Executive Spotlight: Teaching the Teachers: Notes from the AAWC Global Alliance Program in Ghana

     During opening ceremonies for the 2005 Sympoisum on Advanced Wound Care (SAWC), the Association for the Advancement of Wound Care (AAWC) announced that its mission was about to enter uncharted waters. The AAWC was going global. As with any new idea, this news was met with both emotional support and caustic criticism. To quote Joseph Campbell, “The big question is whether you are going to say a hearty yes to your adventure.” The members of the AAWC responded to the Global Alliance adventure with a hearty yes. We now have established active volunteer teaching sites in Cambodia (two), India, Peru, St. Lucia, and Ghana. Of very special significance, we have teamed with the World Health Organization in creating the Global Initiative for Wound and Lymphedema Care (GIWLC).      In February 2009, with the sponsorship of the AAWC Global Alliance and the WHO-endorsed GIWLC, teaching seminars devoted to wound care and lymphedema were conducted in Ghana, West Africa. Faculty included Terry Treadwell, MD; Mary Jo Geyer, PT, PhD, CLT; Janice Young, RN, WOCN; and myself. Seminars were conducted in the university teaching hospitals in Kumasi and the capital, Accra. Each 2.5-day seminar included didactic lectures and 3-hour hands-on workshops. Workshop attendees represented hospitals from all regions in Ghana and comprised a balanced mixture of physicians, nurses, and physical therapists, each enrolled by invitation. Some had driven 8 to 10 hours over difficult terrain to attend. We were delighted and inspired by the fervor of their involvement. From the beginning of the seminars, we stressed that we — the “experts” — were in Ghana to learn as well as to teach. The goal set was for this team effort was to create wound and lymphedema centers of excellence for Ghana. We also emphasized that the format for these seminars would be used as the template for future WHO/AAWC global teaching interventions; therefore, we encouraged questions, advice, and critique of the educational content and style of presentation. A review of the planning and logistics experienced in Ghana will be very important for the success of future interventions. Each nation, obviously, is unique in culture, medical politics, government involvement, teaching facilities and travel realities.

Advance Preparation: Find Your Champion

     From the experiences of Health Volunteers Overseas (HVO) and the influence of the World Health Organization (WHO), we learned the importance of a preliminary site visit and the value of identifying a local champion. Site visits completed by the AAWC Global Alliance have been financially supported by member donations received during SAWCs. The Ghana site visit, completed in July 2008, was funded by the WHO with logistical support from the WHO Buruli Ulcer office in Ghana. At that time, Dr. Treadwell, Dr. Geyer, and I spent 10 days evaluating the needs and expectations of the clinicians in Ghana. We were hosted by the Plastic Surgery Departments of the primary teaching hospitals in Accra and Kumasi. Additional visits were made to three isolated regional hospitals in central and southern Ghana. In each hospital, we did clinical rounds with the medical teams, exchanged ideas, and in Kumasi and Accra provided power point presentations. We also met with representatives from the Ministry of Health and the Ghana WHO authorities. Unexpectedly, we found ourselves in a national talk radio station, answering questions related to our observations in Ghana and the hope for our mission. Over the course of 10 days, we traveled, dined, and talked wound care and lymphedema. With our champions identified, we began to plan our return for formal training.

Formal Training Intervention: Keep It Simple

     Designing a curriculum for wound and lymphedema management in resource-poor nations can be a challenge. The first hurdle is for the teachers not to take the label expert too seriously because the experts in wound and lymphedema management in a resource-poor nation are themselves in a learning phase. As has been previously true in much of North America, wound care in most resource-poor nations consists of Betadine, acetic acid, dry gauze, and no compression. Because of filariasis, lymphedema management is a critical problem in these nations and must be included in any comprehensive curriculum. We have found that Wound Care 101 should include five basic principles that need to be stressed and expanded: • •      Comprehensive patient evaluation •      Avoidance of physical and chemical trauma to the wound •      Debridement and judicious infection control •      Moisture control •      Periwound edema/lymphedema control.      In designing this curriculum, we stressed the importance of using locally available materials for dressings along with topical agents and compression bandages. Much was learned by wandering through the ward supply rooms or by visiting local pharmacies and discovering bandages and supplies that were easily adaptable to our basic modern needs. Dr. Treadwell offered sessions on “How to Make Your Own Unna Boot,” “Growth Factors — Right Here, Right Now!” and for moist wound healing, “Vaseline Gauze is Gauze + Vaseline.”      A multidisciplinary team is ideal for formal training sessions, such as the ones provided in Ghana, where we had two MDs, one PT, and one RN. Of special note: our RN/WOCN teacher was Janice Young, representing KCI. Before our arrival in Ghana, KCI graciously donated two new VAC systems and one year of support supplies for each. These gifts were formally presented to the Chairs of Plastic Surgery in Kunasi and Accra. KCI is the first biomedical corporation to donate and become involved with this AAWC /WHO initiative — a shining example of the best in medical cooperation and one we believe others will follow. We congratulate KCI.

Future Plans

     The teaching model presented in Ghana represents a work in progress. Each future location will require innovative thinking and flexible adaptation. We believe a design that includes 1) site visit, 2) formal seminars, and 3) repeated volunteer visits for re-assessment and mentoring is a realistic formula for success. Planners and participants appreciate that economic restraints and the availability of volunteer teams will determine the realities of interventions. Certainly, opportunities abound for solo interventions by qualified volunteers.      We are encouraged by the recent response volunteers received in each of the established sites. In Ghana, for example, we were informed that both of the university teaching hospitals were making plans for establishing outpatient wound-lymphedema clinics. Ghana is looking forward to extending a warm welcome for future teaching volunteers.      The globalization of modern wound and lymphedema management is about to take a giant step. The chronic suffering, disability, isolation, and limb loss resulting from inadequate or improper care for millions of men, women, and children will be alleviated — not by unaffordable medications, and dressings, difficult to learn techniques, and or transient experts but from sharing knowledge of the basic principles of wound and lymphedema management, techniques for application, and the teamwork of both national and international clinicians.      The adventure is just beginning! For Dr. Treadwell’s thoughts on this adventure, please read the April 2009 issue of WOUNDS.