Final thoughts and wishes for the future

The Ghana trip comes to an end with presentations and presents. Niki Harding gives us a final update:

“On my third day at MCHH Tony joined us for the day. We have been having a lot of debate about how to assist the trainees to show ISUOG progress in their scanning, and monitoring and auditing of their work. Tony has been trying to find out whether we can download data electronically from the machines. Unfortunately there does not seem to be an on-going service arrangement and the local engineer was proving hard to contact. There were issues we would like to have sorted out while we were there, especially with the Manhyia machine which locks up if asked to do anything interesting (Doppler!)

Scanning Ghana style.

At MCHH we tried to advance into these areas of practice but with the newer students, establishing systematic and comprehensive LS and TS scanning to assess the pregnancy was still proving taxing. Descriptions of anatomy or planes became answered with requests to “draw it for us Niki!” As my students back home know, I think in pictures – the examination gloves box will have to be filed for reference, it was covered with diagrams by the end of the week!

Dr Imrana was our newest trainee and was keen for any advice having had extremely limited hands-on. Cecelia, Zenabu and Dinah, our three midwives, were taking in all the little scanning manoeuvres and tips I threw at them; head to femur TS views of fetus making FL measurement a little easier. Zenabu had only had one ISUOG week previously but had a good eye and showed great promise as well as having the greatest laugh which I wish I had on tape! Dinah had to leave us early to take a Public Health exam at a town 4 hours away. With Dr Annie and Yusif we looked at hearts in some of the 3rd trimester ladies where the anatomy was easier to demonstrate. In fact, in review of our patients, we have had a couple of 16/17 weeks but no other 2nd trimester patients.
The women in Kumasi are not committed to following through their care in any one clinic. Many of the ladies we scanned had had scans elsewhere and had more than one EDD given. We discussed, and I stressed the need to stick to the first scan EDD given and carry that forward.

Dr. Annie and Niki Harding with orphaned twins. Dr. Annie sponsors an orphan home and feeding programme.

Between sonograms Drs Annie and Imrana had patients appearing in the clinic with a variety of complaints, resulting from the local conditions and other treatments:
– A Pregnant lady with a nasty eye infection – needing general infection screen and anti-biotics. Baby looked fine.
– A Para 2 teenage mum abandoned by partner whose eldest daughter was suffering the effects of malnutrition. The whole family was being cared for on the paediatrics ward and were also given baby clothes and food money from donations.
– Incomplete surgical abortion with RPC’s – referred to surgeons.
– Our teratoma lady who has been referred to Oncology for assessment.
– A lady with a 4 year old son with developmental delay (and possibly microcephally). Dr Imrana described a possible scenario of infection such as CMV leading to PROM and subsequent problems of prematurity. Again a feeding program be will used to try and kick start residual brain function.

A very interesting discussion developed over lunch about the sequalae of malnutrition and the start up feeding program local staff have developed with local food resources.

Manhyia Mamas and Papa Hamilton (at the back!) lead by Nayana Parange.

Our final day with the trainees also involved an extended seminar to include local midwives. The aim was to introduce the other local midwives to how ultrasound can help them in their practice. This involved our trainees getting on the podium. Lectures were given by Tony, on behalf of poor Evelyn who had lost her voice, on 6 scanning steps, by Erica on ectopics, by Yusif on Oligo/poly -hydramnios and Tony again on twins. The trainees also had post-course tests to do and Abenaa, MCI Representative, attended for the presentation of certificates. Our local speakers were a big hit again. They spoke extremely well and we hope they will carry the banner forward.

Team MCHH lead by Niki Harding.

Suntreso Swingers lead by Janet Horenstein.

There was a general air of merriment starting from when Tony was asked to slow down his rapid Texas via West Virginia patois! As time ran out we had a general forum/ discussion of gynae issues. Presents were presented – flowing Ghanaian robes for all – Tony will be a dream in the OR in his beautifully printed smock! Nayana and Janet had tunics and trousers and I have a full length robe usually seen on stately ladies of “traditional build”. We girls had matching head scarves. Our thanks to Dr Annie et al for these.

Dr. Johnson – man about the OR?

Other personal gifts were exchanged or given and the star item was a beautiful painting of three ladies in the bloom of pregnancy, one carrying her baby traditionally on her back. We thank Abenaa for that gift. I have carried it carefully home from Ghana to Manchester and hope to deliver it safely to Outreach headquarters so it can hang in the ISUOG office. Before going our separate ways we went to visit trainee Doris who had been admitted to Kumasi South with cholecystitis. We wish her well.

Abenaa’s beautiful gift

The Four Musketeers finished off the trip with a lay-over in Accra. We procured the services of a very knowledgeable local guide called Moses who drove us round the highlights of Accra. I am much more in tune with Ghana and its place in the world now. I know my companions will agree when I say it has been a very special week. I have greatly enjoyed the company of all my new friends. The warm feedback and hospitality I received from “my” songraphers was wonderful. We hope our feedback to ISUOG shows that this is a project that can continue to develop and that this shouldn’t be the end of our involvement in Kumasi. There is still so much we would like to do and I thank ISUOG for allowing me to be a part of it.”


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