Ghana is a West African country with 20 million inhabitants. It is an English speaking, peaceful and religious society with a stable government. It is famous for gold, cocoa, and historically, slave trade.

Maternal mortality in Ghana is 540 deaths/ 100,000 live births (according to the United Nations Children’s Fund 2004). The leading causes of maternal death are acute hemorrhage, sepsis, pre-eclampsia, obstructed labor and non-hemorrhagic anemia.

Interventions to prevent maternal death need to occur at the governmental policy making level, in healthcare systems and at the community level. 



The site visit
In November 2004, four anesthesiologists representing Kybele, Inc, the Society for Obstetric Anesthesia and Perinatology (SOAP), and the Obstetrics Anaesthetists’ Association (OAA) visited Ghana at the invitation of the University of Ghana’s teaching hospital, Korle Bu, to seek information and identify opportunities for collaboration to reduce maternal and neonatal death and suffering. 

The preliminary visit consisted of a tour of 3 hospitals: Korle Bu Teaching hospital, Accra, Ridge Hospital, Accra, and Central Regional hospital, Cape Coast. Staffing, training standards, facilities, equipment availability, and the conduct of anesthesia were observed. The group participated in a 1 day anesthesia seminar on maternal mortality and a 3 day pediatric seminar on neonatal resuscitation. Sixty delegates from southern Ghana attended the courses. The seminars were highly evaluated and the participants requested that this be an annual event. There was very active discussion with anesthesia, obstetric, pediatric, nursing and administrative staffs regarding future collaboration and needs in order to reduce maternal and neonatal mortality. Cultural and local issues impacting health care were identified.

A significant and recognized cause of mortality is delay in receiving medical attention.  The delay is recognized to be delay within the community, delay in transportation to medical facilities and delay within the medical facility.  We discussed that effective pain relief during labor and good labor and peri-operative care can be a strong motivation for laboring mothers to seek hospital help early.  Labor pain relief in Ghana is not routinely provided. We proposed that the introduction of safe regional analgesia and anesthesia at affordable costs will significantly encourage mothers to come early. This may trickle back to reduce the out of hospital delays currently observed. The provision of safe and effective pain relief in labor is also a fundamental right of women who should not be allowed to suffer unduly.
According to Dr. Frank Boni, Korle Bu Department of Anesthesiology, “some women in Ghana resent their husbands and babies all of their lives because of their traumatic birth experience”.

In addition, birth asphyxia is a leading cause of neonatal mortality and efforts should be undertaken to teach and improve resuscitation of the newborn.  We emphasized the importance of identifying those who attend the baby on delivery and assess their experience. We also emphasized the importance of effective maternal resuscitation on admission to improve the condition of the baby.  Most concerning of all is the lack of urgency that naturally develops in health care workers who have seen so many bad outcomes and deaths. The later point can be self-fulfilling, given that the folk who see these outcomes are often least equipped and trained to effectively intervene and thus alter these outcomes.

  
Following the site visit, a 5 year strategic plan was developed for the recruitment of doctors and nurses for yearly Kybele on-site training missions. The primary goal of Kybele is education; our vision intends to impact mortality by teaching and collaborating in the acute management of the pregnant woman and in the resuscitation of the newborn. 
This goal is in accordance with the Ghana health services, the WHO and the UN agendas.


The Kybele team arrives
In keeping with the strategic plan, a team of 12 arrived in Accra, Ghana January 18-28, 2006. The group consisted of anesthesiologists, a neonatologist, an obstetrician, a professional photographer and a business planner.

Dr. Medge Owen, team leader, Wake Forest University
Dr. Yemi Olufolabi, team leader, Duke University (originally from Nigeria)
Dr. Vernon Ross, Wake Forest University
Dr. Margaret Sedensky, University Hospital of Cleveland
Dr. Cyril Engmann, University of North Carolina (originally from Ghana)
Dr. Holly Muir, Duke University (originally from Canada)
Dr. Wilson Chimira, University of Michigan (originally from Zimbabwe)
Dr. Emmanuel Yeboah, University of Saskatchewan (originally from Ghana)
Dr. Wendy Gore-Hickman, University of Saskatchewan
Dr. Dragic Kopic, University of Split, Croatia
Mrs. Shelby Turley, Business strategic planner, Winston-Salem, NC
Mr. Gary Smith, professional photographer, High-Point, NC


Following the conferences, the team was split into 3 groups to work for one week in Korle Bu Teaching Hospital, Ridge Hospital and Tema Hospital. The Kybele team worked side-by-side with Ghanaian doctors and nurses to care for mothers and newborns. According to one of the participants:

The trip was an amazing and emotionally stirring journey. Everyday we faced life and death drama... We quickly came to realize that neonatal resuscitation is a BIG issue there. The nurse midwifes are essentially untrained in neonatal resuscitation. If a baby doesn't breath at birth, it dies. We successfully resuscitated 4 babies that would have otherwise died. The nurses were fascinated with it all, to them, it was as if we were bringing a dead baby back to life! One of the "saved" babies was named Kybele! Needless to say, we spent a lot of time on neonatal resuscitation, especially bag/mask ventilation with the nurses.

We gave numerous lectures and practical demonstrations on neonatal resuscitation and on the management of high risk obstetric problems such as hemorrhage.  Spinal anesthesia was safely demonstrated for cesarean section (see picture) and regional pain relief was provided for women in labor. We were wonderfully received by our hosts, the US Embassy and USAID. We were visible at the national level in Ghana both through the media and meetings with high ranking officials. The director general of the Ghana Health Service sponsored a dinner for us and personally attended. There is a lot of enthusiasm for a return visit next year. 

We also identified (with help from the US Embassy) 2 charity organizations in Ghana that sell handicrafts to support women and children’s causes. These are The Celestial Needy Children’s Program (assistyouth @ yahoo.com) and Global Mama’s. Kybele wants to provide ongoing support to these organizations. We made many purchases and were informed that due to our generosity, 2 additional women were employed and 3 children were able to attend school. We want to find ways to continue to support these worthy charities. 

Following our visit, Dr. Michael Quaye of Ridge Hospital wrote:

My wonderful and beloved friends from Kybele, I miss all of you. I wish you were still around to share this wonderful fellowship. I want to thank all of you for the good work done for our people. We are very grateful. You've shown us that with the little we have we can still achieve much and be safe. I am particularly grateful for the organizational work done in the labor ward and in the theatre. The lectures were excellent and practical, tailored to our needs. Our nurses have not forgotten DRY-SUCTION-STIMULATE in the care of the newborn.
I don't know how to thank all of you.

The health care needs in Ghana are many. What is the way forward?  According to Ghanaian Dr. Frank Boni, clear policies and guidelines need to be developed in Ghana, in addition to workshops and seminars to better educate the medical professionals.  There needs to be a subspecialty development in the field of obstetric anesthesia and high risk obstetrics and better education in neonatal resuscitation. 

We will work towards more organization and collaboration between the medical professions of midwives, nursing, OB/GYN and anesthesia in the care of the mother and newborn.


Kybele is committed to a 5 year collaboration to help the health care providers in Ghana realize their goals of reducing maternal and newborn death. We are anxious to return.

More information
Learn more about Kybele, Dr. Owen and about Kybele's work in Turkey and Croatia.