, GHANA

http://southernstrokeforum.org/ghana.html

It was initiated in February 2008 when Jane Hutt, then Welsh Assembly Government Minister for Education, visited TOCIDA (Tororo Community Development Action) project, in the Tororo district of Uganda.  She committed herself to the establishment of a link with the Vale of Glamorgan and invited Dr Maureen Owor (then a PhD student studying Law at Bristol University), whose family set up TOCIDA, to make the initial Link.  The Link was awarded a small start up grant by the UN Goldstar  initiative in Wales.

Fields of work

Ophthalmology

Library Resources

Current activities

Two members of the SAFE Foundation (www.thesafefoundation.co.uk) visited Tororo and with Maureen’s help identified the needs of TOCIDA.  Their priorities are health and education.  There is a desperate need for support of the Library and a list of required books has been drawn up with colleagues in Tororo, as a starting point.  Maureen has also established that there is a priority need for help with eye problems.  An optometrist and ophthalmologist with experience of eye problems and preventable blindness in Africa have been identified and agreed to join the Link.

A core group of about 10 people has met regularly over the past 2 years.  This core group is composed of all sections of the Vale of Glamorgan community.

Additional information

In terms of governance, a core committee of which Steve Tomlinson is the interim Chairman, has been established.  There is a draft constitution and plans are in place to be formally constituted, have an AGM and elect Officers and Trustees designate, with a view to charity status.  A public launch of the Link will take place in the Vale on 21 May 2010.  There are good communications with TOCIDA and a bank account has been opened in the UK and funds already successfully transferred to support the purchase of library books.

Link requests

As far as the link is concerned, the sponsorship of the Library for TOCIDA includes raising funds to equip the library with books on the Ugandan National Curriculum, for use by the school children using the library.  Also, the cost of training support for a librarian.  In addition, funds are required to support the visit to TOCIDA to identify ophthalmology clinical needs, and to fund equipment and clinical assistance at local level.

Contact information

Sue Bowyer
Constituency Office Manager/Senior Case Worker
Jane Hutt AM, 115 High Street, Barry, Vale of Glamorgan CF62 7DT
Susan.katina.bowyer@wales.gov.uk

Maureen Owor
mowor@yahoo.com

www.vale4africa.co.uk

This Link is a specialist eye link and is part of the VISION 2020 Links Programme. The VISION 2020 Links Programme was established by the International Centre for Eye Health in 2004 and aims to increase the quantity and quality of eye training in low income countries by developing sustainable eye links with a suitable UK partner.   We are just in the process of setting up  the linkage with Southampton. The process started  late 2009. 

Fields of work  

Ophthalmology

Current activities

1. Outreach activities at Ubima, a town in one of the local government areas
2. Quarterly eye expeditions at different areas as outlined by departmental resolution
3. Strengthening of the newly established subspecialty units in the department
4. Training in the different subspecialties of the consultants 

Additional information

The Link is currently involved with community eyecare activities in a locality in our environment.  Residents are sent to region on two monthly rotations and are supervised by consultants in their surgical activities.

The Link’s pediatric ophthalmology and vitreoretinal units are in its infancy. The Link wants to develop their subspecialties within Ophthalmology.

Link requests

Donations of equipment to ease delivery of eyecare particularly in paediatric ophthalmology and vitreoretinal-all equipment used in these. Additional needs include laser machines, portable operating microscopes, fundus camera, vitrectomy machines, portable slit lamps, low vision devices, GDx, squint surgery equipment , visual field analyser etc.

We also require assistance in training in the different subspecialties and help in using some of our equipment. We also need volunteers in our surgical expeditions. Sponsorships for procedures will also be appreciated by patients.

Contact information

Nigeria
Dr Adedayo Adio,
Head of Department, Senior Lecturer and Consultant Ophthalmologist
University of Port Harcourt Teaching Hospital
Rivers State.

Tel: +2348033108139

The key aims of establishing a cancer care link between Velindre NHS    Trust and cancer care workers in Sierra Leone:

• To assess the current provision for cancer care within Sierra Leone in the context of: Prevention, Treatment, Palliation
• To establish useful and practical links to individuals and health care organizations within Sierra Leone (SL) that might benefit from a link between Velindre NHS trust, Cardiff University and cancer care in SL.
• To identify key areas for partnership between Sierra Leone and Velindre NHS trust that might be developed.
• To assess the availability of postgraduate training in obstetrics & gynaecology and oncology.
• To support research activities in cancer and palliative care in Sierra Leone
• To support the personal and professional development of those working for or associated with Velindre NHS trust, through this link.

