Expanding cleft care in Ghana

Building capacity

Dr Ampomah has taken part in over 25 surgical programmes, but importantly he has also been instrumental in building local surgical capacity in Ghana, training other surgeons and healthcare staff to address the need for plastic and reconstructive surgery in the country. The ultimate aim of this work is to bring affordable cleft care, closer to those who need it most with a hub and spoke model of care. 

When Dr Ampomah first found out about Operation Smile back in 2011, there were only a couple of hospitals able to provide reconstructive surgery, and cleft surgery was just one in a long list of other conditions requiring this specialty. As a result, resources were stretched to breaking point and very few patients were able to either afford or access the treatment they needed.  In addition to these barriers, geography was a challenge too – in a country the size of Ghana – how could cleft care be brought within reach of those whose nearest hospital may be many hours away?  

A positive impact

He explains, “Operation Smile came in at a good time to help us providing free surgery to people living with untreated cleft conditions. Seeing my first patient for Operation Smile, I knew that this was something impactful to the families, and I saw the kind of gratitude that patients expressed. Also, a lot of these patients were people who, given the kind of conditions that existed at that time, they would not have been able to access care because there was a huge financial gap. 

“When I came on board, what we did was to try and build local capacity in terms of cleft care. Initially, I was just the main surgeon for Ghana. Now we have about five or six surgeons who have been trained through the Operation Smile system.” 

Building a local team

Training programmes like this require time, skill and an investment in teaching and equipment but the rewards are clear – a huge increase in the number of people able to receive timely, and safe surgery.  Since Dr Ampomah has been working with Operation Smile, surgical capacity has increased, but also the multidisciplinary cleft care so necessary to ensuring the long-term health and happiness of patients. 

He tells us, “We now have regular nutrition clinics, orthodontics, dental and all the other specialties that make sure we give the best care to the patients and children we come into contact with. It’s been a very rewarding journey from that point of view. I also look forward to the future with hope because apart from the fact that apart from providing just surgery, I think we’ve also been able to build a local team involving the nurses and all the other workers, even child-life specialists.”

When Dr Ampomah first starting working with Operation Smile, just 10% of the medical volunteers were Ghanaian, and now over 70% are locals, which shows just how much capacity has been built already.  

Working in partnership

Dr Ampomah is chief executive of the Korle Bu Teaching Hospital and the hospital’s partnership with Operation Smile is central to increasing the number of patients able to access the cleft care they need. In addition to the cleft care that’s available during surgical programmes, patients are treated at the hospital in between surgical programmes so that locals can consistently get the cleft care they need.  

With a population of 32 million, the need for increasing the number of trained surgeons in Ghana is clear. There were only five plastic surgeons working in the country before Dr Ampomah became involved in the Operation Smile training programmes, and now there are 17, he tells us more: 

“We still need a lot more surgeons if we are to deal with all the other issues. It is a field that needs more people to get engaged with it. I think it’s a question of interest – it’s also a question of being ready to go the long haul because it’s quite a long period of training that’s required to become a plastic surgeon.” 

Challenges in training

Medical students in Ghana face stiff competition to get into one of only six medical schools in the country. Two of the available medical schools are also private which further reduces the number of students able to afford to train. Dr Ampomah explains: 

“Training in medicine generally is a long process. It takes a lot of resources for people to be able to go to. Those are some of the challenges that I think our medical students would go through in terms of from the financial point of view and also from being able to go to such a long training process. 

“In terms of postgraduate training, that’s if you’re looking at the impact on cleft care, for instance, then you look at people specializing in fields like maybe ENT or plastic surgery, reconstructive surgery, that kind of thing. That also involves another prolonged training programme.” 

Providing high-quality care

The Operation Smile training programmes have extended further than just surgery, and are helping to address the wider disciplines so vital for ensuring the best quality of life for a patient both before after surgery. Nurses, including pre op, post op and PACU as well as speech therapists are all an important part of the comprehensive cleft care that patients need.  

“Speech therapy is also one that is ongoing at the moment. In fact, through Operation Smile, we won a big grant to be able to improve speech training in Ghana, so we’re working with the University of Ghana and then with the Korle Bu teaching hospital to improve the quality of teaching, improve the faculty, and also to support the graduates from the speech training programme in Ghana. 

“All around, there’s a lot of work that’s gone into training local practitioners to be able to provide the high-quality of care, and we are very grateful to Operation Smile for their collaboration and the support that has enabled us to get to this point.” Dr Ampomah says. 

We look forward to catching up with Dr Ampomah in the near future to find out how the training programmes and mentorships are progressing, and to learn more about the hub and spoke model of care which is providing so successful in Ghana.