Ghana

CPA Ghana History
CPA were invited to train physiotherapists in Ghana to specialise in working with children with cerebral palsy after two exploratory visits funded by Voluntary Service Overseas (VSO) in 2005 and 2006. The invitations came in the first instance from Dr. Ben Badoe, a paediatric neurologist working in the main teaching hospital in Accra, Korle Bu. He told us of the desperate plight of families with children with CP unable to find any effective physiotherapy for their children. A later invitation came from the Ghana Association of Physiotherapy – GAP. They wrote the following proposal: -

THE FORGOTTEN DEAR ONES
Proposal for advancing the care of children with Cerebral Palsy in Ghana - The Korle-Bu Teaching Hospital Project.

1.0 INTRODUCTION

• Paediatricians and Physiotherapists are concerned about the rehabilitation of children with cerebral palsy due to the life long implication of the health condition.
  
  
• Adequate rehabilitation facilities are not available to facilitate the care of children with cerebral palsy.

The need to identify and develop a centre of excellence for advancing the care of children with cerebral palsy.

1.1 Background

• Consultation between Dr. Badoe (Neuro-paediatrician) and the Physiotherapists at the Korle- Bu Teaching Hospital resulted in collaboration between the British Executive Service Overseas (BESO) and the Voluntary Service Overseas (VSO) leading to the visit of Archie Hinchcliffe (BESO volunteer) in May 2005 for two weeks’ skills transfer workshop to practicing Physiotherapists in Ghana.
  
  
• Visit by two other BESO/VSO volunteers, Elizabeth Hardinge and Sarah Warrington followed in September 2006.
  
  
• Their visit led to consultative meetings with identified stakeholders
  
  
  • Management of Korle-Bu Teaching Hospital
    
  • VSO representative in Ghana (Nansata Yakubu)
    
  • Dr. E.V. Badoe – Department of Child Health Korle-Bu Teaching Hospital
    
  • Representative of Ghana Association of
  • Physiotherapists – Allen Akaba
    
  • Physiotherapists from Korle-Bu Teaching Hospital.

The group identified the following needs towards the realization of advancing the care of children with cerebral palsy

• Manpower Training (Skills Transfer)
  
• Facilities (Development)
  
• Awareness among parents of children with cerebral palsy, other health care providers and the general public.
  
• Links with non-medical outfits, public health units and community health nurses training programmes.
  
  
• The need of the proposed centre of excellence as an observation outfit for Health Students was also identified. It was agreed that Korle-Bu Teaching Hospital as the leading health institution should not only remain a treatment centre but rehabilitation centre for persons with disability viz the cerebral palsied child.
  
• A consensus was reached that the project starts in a small way towards the establishment of the centre of Excellence.

Proposal written by:
Raphael Yaadar, Principal (Supt.) Physiotherapist, Korle-Bu Teaching Hospital, Accra.

Assisted by Sandra Carsamer, Physiotherapist, Korle- Bu Teaching Hospital, Accra

Supported by Dr. E.V. Badoe, Child Health Department KBTH.

In response to this CPA managed to raise funds specifically for Ghana from the Sit Halley Stewart Trust. This has enabled us to pay for several training programmes for physios and also for training for technicians in New Horizon School for children and young adults with cerebral palsy and learning difficulties to make supportive furniture such as special chairs and standing frames from Assistive Technological Devices (APT).

Programmes already Carried Out
1. In April 2008 we sent a volunteer, Anna Wright, a paediatric physiotherapist from the Royal London Hospital, London, England to lead a two-week Elementary Course. She was assisted by Margriet Langeveld a Bobath trained physiotherapist from Holland. Margriet is currently working in Ghana. She is funded by VSO and based at the New Horizon Special School in Accra. Together they trained a core group of 12 physios from all over Ghana in the assessment, treatment and management of children with CP. (See separate page for description of course)

2. In June we funded a full scholarship for Sandra Carsamer to attend the 8-week Bobath Course in Lusaka in Zambia. Sandra is a fairly newly graduated physio but she has shown herself to be keen and committed to working with children with CP and their families. She is also a good practitioner and the course tutors told us she was one of the best participants on the course. As a result of her training she is now working full time with children in Korle Bu Hospital.

3. Late in 2008 Jean Westmacott spent 3 months researching and developing a new kind of special chair (to be called the Ghana chair) that we hope will be suitable for the many children in Ghana who have athetoid cerebral palsy with dystonic spasms. It is very difficult to find appropriate chairs for these kind of children and there seem to be so many of them in Ghana. Jean worked with a Bobath consultant physiotherapist who explained the principles of successful seating to Jean. Jean has now developed a prototype chair and also a booklet for use when training technicians in how to make and fit the chairs.

