14th Report Working Visit to Berekum
Woforo dua pa a na yepia wed.
“It's when you climb a good tree that we give you a push.” It is a symbol of support for good causes.
The 14th working visit to Berekum, by Harm de Haan and Jules Schagen van Leeuwen, took place in Nov-Dec 2021.
Due to the Covid-19 pandemic, some time had passed since the 13th visit
(Feb 2020), and despite the fact that the pandemic is not yet over and
many hospitals in the Netherlands are experiencing logistical problems,
the situation in Ghana does not seem to be too bad at the moment. This
is despite the fact that less than 8% of the population in Ghana has
been vaccinated. The contrast between the way Ghana tries to keep the
virus out of the country, by requiring a negative PCR before departure,
repeating it upon arrival in Accra and requiring and checking a valid
vaccination certificate with a minimum of two vaccinations, and the
Dutch approach, in which there is no requirement or check after return
to Schiphol Airport, is striking. In addition, Ghana kept its borders
with neighboring countries closed for a long time. Upon return, a PCR
test had to be taken in Kumasi in time to get to Accra Airport in the
first place. Our question as to whether people had ever seen a positive
result at this last, certified test site, was answered in the negative.
That may say something about the reliability of the test, but in any
case, the willingness and discipline of Ghanaians to adhere to the
basic requirements, keep their distance, wash their hands etc, and wear
a mouth mask, is striking. Also, the contrast between the acceptance
with which Ghanaians accept the restrictive measures and the discontent
with which this happens in the Netherlands is great. But it is illusory
that one can prevent transmission with these rules in the small living
quarters where people bivouac in Ghana, and that also applies to the
overcrowded transport vans. The impact that infectious diseases can
have has disappeared from our collective consciousness in the West. In
Africa, this is certainly not yet the case. In addition, scientific
research in tropical Africa shows that the constant exposure to
parasites (e.g. intestinal parasites and malaria) puts the immune
system of many people on edge, enabling them to respond adequately to
the virus (1). In addition, the population structure has a relatively
very young population. In this part of Africa it is therefore the more
affluent and older people with low exposure to parasites, who are
overweight and hypertensive, who are at risk of a serious Covid
infection. Whether this picture will change as the virus mutates is not
yet clear. The hospital staff has been largely vaccinated with 2 Astra
Zeneca vaccines though. The isolation ward, where patients with
drug-resistant tuberculosis used to be cared for, often in combination
with an HIV infection, has been renamed the Covid ward. This was at the
instigation of the United Kingdom, which donated 4 breathing machines
to the hospital, exclusively for the treatment of patients with Covid.
At the time of our visit, no Covid patients had been admitted for 6
months. The respirators have never been used. Nor is there any staff
capable of operating these devices 24 hours a day. The daily
commercials on the radio in which the NHS, through recruitment
agencies, tries to encourage doctors and nurses to come and work in
England in order to solve their staff shortage are also shocking. This
is a blatant violation of the code of conduct drawn up by WHO to
prevent this, to which the UK is also a signatory.
Where have the multidrug resistant TB patients gone now ? No one knows.
What is clear is that in low and middle income countries many more
people now died and are dying from treatable diseases than from Covid
(2). And that the Covid measures are only making this worse. The
lockdown and curfew that they instituted in Ghana at the beginning of
the epidemic meant that many people could no longer come to the
hospital, nor dare they come, for fear of contracting the virus there.
The closure of schools and universities etc for almost a year caused
great damage. The Covid epidemic has shrunk the country's economy by
about 10%, with the poorest people hit relatively harder.
By now the mood has changed somewhat: 'it is not our disease' says the average Ghanaian, and the hospital is as busy as ever.
In the first wave there were 4 deaths in Berekum; a second wave has not occurred yet:
no large numbers of patients with respiratory distress, no sudden
deaths from respiratory problems. Despite the underreporting that is
bound to occur, large parts of tropical Africa seem to have been spared.
Meanwhile, the rebuilding/renovation of the delivery room complex
(which is what we had come for in the end), and the extension attached
to it, is almost complete. In addition to the previously delivered new
part (phase 1), and the renovated maternity ward (phase 2A), the
delivery room part (phase 2B) is now also ready. There is still some
painting to be done, but the moment was there to have an official
plaque unveiled by the bishop.
Upon completion, the entire building now has a usable area of over 3000
m2. There are now 8 delivery rooms, a neonatal intensive care unit.
Wards and rooms for pregnant women with problems such as high blood
pressure and pre-eclampsia, wards and rooms for women who have given
birth, teaching rooms, rooms and rooms for checks on pregnant women,
ultrasound room, rooms and rooms for the staff, an OR room for
emergency operations and 2 courtyard gardens.
Never could we have imagined that what we thought were such ambitious
plans could be realized. Seven years ago we promised Florence Agadzi,
then head of the midwifery training program, that we would do our best
to improve the conditions in which women in Berekum had to give birth
and in which her students had to be trained. And now, with the help of
many donors, including the contribution people made locally, a
beautiful building stands. A building that provides more and better
opportunities for training; for it is ultimately the qualities of the
people on the floor that determine the quality of care!
After painting, the patients will be redistributed throughout the
building, and the "conference room" will also be used for training and
transfers. The logistic processes will have to be adjusted a bit, but
then it might also be possible to have the antenatal clinic in this
building. With the contractor and the management it was decided that
