The development of continuing education for trauma care in an African nation
Introduction
Trauma is an increasingly significant cause of death and disability in most developing countries, to which limited attention has been paid.11, 17, 18, 23, 26 A major emphasis does need to be placed on prevention, such as road safety. However, there is a definite role for low-cost improvements in trauma care.14, 15 A key component of such improvements is optimising training.
In developed countries, the Advanced Trauma Life Support (ATLS) course5 has been a cornerstone of efforts to standardise and improve trauma care.3, 6, 10, 25 This is a two-day continuing medical education (CME) format course, taken by doctors after the completion of their formal training. The ATLS course has been promulgated to many countries in Europe and to several middle-income developing countries, especially in Latin America. In at least one such setting, Trinidad, widespread and regular institution of the ATLS course has been documented to lower the mortality rate of trauma victims.1, 2
Thus far, the ATLS course has only been promulgated to two low-income countries (per capita gross national product less than £500), Indonesia and Papua New Guinea.10 The current estimated start-up cost of the ATLS course is £45,000 and is a significant barrier to initiating this programme in low-income countries, many of which have total health expenditures of less than £5 per capita.
Furthermore, other educational approaches are more likely needed to address the realities of low-income countries. These include the low-technology and resource-poor circumstances, as well as limited capabilities for referral. In many circumstances, general practitioners (GPs) are required to provide not only initial stabilisation of trauma patients, but definitive treatment as well. In many cases, this includes surgical procedures. In Ghana, rural GPs are routinely called upon to perform caesarean sections, laparotomy for typhoid ileal perforations, and small bowel resections. Educational approaches to optimise trauma training, taking into account such circumstances and realities, are needed.
Over the past 8 years, the Surgery Department at the Kwame Nkrumah University of Science and Technology (KNUST) has developed a trauma CME course oriented for the circumstances of rural hospitals in Ghana. We sought to evaluate how well the course is achieving its goals of imparting the essential trauma treatment skills to course participants and of improving how well they deliver trauma care.
Section snippets
Setting
Ghana has a per capita gross national product (GNP) of £180 (€260) and a population of 17 million, 60% of whom live in rural areas.8 Ghana's network of hospitals includes district hospitals which have 50–200 beds, serve rural areas of 50–100,000 persons, and are usually staffed only by GPs. Each of Ghana's ten regions has either a regional hospital or a tertiary care teaching hospital. Regional hospitals are 200–800 beds, serve populations of 1–2 million, and usually have one or more specialist
Background survey
Responses were obtained from 62 doctors at 31 rural hospitals, including 16 doctors at 4 regional hospitals and 46 at 27 district hospitals. The hospitals were located in seven of Ghana's 10 regions. These doctors had graduated a median of 6 years (range 1–27 years) previously. They were all GPs and their training included a 1–2 year house job (rotating internship). In the ideal circumstance, they should all have passed through four major 6-month rotations. In reality, they had passed through
Discussion
The goals of this study were to assess the effectiveness of a trauma CME course that had been locally designed to meet the needs of rural African hospitals. In part, this assessment was intended to provide feedback for the ongoing development of this course. In part, we hoped the assessment would provide information that those working in other low-income countries might use in their own efforts to improve trauma care. Before drawing conclusions from the data, the limitations of the study must
Acknowledgements
Supported by funding from the John Davis Research Scholarship of the American Association of the Surgery of Trauma, for the research and development for the course. Supported by funding from the Ghana Ministry of Health, for the conduct of the course. The authors thank Dr. D. Dovlo and Dr. K. Segoe from the Ghana Ministry of Health for their assistance in arranging this course; Prof. Dr. Dr. G. Brobby, former Dean of the KNUST School of Medical Sciences, for his advice and guidance. We thank
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