So No Child Must Wait

Site Evaluation: Test Driving Interplast Grand Rounds

Test Driving Interplast Grand Rounds
Originally uploaded by interplast.

The Korle Bu Teaching Hospital in Accra, Ghana is the largest hospital in all of Ghana. Plastic surgery has its own unit in a separate building, with 70 beds. They also have their own surgical theatre.

They treat, as in Kumasi, many truamatic injuries, multiple types of skin ulcers, including Buruli's, which is endemic to here and Kumasi. The chair is Dr. Albert Paintsil, shown here "test driving" Interplast Grand Rounds, which he is very enthusiastic about. He also is interested in our Visiting Educator program, and has picked out some topics. His two associates, Dr. Laing and Dr. Mork are also plastic surgeons here. Their cleft work is supported by Transforming Faces Worldwide, with whom we also have a relationship.

Site Evaluation: Interplast, International Aid and J&J

Staff (L to R) Interplast, International Aid and J&J
Originally uploaded by interplast.

I visited Korle Bu Surgical Skills Teaching Center located at the Korle Bu Teaching Hopital. It is a separate structure completely refurbished and equipped by Johnson & Johnson and International Aid (a US based charity). They both continue to support the center and its program. The center is used to teach surgical courses for physicians all over Africa. There are plans in the works to expand the teaching program over the next two years. I met with two representatives of International Aid and with a representative of Johnson & Johnson. We had a long and very fruitful discusson of how Interplast might be able to participate in future teaching projects. International Aid is very enthusiastic about our input. The center has four surgical tables where practice surgery is performed using animal subjects.

Site Evaluation: Astonishing Cleft Story

Pius and I Looking at a Patient
Originally uploaded by interplast.

We also saw two patients, more had been told to come, but didn't...maybe they were afraid, shy or embarrassed. We saw one girl with a cleft and another with a Tessier cleft of the face. Pius also would like her posted on Interplast Grand Rounds. All in all a very intriguing story, with much yet to be learned. His preliminary study suggested there is a great deal of intermarriage in this complex of villages. If all this cleft story were indeed true, it would be truly astonishing...and as a realist with a scientific bent, surprising.

But regardless of the story, we know there are some clefts, and Pius plans to work to get them repaired.

Site Evaluation: Remote and Poor Village

Local Ghanaian Girl
Originally uploaded by interplast.

The village is very remote and poor. The dwellings are mostly mud hut type structures with thatched roofs. Chickens and goats wandering freely, small children everywhere. Some children are in rags.

Site Evaluation: Hundreds of Clefts

Village Head And His Associates
Originally uploaded by interplast.

Pius discussed with the head man
and his associates (the head man, shirtless on the left, his assistant in the middle, and the village announcer on the right with the grey beard) the cleft situation. The announcer travels to all the villages in this grouping and he tells us there are "hundreds of clefts." But there is a great stigma to their being seen. Again, I remain skeptical, but very interested. Emma, his AA as discussed in the last series, is a very intelligent young woman, and a sociology major. She is working on devising a plan to do the study this year.

Site Evaluation: Meeting The Locals

Ghanaian Girl In Need Of Interplast's Help
Originally uploaded by interplast.

We went off the main road on a track into the bush (we of course were in a four-wheel drive vehicle). Pius had, though intermediaries, arranged to have the head man meet us in the main square of one of the villages, with some villagers who had clefts. We were not sure is this would actually happen. We
came to the village at the appointed time. Several villagers were indeed
there waiting. Three wooden benches were arranged in a U shape. A traditional greeting was done...Pius would say in EWE (the local language) a phrase and the villagers would respond in unison. Four different phrases were said with responses. We then walked around the bench and each of us shook each of their hands. Then we were seated and they all walked around and shook our hands.

Site Evaluation: Villages Full of Clefts?

Local Kids
Originally uploaded by interplast.

If Sogokope is off the beaten track, and Denu is way off the beaten track, our final stop for the weekend barely has a track. Pius has been intrigued by anecdotal stories of villages in an area called Wudoaba, also near the Togo border, but north. The stories suggest there are a great number of clefts in the area, more than expected by the population. He has done a preliminary study, but really wants to do an extended survey/study. I may try to find a way to help him do this. Stories abound in this village area that there are many who speak poorly. Also, once a week a market is held at night. No one has ever encountered this in Africa, the suggested reason being that the people who come don't want to be seen because of their clefts. There is much superstition in this complex of villages. Although I am personally skeptical, the circumstantial evidence is of interest.

Site Evaluation: Lots Of Interest In Interplast Grand Rounds

  Ghanaian Baby With Cleft And Her Mother 
  Originally uploaded by interplast.

One of the young patients can be seen with her mother. The other is an 18-year old girl who had Noma as an infant. This a typical outcome. She needs extensive reconstructive surgery, and it is a very complicated problem.

Pius has asked me to post this case on Interplast Grand Rounds when I return. There has been great interest everywhere I have traveled in IGR...we will be adding a number of new participants.

This area of Ghana was a prominent slave market area. We also visited a Danish slave fort in Denu, right on the beach. The slaves from here were sent to St. Thomas, St. John, and St. Croix, the Virgin Islands then controlled by Denmark. The fort is replete with dungeons, chains on the walls, etc. A bleak and stark reminder of a sad past time.

Site Evaluation: Perfect Candidate For The Interplast Outreach Program

  Informing Patients Of Plans For Their Reconstructive Surgery 
  Originally uploaded by interplast.

We went to a place called Denu which is located directly on the coast of Ghana, about one kilometer from the Togo border. We saw a number of patients at a church. The church is really a thatched roof pavilion about 50 yards from the beach. We saw the patients in a back corner. Over the course of the weekend we identified about 20 patients for surgery. Dr. Pius plans to come to the regional hospital at Sogakope to do the surgery. This site is a perfect candidate for the Interplast outreach program. Dr. Pius is sophisticated and skilled enough that he would be an excellent candidate for the Interplast surgical outreach program.

Emma Gudhe, Dr. Pius' administrative asstistant can be seen talking with the patients and informing them of the plan for their reconstructive surgery. Dr. Pius hopes to bring a team down in a few months and do all of them.

Site Evaluation: No Plastic Surgery Services Available...Yet

  35-Year Old Ghanaian With Cleft Lip 
  Originally uploaded by interplast.

Dr. Pius then took me to visit Sogakope, a region near the border of Togo where there is a regional hospital. We spent two days there. The original plan was for me to fly back to Accra where they would pick me up to go on to Sogakope as they said the roads were very bad. But I told them that I would rather drive with them than go back on that same airline. So we drove 8 hours to get to Sogakope.

Dr. Pius is trying to establish an outreach program there as there are no plastic surgery services available in the area. The local doctors had arranged for us to see several patients when we arrived late in the day.

One was a six-day old infant with a cleft lip and no palate. Dr. Pius plans to repair it later. Also there was a 35-year old man with an untreated cleft lip.