the number of toilets and showers placed outside the building is too
low and that a drawing will be made to adjust this. Then there will be
a future-proof building where, besides clinical care, many training
sessions can be given.
After these developments, the University of Kumasi now sends many more
final year students (house-officers) to Berekum. But also the own large
obstetric training in Berekum, benefits from the expanded
learning-working opportunities which above all enables local women to
become mothers in a respectful and safe way.
With the new house-officers, the new medical officers and the two
present tropical doctors in training, a lot of surgery was done, with
Edward Mintah as always taking excellent care of the organization but
also of the anesthesia. Phantom lessons were given to the midwives and
the house officers. Conversations were held with the medical staff,
about care, training and the future. With the head of the delivery
rooms, Joyce Tachie, plans were made for even more cooperation between
the Netherlands and Berekum. We have great confidence in this
enthusiastic, modest and very knowledgeable midwife. The role of
midwives in monitoring the physiological partus needs to be
strengthened. Despite our previous efforts, the cesarean section rate
is not decreasing (now over 30%). Young doctors do learn how to do this
procedure in the beginning of their training, but much less when there
is a real reason for the sectio caesarea. They also have much less
mastery of doing vacuum extractions and breech deliveries. This will
have to be a challenge for the future. The same applies to getting
uterine cancer screening functioning again. Midwives can also play a
role here.
Unfortunately, the container that we had stuffed with medical equipment
together with some partner hospitals has not yet arrived in Ghana. The
boat had been delayed in Senegal. We could have used the many surgical
instruments in particular. The clamps with which we now had to operate
were sometimes a challenge.
In two rest days we visited the monastery in Kristo Boase, and then the
"hand-in-hand project" in Nkoranza; a place where mentally and doubly
handicapped children who were left behind/found somewhere in Ghana are
given a safe place and are cared for. Small houses furnished as
guesthouses make it possible to support this fantastic project.
See also www.operationhandinhand.nl The rest days were welcome. The
stay in the guesthouse, also a project of our foundation, was very
pleasant indeed, and we let ourselves be spoiled by our cook Peter.
Only at night, in the run-up to Christmas, there is an increasing need
for small evangelical religious denominations to use a 'public address'
system to demonstrate their adherence to God through an uninterrupted
stream of noise and hell and damnation sermons. Advice: take good
earplugs with you!
The way back was via the "Peace and Love Hospital" in Kumasi, also for
the taking of the necessary Covid-PCR. Dr. Beatrice Wiafre, also like
Lawrencia Dsane, was warmly thanked for the support and cooperation
given.
1. D. Wolday et al. Effect of co-infection with
intestinal parasites on COVID-19 severity: A prospective observational
cohort study. EClinicalMedicine 39 (2021) 1010
2. D. Bell et al. Relative Burdens of the COVID-19,
Malaria, Tuberculosis, and HIV/AIDS Epidemics in Sub-Saharan Africa Am.
J. Trop. Med. Hyg., 105(6), 2021, 1510–1515
13th Report Working Visit to Berekum
This visit took place between mid-January and mid-February, by Dr.
J. Schagen van Leeuwen.
For the report, please refer to the Annual Report 2020: click here
12th Report Working Visit to Berekum, Sampa and Hwidiem
From 6 to 20 October 2019, a team consisting of Lawrencie Dsone
(AIOS gynaecology), Sacha Evenhuis (gynaecologist in Assen), Heleen
Winter (midwife from the UMCG) and Harm de Haan (gynaecologist in
Zwolle) again visited Berekum.
Skills and drills were given to the house officers and midwives, who
were all exempted for this in the morning. In the afternoon, education
was given to the third-year student midwives at the school for
midwives. There were also daily surgeries with the house-officers and
tropical doctors (in training).
For the first time we stayed in the guesthouse, which was very
satisfactory. The space, atmosphere, location and possibilities of this
guesthouse are appreciated by many. We visited Dr. Isaac Doudu in Sampa
(where residents stay in the Fountain Care Clinic) and the ST.
Elisabeth Hospital in Hwidiem, almost two hours drive south of Berekum.
Also in this hospital there are good opportunities for internships for
residents: we received a warm welcome and made good plans with them.
In the weekend between both working weeks we visited Cape Coast where
we participated in the annual "awareness-walk" for breast cancer which
was organized by the "Peace and Love Hospital" in Kumasi. An impressive
event where an estimated 50.000 people participated and where a lot of
radio, TV and internet publicity was generated. Meetings were held with
the management, the Bishop of Sunyani, the contractor and Form Ghana.
The renovation of the Maternity ward is in full swing. Temporarily the
patients have been transferred to the new building, attached to the old
maternity. This has set in motion a logistical process through which
they seem to be skilfully making their way. The renovation is going
well and on schedule and the end result seems to be very nice,
especially when this building will be connected to the new one and the
available space will be a bit bigger again. Without the tremendous help
of Mr. Edward Mintah these weeks would not have been possible: all
coordination, appointments and organizational matters he picked up
quickly and we therefore owe him (again!) many thanks.
11th Report on Working Visit Berekum 26 February - 4 March 2019
At the end of February 2019, the 11e mission to Holy Family Hospital
took place. This time the team consisted of Dr. Arnold Kruse and Dr.
Vincent Jongen (gynecologists Zwolle) and gynecologist-in-training
Lawrencia Dsane. Highlight of this trip was the opening of the new
guesthouse. In this guesthouse, which for a small part is also
sponsored by Berekum Foundation, the residents of the Universities of
Nijmegen and Groningen / Zwolle can stay (their current residence is
about to collapse). In addition, there is room for visiting medical
specialists and for the Dutch tropical doctors in training who always
