Zambian Link update September 2023

Since 2020 an informal link between WGSP and the University of Zambia (UNZA) / University Teaching Hospital (UTH) in Lusaka, Zambia has developed: the Zambian team are developing a neurology training programme including a focus on stroke.  In July 2023 a Letter of Agreement was signed between WGSP and UNZA / UTH outlining the relationship which includes sharing of resources, knowledge, and experiences for the benefit of both parties.

In order to support Zambian staff training ahead of the imminent opening of the first stroke unit in their country, during September 2023 two Zoom calls were facilitated between nurses from KBTH in Ghana and nurses from UTH.  These took a semi-structured format with questions being asked about the experiences of the KBTH nursing team as the stroke unit there has developed from small beginnings to the widely recognised regional centre of stroke care that it is today.  Challenges and successes were explored and the positive impact on patient care was discussed.

The Zambian nurses engaged in the discussion with insightful questions and observations, reporting that it was one of the most helpful and best sessions during their training.

World Stroke Academy Webinar July 2023

This was the second World Stroke Academy (WSA) webinar that WGSP had been asked to host.  The first (Feb 2022) focussed on setting up the partnership and establishing a multidisciplinary (MDT) stroke unit at KBTH.  Members from across the KBTH MDT told their stories of how they have seen care and outcomes for stroke patients improve because of WGSP work.

The second webinar in July 2023 was an overview of the core skills training programme, how it has been implemented and the positive impact that it has had for both stroke patients and staff members working on the stroke unit at KBTH.  Members of the EFSTH MDT told of their experiences of being at the start of the training and implementation process.  Both teams explained the challenges and successes that they have encountered.

Both webinars were very well attended by people from all over the world, raising the profile of MDT stroke unit care and signposting others to resources to support them in developing their own teams.  WGSP hopes to host more WSA training events in the future.

Gambia Visit Jan 2023

In January 2023, Lucy, Louise S and Louise J returned to EFSTH and were delighted to spend another productive week with the team.  An early highlight was reviewing their skills retention and discovering that not only are they still practicing to a high standard all that we had taught them, the first 2 core skills are also being successfully cascaded to newer members of the team.  Anecdotally, they are already reporting a reduction in aspiration pneumonia and pressure sores, although collecting the data to back this observation up is proving a challenge.  The skills have been adopted so well that we felt confident to introduce a third core skill: continence management.

We provided further training materials including 2 laptops, as well as 3 additional slide sheets to help with positioning of patients.  We continued the small group teaching as well as presenting at a Grand Round, and also facilitated a virtual training session via Zoom on swallow done by Katherine back in the UK.  This model worked well, although we discovered that we needed to buy some external speakers so that the sound could be heard by everyone in the room.  This was rectified and it has proved a useful test for future virtual training sessions which are likely to be our main contact with the Gambian team over the next few months as we have not got any future visits planned at present.

During this visit, as well as the EFSTH VIPs, we were lucky to have the opportunity to meet with the Director for Health Services at the Ministry of Health (MoH).  He was interested in our partnership and supportive of the long-term goal to establish a stroke unit at EFSTH, although unfortunately stroke is not currently one of the current MoH priorities.

Before leaving EFSTH we agreed a programme of virtual MDT training for the year ahead and actions to be done before the next project planning meeting in March.  Overall, it was a very productive and busy week.  A highlight was being hosted by Louise Sarr’s lovely family for supper at their home.

Gambia visit Oct-Nov 2022

Since 2020 WGSP have been developing a new partnership with Edward Francis Small Teaching Hospital (EFSTH) in Banjul, The Gambia.

Lucy, Claire FS and Amelia were excited to be finally going on the first ever WGSP visit to meet our colleagues at EFSTH!  After months of virtual discussions and COVID restrictions, we were met by a warm welcome from the team.  The whole hospital was buzzing with activity as they were preparing for a visit from the West African College of Physicians: this occurred about halfway through our visit and resulted in EFSTH being given accreditation for resident doctor training.  A big achievement.

The 4 focus points for our 3-week visit were: to engage with senior stakeholders; to increase knowledge and awareness of stroke at EFSTH; to begin training in the first 2 cores skills of swallow and positioning; and to establish multidisciplinary (MDT) data collection.

During the visit we met many members of the EFSTH team from the high-ups (CEO, Deputy Chief Medical Officer, and the Chief Nurse) all the way through to the Chief Orderly, as well as nursing, physiotherapy, and medical staff of all grades.  The concept of MDT care was embraced and a multiprofessional stroke lead team was identified, including staff from both the main EFSTH site and the Ndemban clinic 7 miles up the road.  Ndemban is where the Emergency Department (ED) is currently operating from while the EFSTH ED is being rebuilt.