4. In February 2009 Jean Westmacott went to Accra to run a two week training programme for technicians wanting to learn to make special chairs and standing frames from waste cardboard and paper to children with CP to use at home. See Jean’s own account of this below.

5. Also in February Charity Adjetey and Dorothy Ekua, two Ghanaian physios who proved themselves to be keen to learn and committed on the Elementary Course, went to Johannesburg to attend the 8-week Bobath Course there. Charity works in Ho Hospital in Volta region and Dorothy works in 37, which is the Military Hospital in Accra. They both succeeded in completing this tough course and receiving their certificates. We have been assured by their line managers that both Dorothy and Charity will be working with children exclusively in future.

6. In April we funded Liz Hardinge (who was one of the two physios funded by VSO in 2006 to carry out a fact finding mission and run a short training programme in Korle Bu Hospital) to return to Ghana. This time her role was to work with a programme in Cape Coast in which a group of special needs teachers wanted to learn to handle and teach children with cerebral palsy Liz’s job was to teach the school teachers about cerebral palsy and how it affects children and also to help them to learn to handle the children so as to help them to learn as much as possible in the same way as the other children. At the end of the course the teachers were so inspired they have decided to set up a permanent centre where children not accepted in normal schools can come for some therapy and learning.

Future Programmes
In October we expect to run a follow-up workshop for all those physios who did the Elementary Course last April. These workshops will be conducted by two experienced British paediatric physios, Renate Hallett and Catherine Fisher. They will take place in different hospitals and the idea will be for each pair of physios to present a child they have been working with, explaining the child’s difficulties and showing what treatment they have been doing. The workshops will be both an assessment of how much participants have learnt and retained from the Elementary Course and a learning experience. The trainers will use video cameras to record each child and later the participants can discuss what worked and what didn’t while they watch the recordings. We hope that all 3 of the Ghanaian Bobath trained physios, Sandra, Dorothy and Charity will be able to take part and help to teach on these workshops.

Continuing work in Ghana
by Jean Westmacott

The planned training course in making Assistive Cardboard Equipment was run in Ghana by CPR in February 2009. In 2008 CPA ran a 2-week training course for physiotherapists in Ghana on assessing and treating children with cerebral palsy. Two paediatric physiotherapists, Margriet, supported by Voluntary Service Overseas and Anna, a CPA volunteer trainer from UK, ran the course. Afterwards one of the participant physiotherapists from Korle Bu hospital, Accra, was sent to Zambia to do an 8-week course. Now in February 2009 two others left to do the same course in South Africa. As a result there is a growing cadre of physiotherapists in Ghana with new skills in helping children with cerebral palsy.

So the time had come to facilitate the production of chairs and standing frames in Ghana. These are hugely expensive if imported. The children with cerebral palsy need equipment to sit and stand in good positions between physiotherapy sessions at home and school. Therefore a Training Workshop in making assistive cardboard equipment using APT in February 2009 in Accra. This useful and cost-effective method means that each item can be easily adapted to the needs of the child.

The Assistive Cardboard Equipment Training Workshop

There were 14 participants; from Sunyani, the St Theresa Centre for the Handicapped, Abor, Tema and Accra. There was also a physiotherapist from Somalia. Three are mothers of children with disabilities. It was wonderful to have them working enthusiastically and it helped everyone keep focussed on the reason for the equipment!

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Dorinda’s little boy was only 8 months old so he accompanied her for the whole workshop. He was a first class demonstrator as he has athetoid cerebral palsy and very ably demonstrated the good use of a standing frame. He spent time each day standing in the one that had been repaired for Korle Bu Hospital, and playing beautifully, strengthening his trunk muscles and trying to use his hands. Dorinda made a new one for him with the help of fellow participant.

The participants worked in groups according to their project or Hospital. This meant that they could all keep and use their learning pieces. They started with making benches; a good exercise to practice basic techniques helpful for physiotherapy too.

By the second week everyone was in full creative flight with earth paints, traditional Ghanaian designs and hundreds of magazine pictures! We also had an exercise to underline the engineering principles that are used to make the weak materials of cardboard and paper into strong and safe weight-bearing items.

Participants showed each other what they were making and explained the reasons.

Exhibition and Cerebral Palsy Awareness -raising

Our big Exhibition and Awareness-raising programme on cerebral palsy was organised for the last day. Raising awareness is an integral part of Cerebral Palsy Africa’s work. The Exhibition gave us the opportunity to showcase the equipment and demonstrate that things can be done to facilitate the children to function better and enable families to work more effectively with their children at home. Many friends and visitors came including the British High Commissioner, Nick Westcott. Thanks to all Margriet’s networking a large number of the press came with the result that the message of hope and action for people with cerebral palsy was on the TV news and in the newspapers.