spend half a year abroad. The opening by the bishop was festive and of
course the opportunity was taken to discuss a number of current issues
with the bishop and the hospital administrator Sr Reena. The renovation
of the old maternity ward (phase 2) was discussed now that the
construction of the new maternity ward (phase 1) has been completed.
Another important event was the implementation of population screening
for cervical cancer. Women in Berekum were called via e.g. churches to
come forward. Specially trained nurses assessed the cervix and any
abnormalities found were immediately removed by Dr. Okine, the
gynecologist at Holy Family Hospital. Our role was to support the start
and set up of this, supervise the cervical clinic and train the
gynecologist in the treatment of the cervix. It is now intended that
this important prevention will continue after our departure and plans
have been made for this.
As always, we were involved in many operations, with the main objective
being to train the operating skills of the local doctors. Some ten
major surgeries were performed by us.
At the midwifery school we provided practical education (skills and
drills, suturing course) and thus some 80 students were retrained.
On the last day we visited the Peace and Love Hospital in Kumasi, where
Dr. Beatrice Wiafe treats patients with breast cancer from all over
Ghana! Here we also operated on an emergency gynaecological patient.
All in all, a somewhat short but very efficient and above all useful
visit!
10th Report on Working Visit to Berekum, December 2 to 14, 2018.
The team for this visit consisted of Dr Jules Schagen van Leeuwen
(gynecologist in Niewegein), Annet van Veen (gynecologist in
Harderwijk), Dr Harm de Haan (gynecologist in Zwolle) and Mr Henk de
Haan (treasurer Berekum Foundation).
The visit was planned around the celebration and opening of the new
delivery rooms (on December 6), as well as the 70th anniversary of the
hospital. To our pleasant surprise, the president of Ghana indicated
that he wanted to officially open the new buildings himself. This meant
that the official opening had to be postponed till 18th December, and
the team from the Netherlands could unfortunately not be present.
An unofficial opening took place nevertheless, and was attended by
the bishop, the architect, the contractor, the hospital management and
staff. Following this event, a meeting was held to discuss construction
and financial matters.
The hospital has ordered 65 beds for the delivery rooms. It is
expected that these will arrive early 2019, after which the move from
the old to the new building can be organised. The new building can
accommodate only a part of the patients from the old maternity wards.
Because of the logistics related to housing the patients, the
renovation of the old maternity wards will be done in two phases.
We also visited Form Ghana, near
Berekum, one of our annual sponsors.
Meetings were held with the house officers and the assistant doctor
in tropical medicine. The housing situation of the house officers is
currently not ideal and the assistant doctor also had to vacate her
temporary lodging to make place for a midwife. We have therefore
started with the construction of a guesthouse, which will provide space
for assistant doctors in tropical medicine, house officers, visiting
specialists of the Berekum Foundation (or from other organisations).
The walls of the guest house have already been built and it is expected
that the building will be ready early 2019. During the visit, we
discussed some adjustments with the contractor.
No additional training for the midwifes were planned during this
visit, because the midwifes were busy studying for their exams that
were scheduled to take place just before Christmas. This gave the three
gynecologists more time to support their Ghanaian colleagues with some
surgeries and to provide in-service training to one the younger
Ghanaian medical doctors.
In recent months, there was some unrest between various population
groups in Drobo. Therefore, for the time being, no house officers are
placed in the Drobo hospital. We nevertheless visited the hospital and
Annet van Veen supported Ghanaian staff with surgical interventions,
which was very much appreciated. We also visited Isaac Duodo,
paediatrician in Sampa. He provides great and enthusiastic support to
the Dutch house officers. We also visited the clinic which is being
constructed.
A very special visit was organised by Edward Mintah. He brought us
to the palace of the chief of Berekum. We were warmly received and
welcomed by the Queen-Mother of Berekum.
On our day of departure we met Mr Ron Strikker, Ambassador of the
Netherlands in Ghana. We informed him about the activities, the
presence of Dutch students and medical doctors, and our future plans.
He planned to attend the official opening of the new maternity wards,
as well as the celebration of 70 years Holy Family Hospital in Berekum.
Travel report from Sterre and Shari
The past three months we did our clerkship in the Holy Family Hospital
in Berekum. We have experienced a learning full but most of all
fantastic time. We learned about tropical diseases such as malaria,
tuberculosis, RVI and snakebites. We have never seen these clinical
cases before in the Netherlands.
Besides the clinical work in the hospital we went on outreaches with
FOHA and assisted at the UNCHR Fententaa refugee camp.
Furthermore we did a little public health research about Family
Planning. We distributed questionnaires among women in the hospital to
get an general idea about their opinion and usage of Family Planning
methods. We found out that many women doni't use contraceptive methods
because of the side effects. Especially infertility came out as a side
effect that restrained women from using contraceptives. We hope our
little research on Family Planning will be continued.
Besides medicine we learned many things about the Ghanaian culture.
The people are so friendly and welcoming, that we really felt at home
in the Berekum community. For example we learned how to dance like a
Ghanaian and we tried almost every dish from the Ghanaian cuisine.
However contrary to the Ghanaians, fufu will never become our favourite
dish, unfortunately. To conclude, we had an amazing time in Berekum and
would love to come back one day when we are graduated.
Report 8th visit to Berekum, February 10 to 23, 2018
On Saturday February 10, 2018, we left for Ghana with a team of six