The first visit of the Velindre Team to Sierra Leone was funded by a grant from ‘Wales for Africa Health Links Fund’ with the aim of exploring the benefits of a cancer care link between Velindre NHS Trust and cancer care workers in Sierra Leone. This visit occurred in January 2010. The establishment of the cancer care link between Velindre NHS Trust is the first cancer health care link between Wales and an African country.

Fields of work

Cancer

Additional information

(a) Cancer poses a global problem, accounting for 12.5 % of all deaths worldwide in 2005; by 2020, new cases of cancer are projected to reach 15 million annually, 70% of which will be in developing countries, including over one million in the African Region1.  Whilst available studies and cancer incidence and mortality estimates in Africa are largely insufficient, African cancer registries suggest a rising cancer incidence due to infectious diseases, tobacco, polution and unhealthy diet.  Cancers in Africa  mostly occur in the economically productive age groups with major implications for communities and families, particularly the children.

(b) The most common cancers in Africa are cancers of the cervix, breast, liver and prostate as well as Kaposi’s Sarcoma and non-Hodgkin’s lymphoma2.  The precise cancer profile for Sierra Leone is not known as there is currently no cancer registry and no published accounts for cancer incidence and mortality2.  However, the published cancer profile from the Conakry cancer registry3 in an adjacent country, Guinea, suggests the highest incidence of cervical cancer in Africa, (see table 1 below).  In West African countries, Senegal, The Gambia, Mali, Niger and Nigeria cervical cancer is the most common female cancer followed by breast cancer and in males the most common malignancy is hepatoma with Burkitt’s lymphoma the predominate malignancy in children. 2

(c) Current evidence would support the potential for prevention of approximately 40% female cancers with HPV vaccination to prevent cervical cancer and hepatitis B vaccination with the potential to prevent hepatoma in males.  For other cancer there is the potential for potentially affordable treatment eg mastectomy and tamoxifen in breast cancer and cyclophosphamide based chemotherapy, which can be curative in 60% of childhood Burkitt’s lymphoma.  For all cancers there is the potential for palliation eg pain control with morphine.

1 WHO, Preventing chronic diseases: a vital investment, Geneva,World Health Organisation 2005.
2  Cancer in Africa-Epidemiology and Prevention IARC Scientific Publications No.153 IARC Press 2003
3 Koulibaly M et al. (1997) Cancer incidence in Conakry: first results from the Cancer Registry 1992-1995.Int.J Cancer, 70,39-45.

Contact information

UK
Dr Richard Adams & Dr Malcolm Adams
Velindre Cancer Centre
Velindre Rd
Whitchurch
Cardiff
CF14 2TL

Tel:02920196127
Email: richard.adams@wales.nhs.uk
Email: malcolm.adams11@yahoo.co.uk

Sierra Leone
Dr. Bash Taqi
Director of Non-communicable diseases research and postgraduate training
Ministry of Health and Sanitation
4^th Floor Yougi Building
Freetown
Sierra Leone

Email: dabashtaqi@yahoo.com

In 2004 Dr Abuh, Medical Director of ECWA Eye hospital, Kano, requested a link through the VISION 2020 links programme run by the International Centre for Eye Health. He wanted to develop his paediatric ophthalmic service – improving management of paediatric cataracts, developing his team’s skills in performing orthoptic assessments and visual acuity measurements in children, and enhancing his own strabismus surgical skills.  In 2008 Mrs Rosie Brennan asked ICEH to find a VISION 2020 link partner for WHSCT. The two institutions were considered a potentially suitable match and in Sept 2009 six people from the WHSCT made a Needs Assessment visit to ECWA Eye Hospital, Kano.  This group comprised a senior manager, an anaesthetist, an orthoptist, an optician, an ophthalmologist and a theatre sister.  A return visit of a team of six from ECWA came to the WHSCT December 2009.   This group comprised an ophthalmologist, an optician, an anaesthetic nurse, the theatre charge nurse,  a theatre nurse and an orthoptic nurse.  The Needs Assessment phase of the link was completed, a three-year activity plan was devised and an MOU signed.