Continuation

People are making items now at the New Horizon Special School in Accra and there is news of planned workshops in Sunyani and Abor.

Ghana Information relating to Cerebral Palsy

Ghana has a population of over 23 million people and a life expectancy at birth of 59 years. 75% of children go to primary school (World Bank statistics). However for every 1000 live births there is a probability of 120 infants dying compared, for instance, to 6 in the UK. Between 1999-2006 16% of children had a disabi(http://www.unicef.orglity
/infobycountry/ghana_statistics.html)

This means that there are many families with a disabled child. It is estimated that in developing countries there is 1 in every 300 babies with cerebral palsy.

It was interesting that a number of people on different occasions said that it is very common in Ghana for people to keep a child with cerebral palsy at home. This could be for a number of reasons including shame and fear related to the disability and other people incorrectly presuming it is in the family, congenital. Another reason cited was lack of hope. This could be linked to lack of good diagnosis and knowledge about the medical basis of the impairment. It could also be that parents do not have opportunities to find out how much can be done to help the child develop and prevent secondary disabilities. Therefore there was no reason to believe that the child can lead an active and fulfilling life.

However there are encouraging signs of awareness growing through schools like the New Horizon Special School, the work of the physiotherapists and Doctors, the push for Inclusive Education and the work of Disabled People’s organizations. Of course individuals with cerebral palsy themselves are concerned and trying to have their say (see Muktar’s article http://www.peoplepotential.org.uk/page8.htm). The parents are getting organized and there was a meeting of the Association of Parents with for children with cerebral Palsy at Korle Bu hospital – the Physiotherapy department can give information on the latest meetings. Some of the participants from the ACE training attended and were fired up with enthusiasm to help start associations in their places of work.

3 months in Ghana, an amazing experience 

Ghana is a country full of opportunities for physiotherapists. The treatment of children especially needs a lot of improvement. And not only the treatment, but also the knowledge of Ghanaian people in general about disability would be an important thing to work on. 

That was the reason that we went to Ghana, to establish an ACE(Assistive Cardboard Equipment)-workshop in Sunyani Regional Hospital. We are four physiotherapy students and in September 2008, we came in contact with Margriet Langeveld. She is a Dutch physiotherapist who has been in Accra (the capital) now for almost 2 years and helped with the establishment of an ACE-workshop. With Margriet we came to the plan to start a new workshop in the Brong-Ahafo region, in the interior of Ghana. Our contact there in Sunyani was Samuel Gyamfi, head of the physio-department, who studied in Amsterdam. Samuel was very enthusiastic about the plan (sometimes a little bit too enthusiastic, we had to calm him down at times!). 

In the 3 moths that followed we helped the people in Sunyani to establish the workshop. 2 people in Sunyani already followed the APT-course in Accra: Joseph Anfre (Jo the Carpenter, because he was an unemployed carpenter until then) and Joseph Prince (Jo the Assistant, because he was also a physiotherapy assistant). With the money that we collected in Holland, we bought the interior and all the tools that are required for an ACE-workshop. We also made a plan for Jo and Jo how to continue after the 3 months. That was the most difficult task we had, because many Ghanaians are used to the fact that financial help from rich countries won’t stop. Our plan was clear from the beginning: after 3 months, the Ghanaians have to continue with the workshop without our help. 

Besides that we also spent time informing the people in the region about cerebral palsy. We did this with the help of several local radio stations. The effect was overwhelming: one week after the broadcasting, the physio-department was not big enough to examine all the children who came with their parents. Parents of children that lay in a corner of a dark room for years, because the parents were ashamed of their child, now came out of their houses to discover the reason why their children were so different to other children.

Because of the increase of the child patients, we “upgraded” the child-treatment room. Now there are opportunities to give these children a future. 
But it was not all good what we saw in Sunyani. The first thing we discovered was that so much money had been spent on the building of the hospital. On the other hand, the medical staff (physiotherapy included) was not of the level that you should expect with such a building. The hospital was built with money from rich countries of course, but we asked ourselves the question why the money wasn’t spent in schooling doctors, nurses and physiotherapists. For example: Sunyani Hospital has two X-ray machines. One has been broken for several years! The room with the X-ray is now used as a storage room, because nobody knows how to repair the machine, or maybe there is no money for it. 

We were very happy when we heard from my former secondary school, Gertrudis College, that they want to collect money for children with cerebral palsy. They organized a cycle rally for the children on the school with the plan to look for sponsors.

We want to support Cerebral Palsy Africa with this money, with the reason that we believe that this organization cares about the future of the Ghanaian people (and not about the color of a hospital and nice lawns). 

Kim van der Aa
Iris Buijs
Daan van Weegberg
Mitchell van Doormaal