Tropical medicine excursion for healthcare professionals

TROPMEDEX Ghana 2014

Professional development for healthcare providers in the field of clinical tropical medicine and travel

health is becoming increasingly important. There are now over 1 billion international tourist arrivals

around the world each year and 8.9 million short term resident departures from Australia

annually.

1,2

Increasingly, tourists are travelling to tropical and subtropical regions with known risk of

exposure to infectious diseases, yet studies have indicated that only about 40% of Australians seek

pre-travel advice from a health professional.

2,3

Approximately 13,000 refugees migrate to Australia

annually from Asia, the Middle East and Africa, a proportion of whom present with a variety of

infectious diseases.

Patient-focussed educational programs delivered in health care facilities in

endemic regions provide an invaluable opportunity for developing the necessary travel and tropical

medicine skills required in Australian clinical practice.

One such program held in Sub-Saharan Africa is TROPMEDEX (Tropical Medicine Excursions), led by

Dr Kay Schaefer (MD, PhD, MSc, DTM&H), a German consultant in Tropical Medicine and Travellers’

Health. Over the last 20 years, he has organised 45 Tropical Medicine excursions for over 450

international healthcare professionals to Kenya, Tanzania, Uganda and recently Ghana. In

collaboration with leading university teaching hospitals and medical institutions in Africa, Dr

Schaefer and local experts provide on-site bedside teaching, give lectures, and lead laboratory

sessions. The program encompasses epidemiology, clinical manifestations, diagnosis, treatment,

prevention and control of Africa’s most significant infectious diseases.

Initially a TROPMEDEX Uganda 2013 participant, the author of this article returned to Africa as a

participant of the TROPMEDEX Ghana 2014 excursion, joining 10 medical colleagues from Austria,

Canada, Germany, Sweden, Switzerland and the United States of America. The 11 day round-trip in

Ghana began in the capital Accra, proceeded to the Volta region, continued on to Kumasi, home of

the Ashanti Kingdom, and via Cape Coast returned to Accra. This covered approximately 1200km on

bitumen roads in an air-conditioned minibus, driven by an experienced local driver.

Dr Schaefer’s opening lecture was dedicated to the Ebola virus disease (EVD) outbreak in West

Africa. Multiple factors contributed to the rapid spread and high mortality rate in resource-poor

Guinea, Liberia and Sierra Leone, including poor preparation for a newly introduced infectious

disease, highly porous interconnected borders, dense populations, complicated contact tracing,

traditional burial practices, and damaged health infrastructure due to decades of conflict. One of the

participants also presented her experiences in Liberia during the EVD epidemic. Ghana has never

experienced a case of EVD, however high alertness was evident. On the road to a sophisticated

laboratory capable of diagnosing EVD in the Greater Accra area, large billboards displayed

information about the prevention and control of Ebola.

After a morning lecture on schistosomiasis, we

drove to Akosombo. Since the creation of

Akosombo Dam and Lake Volta, schistosomiasis

haematobium has been widespread in the Volta

region, being particularly prevalent in school-aged

children. During a boat ride on the Volta River, we

visited a fishing village and came to appreciate the

challenges involved in prevention and control of

schistosomiasis in this region.

In the Volta Region, we visited Jonathan Porter at

Kpong airstrip. He is a British pilot, who in 2006,

founded the non-government organisation Medicine

on the Move. Utilising air-drops, he and his

inspirational Ghanaian wife Patricia distribute medical

equipment and medicines to remote villages that are

inaccessible by road. The organisation also provides

community-based healthcare education.

During ward rounds at the Agogo Presbyterian Hospital, the oldest mission hospital in Ghana, we

reviewed a post-operative 9 year old female patient in the intensive care unit (pictured), who had

presented the day previously with an acute

abdomen. Intestinal perforation of ulcerated

Peyer’s patches in the distal ileum, a

complication of typhoid fever, was confirmed in

theatre. We reviewed teenage siblings with

suspected Buruli ulcer, a 14 year old male with

end stage multiorgan failure, and an infant with

cerebral malaria who presented with high fever

and convulsions. Malaria is the leading cause of

death in Ghana.

Several days later we reached Cape Coast, a

university town and fishing port on the Atlantic

Ocean. Signs of lymphatic filariasis were

evident within the community, despite the

Ministry of Health’s implementation of the mass

drug administration program of annual

albendazole and ivermectin. At the Cape Coast

University Teaching Hospital, we reviewed a

female patient with secondarily infected

lymphatic filariasis complicated further by

osteomyelitis. Lower limb amputation was

pending.

Diarrhoeal diseases continue to contribute to morbidity and mortality in Africa. A large, white tent

on the front lawn of the Cape Coast University Teaching Hospital served as a reminder of the recent

cholera epidemic in Ghana in which more than 27,900 cases were reported, including 217 deaths.

Throughout the excursion, the dedication of the local medical professionals was strikingly apparent.

Often working with limited resources, highly knowledgeable, broadly skilled, inspirational doctors

provided insight into the Ghanaian healthcare system. Through hospital ward rounds, field

excursions and interactions with international colleagues, valuable lessons in clinical tropical

medicine were imparted, in the setting of this vibrant African country.

Dr Lisa Chapman MBBS FRACGP

Australia

References:

1. United Nations World Tourism Organization. UNMTO World Tourism Highlights 2014 Edition. Available at

http://mkt.unwto.org/publication/unwto-tourism-highlights-2014-edition [Accessed 8 March 2015].

2. Henderson J, Harrison C, Bayram C, Britt H. Travel advice and vaccination. Australian Family Physician 2015;44(1-2):14-15.

3. Heywood A, Watkins R, Iamsirithaworn S et al. A cross-sectional study of pre-travel health-seeking practices among travellers

departing Sydney and Bangkok airports. BMC Public Health 2012;12:321

4. Murray R, Davis J, Burgner, D. The Australasia Society for Infectious Diseases guidelines for the diagnosis, management and

prevention of infections in recently arrived refugees: an abridged outline. Med J Aust 2009;190(8):421-425

5. Centers for Disease Control and Prevention. Travelers’ Health: Ghana-Centers for Disease Control and Prevention. Available at

http://www.nc.cdc.gov/travel/destinations/traveler/none/ghana [Accessed 10 March 2015]

Forthcoming TROPMEDEX excursions:

Ghana 25

November – 5 December 2015

Uganda 14

February – 26

February 2016

Tanzania 13

March – 25

March 2016

Ghana 30

November – 10

December 2016

Further information check www.tropmedex.com

TROPMEDEX excursions are listed on the website of the:

American Society of Tropical Medicine and Hygiene

www.astmh.org >Education & Training >Events/Calendar

International Society of Travel Medicine

www.istm.org >Travel Medicine Meetings > Meetings Calendar > Courses/Educational Travel