people from the Isala hospital. Two orthopedic surgeons, Dr Jan van
Haastrecht and Dr Nico Groot, joined for the first time. Lawrencia
Dsane Bawuah, assistant doctor gynecology, and gynecologists Dr Hans
Beekhuis and Dr Harm de Haan were part of the team too. In addition,
Jopke Janmaat, house officer, joined and will stay for a 10 week period
in Ghana.
The orthopedic surgeons have worked for many years in Cameroon.
Unfortunately, that project location is no longer safe to reach and
they thus wanted to explore whether the activities thus far carried out
in Cameroon, could be moved to Berekum. Prior to the visit, discussions
were held with Dr Romeo Hussey, surgeon in Berekum, who would become
responsible for this collaboration. Dr Hans Beekhuis joined to provide
training to midwifes (from the Berekum region) in conducting echo's.
Five midwifes were asked by the hospital and the school for midwifery
to come to Berekum for this training.
After spending the night in Accra, we flew to Kumasi where transport
from the hospital was awaiting us to bring us to Berekum. We were
provided with rooms on three locations around the hospital grounds, and
had a kitchen to ourselves in a central location in between our rooms.
Peter, the cook, was again present to take care of our culinary needs.
The next day we were shown around the hospital grounds, met all
medical doctors, as well as the new internist, Dr Hagan, who was also
acting head because Dr Attu was on leave. We also met with management
and discussed the work schedule which was shared with management prior
to our arrival.
The orthopedic surgeons were accompanied by Dr Hussey, while the
gynecologists were supported by Dr Okine (the Ghanaian gynecologist).
During the first week, the surgeons noted the big need for training in
dealing with acute trauma. They also noted a lot of areas in the
hospital that could be improved: better screening prior to surgery;
improving surgery techniques and processes; or improving rehabilitation
and support of recovery following surgery. Many discussions took place
with Dr Hussey, and plans were made regarding how the collaboration
could be continued in the near future. This would mean an expansion of
the collaboration between Isala Zwolle and the Holy Family Hospital in
Berekum. Preoperative roentgen pictures could be taken, the plaster
facilities could be improved, and the physiotherapy unit could be
strengthened so that rehabilitation opportunities would become more
successful.
In the first week we also visited the St Mary Hospital in Drobo.
During the day, we supported various surgeries carried out by Medical
Doctors and a tropical doctor (who had screened patients ahead of the
day). The following day we participated in festive opening (and
blessing) of the new eye clinic in Drobo. While Hans Beekhuis provided
echo training to midwifes in Drobo.
We also visited the Fountain Care Clinic in Sampa, located in a poor
and isolated part of Ghana near the Ivory Coast border. Pediatrician
Isaac Duodu has the responsibility for this Clinic, where House
Officers from Zwolle are also working. We visited the very nice
accommodation, discussed further cooperation, the sharing of pediatric
protocols and more frequent visits.
Dr Lam Trang is a tropical doctor in training from the Royal
Tropical Institute Amsterdam and is also supported by our team in
Berekum. She has followed a year of surgery, as well as a year of
obstetrics training in the Netherlands. She will complete her training
with 6 months of tropical medicine in Berekum. Drs Hagan, Okine and
Hussey will supervise and appraise her work. Edward Mintah has
organized her accommodation on the hospital grounds.
On Saturday, 17th February, the two orthopedic surgeons left for the
Netherlands. The team that stayed behind, jointly with two House
Officers, made a trip to Mole National Park. We traveled through
Techiman, Kristo Boase and Kintampo and also visited the 500 year old
mosque in Larabanga.
The second week of our visit was oriented towards training. Dr
Beekhuis provided a daily echo training for midwifes. In the afternoon,
Dr Dsane, Beekhuis and de Haan provided training to third year
midwifery students. Obstetric emergency situations were practiced
during so called 'skills and drills' sessions.
The new construction of the maternity hospital is becoming
beautiful. The builders are using good and solid materials, the lay-out
of the new building is good with sufficient opportunities to connect
the new to the old building. Unfortunately, the construction has come
to a hold, because of insufficient financial resources. During
discussions with the constructor and the bishop, it turned out that the
disappointing exchange rate of the Cedi, and the fact that the
constructor had prefinanced building materials and was now waiting for
further payments, caused the temporary hold of the construction.
Following additional discussions with the bishop, it has been agreed
that the Berekum hospital will contribute its share to the construction
costs. After this, Foundation Berekum will have to raise additional
funds and contribute these to the constructions. The hospital in
Berekum will exist 70 year at the end of 2018. The management would
love to be able to open the new maternity ward at that occasion. This
is quite a challenge.
We held discussions with the management of Form International and
Form Ghana - a large reforestation company nearby Berekum. The aim was
to improve collaboration, provide training to the nurse working with
Form, while at the same time ensuring the financial support from Form
to the Berekum hospital (through Foundation Berekum) is valued.
On Friday, February 23rd, we left for Kumasi, flew to Accra and
returned to Amsterdam that same evening.
In conclusion, we were very pleased with this work visit. We
received a very warm welcome. The hospital staff had taken care of our
transport, food, accommodation, and had organized the training. We held
many meetings, regarding the construction of the maternity ward; the
collaboration with the orthopedic surgeons (in Berekum and in Sampa);
and the collaboration with the Royal Tropical Institute in Amsterdam.
The accommodation available for guests in Berekum is not ideal. This
accommodation may need to be improved, especially if we are considering
expanding the collaboration with additional tropical doctors in
training, and additional activities between Isala and Berekum. Better
accommodation would also allow others from Isala to join: technical