Fields of work

Anaesthesiology, Cancer, Nursing, Ophthalmology, Surgery

Current activities

In April 2010 a team of six from the WHSCT will go to Kano for a week.  During this week  the following activities will occur.  For paediatric cataract management, biometry and postoperative care will be discussed focused around specific cases.  A specific children’s outpatient clinic will be set up.  Training will be given to 3 members of staff in visual acuity assessment in children, stereopsis assessment and how to perform the prism reflex test, cover test, prism cover test and how to assess ocular movements.  Surgical planning for concomitant squints will be discussed.  Horizontal squint surgery will be performed.   The WHO guidelines for surgical safety were implemented following the last visit.  There will be an audit review of this.  Biomedical engineering support will be provided by an engineer for preidentifed equipment.   The necessary parts for these repairs will be brought with the team.

Please see our website www.vision2020kano.org for our reflections on the visits so far, our expectations of the visit from the WHSCT team to Kano in April 2010, photos of our times together and details of our fundraising acitivities.

Link requests

A link with the Kenyan National Retinoblastoma strategy group.  Investigations into how to establish this are ongoing.

Contact information

UK
Mrs Rosie Brennan
Altnagelvin Area Hospital
Glenshane Rd
Londonderry
BT47 6 SB

Tel: +44 28 7134 5171
Email: rosie_brennan@btinternet.com

Nigeria
Dr Abuh Sunday Omogani
ECWA Eye Hospital
PO Box 14
Kano
Kano State
Nigeria

Tel: + 234 8060297605
Email: ecwakano@hotmail.com

This Link was established in 2009, though there has been a long established link between NHS Borders in Scotland and St Francis Hospital (SFH), Katete, Zambia since Dr Sandy Logie worked there in 1992. Both hospitals serve rural areas and are the same size with 350 beds each. Dr Dorothy Logie set up a charity to support the hospital after her husband’s death, and that now contributes to supporting the large HIV/AIDS clinic and the other work of SFH which serves a poor rural community of over I million people.

Fields of work

HIV/AIDS, Malaria and TB, Maternal and Child Health, Primary Health Care, Reproductive Health, Tropical diseases

Current activities

Work in progress is dependent  on an exchange of  skills and mutual awareness between health staff at NHS Borders and SFH in the areas of:

• Training of Labour Ward Skills modelled on the evidence-based Liverpool School of Tropical Medicine / RCOG (UK) training programme
• Setting up a service for, and training in, Syndromic Management of Sexually Transmitted diseases, including couple counselling
• Deliver paediatric training in acute emergencies to SFH staff
• Pharmacy support and installation of ACSCRIBE software to ensure constant drug supply

Additional information

Dr Dan Clutterbuck, STI and HIV/AIDS specialist in Lothian and Borders, has visited SFH three times to set up a STI service linked to the hospital HIV clinic, which now has 12,000 patients on its books. This clinic works with the District Health Service, and rural health staff, to train and support in: Syndromic Management of Genital Ulcers, enhanced Syndromic Management of Vaginal Discharge, couple counseling, and HIV clinical teaching, according to  Zambian Syndromic STI management protocol.  Funding has been found to appoint a part-time clinical officer to supervise and monitor the clinics. Regular visit are planned by NHS staff.

Link requests

Funding to allow further exchange of staff, to purchase and transport equipment, and for medical and technical exchanges for clinical teaching.

We hope to  continue the liaison with SFH and to support  the hospital in general.  (A Mission and 2^nd level government hospital).

Contact information

UK
Dr Dorothy Logie
Dr Brian Magowan
NHS Borders
Newstead
Melrose
Scotland

Email:
delogie@aol.com
Brian.Magowan@borders.scot.nhs.uk
bordershb@borders.scot.nhs

Zambia
Dr Shelagh Parkinson
Exec Director
St Francis’ Hospital
Private Bag 11
Katete
Zambia

Tel:  +062 52210/52344
Fax:  +062 52278
Email: stfrancishospital@iwayafrica.com

www.saintfrancishospital.net/