people for maintenance of equipment; paramedics to support
rehabilitation programs; other experts who can provide training to
Ghanaian medical specialists. Because teaching and training is and
remains our main objective it is important to give some attention to
this aspect.
 |
 |
The main entrance of the maternity ward,
of which the roof will be constructed next. |
The maternity ward under construction:
with the entrance on the right and the training and
conference facilities (where daily patient discussions
will take place) on the left. |
Report 7th visit to Berekum, November 2017.
By: Gunilla Kleiverda, gynecologist in Almere, Deodata Tijssseling AIOS
cluster Utrecht and Jules Schagen van Leeuwen, gynecologist in
Nieuwegein/Utrecht.
This was the 7th time a team visited the Holy Family Hospital in
Berekum. The team included three people: One gynecologist in training,
and two experienced gynecologists.
Throughout our stay, we gave several trainings. A training was
provided at the Nurse and Midwifery Training College, as well as to the
school in Drobo which is linked to this college. Over 100 midwifery
students received training. We provided some theory, but our focus was
on skill development through role plays of emergency situation during
deliveries. We addressed breech delivery, umbilical cord prolapse,
serious preeclampsia during pregnancy, massive blood loss during
delivery, and failure of progress during delivery. We also trained the
students in attitudes, behaviors, family planning and safe abortions.
School management evaluated positively the format of a full-time
training, involving all final year students. Because we have now been
providing this course around three times per year, students are more at
ease and manage to master the course content better in the available
time.
We also provided bedside teaching: visiting patients jointly with
the local staff, as well as teaching surgery skills to Ghanaian
doctors. Various surgeries were conducted by the team, including large
abdominal surgeries. During earlier visits the younger staff members
were trained in performing Caesarian sections. During this visit, we
stressed to only use a Caesarian when needed, to avoid overuse. The
local gynecologist, Emmanuel Nii Okai Okine (who is since a year the
only gynecologist in the district), plays an important role in ensuring
guidelines for this intervention are followed. Because of our presence,
Emmanuel could also spend more time on the quality of care, for example
the maternal and perinatal audits. In the meantime, the hospital also
has started using electronic patient records, and employed a person to
help enter all information, and to avoid doctors spend their time on
this administrative work. The Hospital matron stated: "doctor, I don't
want you to waste your time on a computer". There are many things we
can learn from Ghana!
In addition to all of the above, we provided ultrasound training to
the midwifes. Local doctors received a refresher course in this area
too.
In between all activities, we held frequent meetings with the
hospital management. The funds transferred by Foundation Berekum have
been used to lay the foundation of the new maternity ward. Funds have
been well spent. The aim is to build a maternity ward with 100 beds.
The current ward has 35 beds only, which is totally insufficient. We
inspected the construction side with our Ghanaian colleagues. After
completion of the new ward, the intention is to renovate the old ward.
Although progress was made with the construction, we realized that
the limited financial resources have slowed down construction. The aim
is to complete the roof by the end of the year, making sure that the
start of the rainy season in April will not damage the building. The
last rainy season, and a big storm, caused some serious damage to some
vital hospital buildings. The repair after the storm used up many of
the available hospital resources.
Each one of us had brought around 46 kilos of useful medical
material for the hospital from the Netherlands. This mainly concerned
materials requested by the hospital, such as equipment for the
operating theater to measure heart frequency, blood pressure and oxygen
saturation.
During the weekend, we visited the Bia National Park. Jointly with
our local project manager, Mr. Edward Mintah, and the driver, we went
for a long hike in the Park. We did not see forest elephants, but it
was impressive to observe how people manage to survive in and around
the jungle.
At the end of the visit we had a nice dinner with the hospital
management team. The final evening of the visit was spent at the KoSa
beach resort near Elmina.
In short, we spent again two very successful weeks in Ghana. Our
biggest concern for the near future is the lack of financial resources
to complete the construction of the new maternity wards.
Report 6th visit to Berekum, March 25 to April 6 , 2017
By: Maarten Glas, gynecologist Wilhelmina Hospital Assen; Vincent
Jongen, gynecologist Isala Zwolle;
Miriam Schubert and Emily Diekman, midwifes Isala Zwolle.
The team that joined the 6th visit to Holy Family Hospital in
Berekum consisted of four people: two midwifes from the Isala hospital
in Zwolle and two gynecologists. This time the visit focused on
midwifery training at the Nurses & Midwifery Training College,
which is affiliated with the Berekum hospital. The training course,
provided by the two midwifes and one gynecologist, was run three times:
twice in Berekum and once in Drobo. Each group consisted of 35
students, and we thus reached over 100 students with this training! A
small part of the training was theory oriented. The main part, however,
was oriented towards training of practical skills for midwifery
calamities using role-play.
Topics addressed included: breech birth, cord prolapse, preclampsia,
severe bloodloss, and prolonged labor. A lot of attention was also
given to issues of attitude and moral. During the course evaluation,
conducted jointly with the school management, positive feedback was
received on the format used - a full time training reaching final year
midwifery students. i
It might be possible to provide the same course annually.
The fourth team member (a gynecologist) focused mainly on bedside
teaching - judging patients jointly with local medical staff and
teaching surgery skills to Ghanaian physicians. Surgeries were
conducted jointly with Ghanaian physicians to expand their surgical
skills. Sixteen large abdominal surgeries were carried out. Following
the training, the local physicians were able to perform certain
interventions themselves, thus reaching am important learning goal.
In addition, around 16 midwifes and a local gynecologist, all
working in the Berekum hospital, received training in using ultrasound.
One of our gynecologists also spend a day in the neighboring hospital
of Drobo to provide further education in midwifery to a Dutch physician
specialized in tropical medicine.
In between all these activities, frequent meetings were held with
the hospital management. The construction of the new maternity ward,
partly financed by the Stichting Berekum, was discussed as well. The
hospital administrator, the contractor, the medical director, the
architect, the bishop, and one of the Dutch gynecologists attended this
meeting. The funds transferred by our association have been used to
construct the fundaments of the new maternity ward, and we could
establish that funds have been used well. We jointly inspected the
building site. The new construction is progressing well, and
construction work is being documented on video. The aim is to build a
ward that can accommodate 100 beds. The current maternity ward of 35
beds is totally insufficient for the future of the Berekum hospital.
The plan is to renovate the old midwifery ward after the new ward has
been finalized. It became clear to us, however, that we still have a
big job to do to secure the necessary funds to finalize all the
construction work. The construction work will continue in the phases
described above. Progress will be monitored during our half-yearly
visits to Berekum.
As during the previous visits, we also brought with us equipment and
materials for the hospital which it had specifically requested: for
example a machine to measure heart-frequency, blood-pressure and oxygen
saturation that will be used in the operating theatre; clothes to be
worn in the operating theatre (which will replace the old and often
torn clothes); as well drugs to be used during loss of blood (which
were not available). People were very pleased with all these materials.
During the weekend the team visited the Mole Game Reserve in the
north. In addition to the team, our local project manager (Mr Edward
Mintah), the driver, and the four Dutch house officers,
also joined us in the bus of the Midwifery School. We made up a merry
group of ten people who enjoyed the swimming pool of the lodge and the
elephants of the game reserve.
We ended the, highly valued, visit with a joint dinner with the
hospital management. The previous evening the team had already been
invited to the home of the bishop of Sunyani, a very honorable
recognition of the work conducted.
In conclusion: the mission was very successful and flawless. This
time we focused on midwifery skill training for midwifery students.
Besides this, it was important for Stichting Berekum to inspect the
construction process of the maternity ward and to discuss the next
steps with the bishop.
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Fifth working visit: 14 to 27 November 2016.
Team members: Aren van Loon, gynecologist Martini Ziekenhuis
Groningen; Hans van Unen, paediatrician Isala Zwolle; Lawrencia Dsane
Bawuah, assistant doctor gynecology UMC Groningen; and Harm de Haan,
gynecologist Isala Zwolle. Aren has been tropical doctor in Zambia,
Hans has followed his education as paediatrician in South Africa.
After a quiet flight to Accra, we continued our travel to Kumasi by
air the next day. In Kumasi a driver and car from the Holy Family
Hospital met us. The drive to Berekum took another three to four hours.
In Berekum we were again welcomed warmly and enthusiastically, as was
the case during our previous visits. The Holy Family Hospital had
organised housing for all four of us on the campus of the Nurses and
Midwifery Training College, located directly next to the school, which
was ideal for our training work. Peter, through the Holy Family
Hospital, catered for breakfast, while lunch and diner were organised
by the school.
Each day started at 7.30 am with a handover meeting. All doctors,
medical students and physician assistants participated in this meeting,
which now takes longer than before because much more time is devoted to
presentations and to the problems encountered during the night shift.
Participants also ask many more questions, which results in staff
coming well prepared to the meeting. In particular, the inputs from
Frank Gyamfi and Hussey (both surgeons), and Okine (gynecologist) have
contributed to this development.
Following the handover meeting, Lawrencia Dsane and Harm de Haan
visited the wards and provided bedside teaching. After each ward round,
the assistants and house officers followed the OK-programma. At the
same time, Aren van Loon and Hans van Unen taught nursing students as
well as 3rd year midwifery students. Aren also provided echo-lessons in
the morning to medical doctors and midwifes. This was very much valued.
Groups of students were split into small groups in order to receive
hands-on training (in delivery, stitching, reanimating a new born).
Our first weekend was spent in the Mole National Park, where we
enjoyed a bush walk and a safari drive. On the way back to Berekum, we
took the (very bad) road via Wenchi to Sampa, a remote part of
North-West Ghana. Hans van Unen stayed three days in the Fountain Care
Clinic in Sampa, where doctor Isaac Duodu runs a children clinic and
had organised an outreach programme for these days.
The other team members continued their travel to Berekum, where a
large conference was planned for Monday, 21 November. Led by the bishop
of Sunyani, the drawings for the renewal and rehabilitation of the
out-dated delivery rooms and maternity ward were discussed. The medical
staff; head of nurses; head of the midwifery school; hospital
management; building contractor; bishop; Lawrencia Dsane and Harm de
Haan were present. After four hours of discussing the various aspects
of the new construction and renovation, the soil, on which the
construction will take place, was blessed and the bishop and Harm de
Haan dug a first symbolic ditch. Following some final adjustments to be
made to the drawings, phase one of the building project will start in
January 2017. The financial resources for the renovation are already
available. During this first phase a new building, attached to the old
building, will be constructed. After phase one, patients will
temporarily move to this new part, so that the old building can be
completely renovated (phase 2). The third and fourth phase of the
renovation include a small extension to the maternity ward and the
addition of a midwifery operating theatre. The atmosphere during the
discussions about the renovation was very constructive and inclusive.
All participants contributed and jointly assumed responsibility to
complete the project within time and budget.
The remaining of the week was spent teaching at the midwifery
school, the echo-room and the operating theatres. In addition, patients
from Drub were sent to Berekum for surgery. Van Unen returned from
Sampan for the final lessons in reanimation for midwifes in training.
The week ended with a quiz for the 65 midwifery students. With great
enthusiasm, the students sang for the prize-winners and the teachers
received traditional shirts.
The last evening ended with a dinner jointly with the medical staff
and the hospital administrator. We all could look back at a very
inspiring and positive two weeks.
Early Saturday morning we took the plane from Kumasi to Accra. In
Accra, we met Mr Ger Steenbergen, the first secretary of health at the
Dutch Embassy in Ghana. We informed him about the collaboration
achieved so far, the teaching, the house officers in place, and our
objective for the collaboration: to support Ghanaian doctors and
midwifes in improving the healthcare for mothers and children in a
sustainable manner.
During this visit we saw a couple of new and important steps made
towards such strengthened healthcare for mothers and children.
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Management, medical staff, the bishop and others
from the Diocese, the staff of the school for Midwifery and members of
the Berekum Foundation, at the site where the new building for
deliveries, meternity and newborns will be located. |
Harmen de Haan symbolically starts the building
process putting the first spade in the ground. |
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Aren van Loon, gynecologist working in the
Martini Hospital ( Groningen ) teaches third year midwifery students
how to suture and tie knots. |
After two weeks of teaching the entire group of
65 students engage in a quiz. Hans van Unen, paediatrician from Isala (
Zwolle ) supervises. |
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Six weeks after birth there is reason for great
joy and thankfullnes. Mothers, neonales and sometimes fathers come,
specially dressed for this occasion, to the 40-days clinic to have the
condition of their child checked. |
During the conference on the new building and
renovation of the existing structure, the architect and contractor
presented the final drawings to the medical staff, management, bishop
of Sunyani, deans of schools of nursery and midwifery and the people
from the Berekum Foundation. Everybody was engaged, could make
suggestions for improvement and felt responsible for the final result. |
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Aren van Loon, gynecologist from the Martini
Hospital ( Groningen ) teaches in small groups of house officers and
medical officers, how to use the ultrasound in obstetrics. |
Waiting area for the out patient department. |
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Hans van Unen, paediatrician from the Isala
Clinic ( Zwolle ) supervises after the baby is born by caesarean
section. |
Aren van Loon, gynecologist from the Martini
Hospital ( Groningen ) participates in a saesarean section performed by
the senior house officers. |
Fourth working visit: March-April 2016.
In March 2016, another visit was paid to the Holy Family Hospital in
Berekum by two gynecologists from Zwolle.
We have by now developed a good routine for the conduct of our
‘missions’. Our suitcases were again stuffed with useful medical
supplies. This time, the Holy Family Hospital had specifically asked
for some surgery utensils, which we were able to bring along. These
were very well received. We also brought a second hand, but still very
usable, colposcope for Dr Okine, the Ghanaian gynecologist who has
recently based himself in Berekum. A colposcope can be compared to a
magnifying glass on wheels, and is very useful for obtaining a better
view of the cervix. We examined many outpatients jointly with our
Ghanaian colleagues, and provided a colposcope training to our
colleague. A lot of topics were discussed and, jointly with Dr Okine,
we planned the development of a cervical cancer screening programme.
We worked long days. Every day surgical interventions were conducted
jointly with the Ghanaian doctors. The aim is to train the Ghanaian
doctors in conducting the interventions, as well as to conduct
complicated interventions jointly. We thus managed to treat many women.
In addition, meetings were held with hospital management and the bishop
to discuss the targets of Stichting Berekum, including the construction
of a new delivery ward. The construction plan and budget needs to be
developed by the local staff. Clear ideas have already been developed
by the Ghanaians, and work on this will continue.
Towards the end of our stay, we spent a couple of days in the
neighbouring hospital in Drobo. This is a smaller, but very well
organised hospital, managed and equipped by the same diocese. During
these days, and at specific request of the Drobo Hospital, we performed
surgical interventions on a large number of patients, jointly with the
local medical staff. Part of this staff was trained by us the year
before in Berekum. From Drobo we also visited a children’s hospital in
Sampa, near the Ivory Coast border. At this hospital a Ghanaian
paediatrician is, all on his own, working towards improving medical
facilities for children. In Drobo and Sampa, we discussed with local
management the possibility of engaging medical students and house
officers from Zwolle in these hospitals.
After having said goodbye to the all the hospitable people in
Berekum, we visited Fort Elmina on the Ghanaian coast. This is the
place where in the 17th and 18th century many Ghanaians were
transported to Curaçao by the VOC (the Dutch East India Company). This
is a dark period in the Dutch history and it was impressive to reflect
on this during our visit of the Fort.
In November the 5th working visit to Ghana will be organised. Four
medical doctors, including a paediatrician, will join the team. The
visit will again be combined with training sessions in Drobo and Sampa.

The colposcope, to examine the uterine cervix, is reassembled after
transport from Holland to Ghana. |

The colposcope is being used again. |

Dutch and Ghanaian doctors doing surgery together. |

Consultation using ultrasound. |

Ghanaian doctors performing surgery, supervised by dr. Kruse from
Zwolle. |

The old deliveryrooms. |

The delivery ward needs a complete renovation. |

Ward rounds in Berekum with bed-side teaching. |
Report of the 3rd visit to Berekum, Ghana; 14-28 November 2015
by: Dr. Harm de Haan, Dr. Jules Schagen van Leeuwen, and Dr. Lawrencia
Dsane
We had high expectations in the run up to our third visit (within
the period of 1,5 year) to the Holy Family Hospital. And so had the
doctors, midwifes and management of the Hospital in Berekum. All
expectations were more than met, especially due to the excellent
planning and the real dedication of the staff in Berekum.
The local staff had, in anticipation of our visit, identified 40-45
patients for a surgical intervention. These patients arrived in small
groups of 4 to 6 a day, and had all been well informed by the local
medical doctors. Mobile technology has changed life in rural Africa!
All patients on the waiting list could be reached efficiently. In
addition to the ‘senior House officers’ from Berekum, a couple of other
doctors (who had already completed their training) stayed on because
they had heard they could learn a lot from our visit. Other doctors,
nurses and students thus also attended every surgical intervention
conducted by the ambitious Ghanaian doctors, under supervision of the
Dutch team. People were willing to invest time and energy. Prior to an
intervention, the surgical procedure was discussed, amongst other by
using video tutorials. So doing, the intervention could take place in a
safe manner. We did not experience any complications, despite the fact
that the patients presented rather complicated pathology, the surgical
instruments were of low quality, and the doctors were inexperienced. A
big thanks goes to the anaesthesia team led by Edward Mintah!
The afternoons were devoted to teaching at the school of midwifery,
as we did during our first two visits. Third year students were
regrouped in small groups of 8-9 students. In three parallel
classrooms, 56 students were thus trained with ‘skills and drills’.
Despite the late hour of the training, students really appreciated the
approach. An additional asset was that one of our team, Dr Lawrencia,
is Ghanaian and speaks the local language fluently.
Our accommodation in the guesthouse was again excellent. Peter
cooked delicious meals from ingredients freshly bought every day. Mr
Edward Mintah was in charge of the patients’ logistics, and did an
excellent job. We were also inspired by the visits to neighbourhood
hospitals in Drobo and Sampa. We met local doctors who tried, with the
little means available and a lot of energy, to run a health post or
small hospital. This deserves a lot of respect!
This was our first visit during which “house officers” , medical
students in the final part of their training, joined us. Sophieke
Olijve stayed in Berekum more than a month and really enjoyed it. The
‘medical student’ also impressed the hospital management, and it was
therefore decided to place 2 to 3 house officers from Zwolle in Berekum
on a continuous bases. They will be able to do their practical in
Social Medicine, Tropical Medicine and Gynaecology, during a period of
8-12 weeks.
On the way home, while traveling through Kumasi, we visited Bishop
Gyamfi in Sunyani to discuss the construction of delivery rooms. The
ones currently in use are old and dirty. They do not allow for
appropriate childcare, there is no privacy and no space for family
members. In addition, the current delivery rooms are not set-up for
educational purposes. In short, these delivery rooms need to be
renewed. The Bishop agreed and gave all his support. Of course the
problem is the financial aspect. The Ghanaian government is currently
facing real difficulties in paying the bills submitted by hospitals.
Delays of 9 months are possible. This situation makes it very hard for
hospital management to plan and reserve resources for renovation or
construction work.
Shortly after our return to the Netherlands, Florence Agadzi, the
head of the midwifery school, suddenly passed away at the age of 64.
She took care of course coordination, was our contact person at school,
and has been a good friend of Jules for 40 years. But above all, she
was a good and very kind human being, who taught generations of
Ghanaian midwifes the skills of the job. With her death, just before
her retirement, Berekum has lost a very capable professional and a good
human being.
In the meantime, the fourth visit to Berekum has been scheduled: in
March and April 2016 a team will travel to Ghana. A list with names of
house officers has been developed, each one them plans to spend around
8 weeks in Berekum in 2016. Finally, the annual charity dinner of
Zwolle, organised by the house officers, will be dedicated to raise
money for the delivery rooms in Berekum.

House Officer from Zwolle assisting at an operation. |

Education by Dr. J. Schagen to midwives. |

Dr. L. Dsana teaches doctors how to use echo equipment. |

OK Ghanese doctors at Dutch supervision. |
Second working visit: March 2015.
From March 21 to April 5, two Dutch gynecologists from the Isala
hospital in Zwolle visited Berekum. During their two-week stay at the
Holy Family Hospital they managed to conduct many useful tasks.
They brought with them medical devices and drugs, including a
coagulation device for use during surgical interventions, stitching
material, surgical clothing, metal specula, and a large supply of drugs
to fight loss of blood during deliveries.
The hospital in Berekum hosts a large midwifery school.
During the visit, the Dutch doctors trained 40 3rd year students.
Training was provided in groups of ten and focused on practicing the
delivery of obstetric care in an emergency situation. The same
programme was provided to a group of midwifes from the region. The
facilitators made use of DVD's specifically targeting the African
health care situation. These so called 'skills & drills' training
programmes were very much appreciated by the students.
In addition, a course on the use of echo was provided for midwifes
from the region. In many clinics echo making devices are available.
However, the knowledge to use the device in a correct manner is
lacking. The transfer of knowledge in this area was also perceived as
very useful.
Almost daily, surgical interventions were carried out jointly with one
and the same Ghanaian doctor.
Twenty women with uterine fibroids were operated. The Ghanaian doctor
was able to conduct this intervention by himself at the end of the two
weeks.
A good number of caesareans were also carried out jointly with Ghanaian
doctors. This allowed them to further improve their surgical skills.
In between the trainings and surgical work, regular discussions took
place with a large number of people to discuss the future plans of
Foundation Berekum. A possible renovation of the delivery ward was
discussed with Sr. Wilhelmina (head of the Sunyani Diocese) and with
the medical director of the Holy Family Hospital. An option would be to
set up an operating theatre within the delivery ward itself, to ensure
that in case of emergency the needed intervention can be provided much
faster.
It is expected that a Ghanaian gynecologist will start working in
Berekum in the near future. A discussion took place with her as well to
determine what the Foundation can do to facilitate her work, i.e.
through the purchase of medical equipment.
The two visiting Dutch gynecologists were very impressed by the
dedication of the local staff. They noticed that Ghanaian doctors often
visited their patients outside their official working hours. The local
doctors, midwifes and midwifes in training, expressed over and again
their appreciation for the Dutch gynecologists. The hospital's medical
director also expressed his enthusiasm for the support provided to the
various levels of the hospital.
It is clear that there is a lot of potential in this project. This was
already illustrated by the fact that almost immediately upon arrival in
Berekum, a next visit for the end of 2015 was planned. For this next
visit the focus could be on fistula-surgery. Loss of urine, caused by a
hole in the bladder, after having given birth, is a very unpleasant
disorder. Especially for young women this may mean exclusion from
society and may result in a life lived in poverty. In the north of
Ghana, fistula of the bladder is a frequent and stigmatising disorder.

In the operting theatre. |

Visiting the patients. |

Training the 3rd year students. |

Group training provided by Dr. Jongen. |

Providing guidance during a patient visit. |

Graduated students receive hands-on training. |
First working visit: Juni 2014
In June 2014, two Dutch gynecologists visited the Holy Family
Hospital in Berekum. The pictures below give an impression of that
visit.



Unfortunately, the planned visit for September 2014 did not take place
due to the Ebola outbreak.