The hospital itself is much smaller than KBTH, which comes with pros and cons.  All staff know each other well and there is already a sense of working together for the patients.  A big challenge for EFSTH is the small number of local Gambian consultant doctors: many of the senior physician team are from other countries and some of them are only working at EFSTH for relatively short periods.  This can present difficulties for continuity of service development, but the team are working hard to make the most of the resources and opportunities that they have available.

The initial skills training went well.  Overall, we trained well over 100 members of staff in swallow and positioning during our visit.  Materials were provided for the team to continue to cascade training after we left.  Due to a lack of resources such as thickening powder for water, improvisations had to be made: powdered mashed potato was the best solution we could find for this!  As well as small group sessions we also delivered more formal Grand Round teaching to the medical staff which prompted good discussion and engagement.

Amelia spent time specifically with the physiotherapists, while Claire and Lucy focussed their time with the ward nursing staff.  Three slide sheets were provided to assist with patient moving and positioning.

It wasn’t all work and no play.  We were lucky enough to have time to go on some interesting visits to the surrounding country including learning about the historical slave trade from Gambia, and a wonderful trip upriver to see hippos!

Celebrating success...and World Stroke Day!

Lucy, Sarah and Claire have just returned from a week at Korle-Bu, reviewing progress and supporting the team both in clinical practice and with their training for staff at Ridge and La hospitals.  As always we were warmly welcomed and impressed by the good practice seen on the KBTH stroke unit.  Core stroke skills have become embedded here, and although there is always room for improvement it is heart-warming to reflect on the impressive progress made in MDT care over the last 9.5 years.

Training for staff at Ridge and La has gone well and key elements of stroke care were seen in practice at both hospitals: for example both have dedicated stroke beds; both have evidence of MDT documentation in place.  Ridge has unfortunately been subject to several changes in staffing which has impacted progress in recent weeks.  Despite this some improvements in care have been noted e.g. falling mortality and reduced use of catheters.  The KBTH team have a plan in place to support Ridge and to continue to develop sustainable practice amongst remaining staff.

The care for stroke patients at La has become demonstrably more coordinated: through this they have seen a significant reduction in both pressure sores and aspiration pneumonias.  Mortality over the last 7 months has been lower than predicted.  Staff are passionate about stroke care and have begun to disseminate their skills out to other staff within their hospital.

A stakeholders meeting was held on World Stroke Day (29/10/18) including representatives from all 3 hospitals, patient representatives, local and national media, and the Director of Ghana Health Service Non-Communicable Diseases.  Key updates from all parties were heard and the room was buzzing with enthusiasm for the future.  Special stroke t-shirts had been made with the FAST message on the back: this resulted in a lot of excitement and photographs!

Much of our time was spend gathering data and reflecting on progress with the KBTH team.  This latest grant period comes to an end in December, so it is uncertain when our next visit to KBTH will be.  Whatever the future holds, it is certain that stroke care in Ghana is demonstrably better than it was when we started the Partnership in 2009.  We also have to plan our 10 year celebrations!

It could have been Accra...

So on another hot, humid and beautifully sunny day the Wessex Ghana Stroke Partnership set out for another hard but inspiring day of work. But this was not Accra or Korle Bu Teaching Hospital this was the Education Centre at Royal Hampshire County Hospital in Winchester!!

After several months of preparation and hard work it was time to hold our first (of many?) sharing and networking event for those working with stroke in low and middle income countries (LMICs).

Just after nine in the morning the planes, trains and automobiles arrived from Sudan, Vietnam, India, Sierra Leone, Ghana and other areas of the world. Well to be honest it was trains, automobiles and bikes from Preston, Sheffield, Manchester, London, Cornwall and other areas of the UK. A group of 30 people with experience of working with stroke patients in LMICs gathered; eager to learn from each others’ experiences.

An informative start to the day. A lecture from Prof Allan Hill and Dr Sara Ashfar Morgan (University of Southampton) who discussed the current epidemiology of stroke in LMICs and how this may develop in the future. They were followed closely by Sarah Belson from the Stroke Association and World Stroke Organization informing us of the importance of stroke survivors’ organisations in delivering long term stroke care in LMICs.

We then heard the history, objectives, achievements and challenges of the attending partnerships:

• The British Ghana Therapy Partnership
• The Organized Stroke Care Across Income Levels (OSCAIL) Study
• King’s Sierra Leone Project
• Cornwall-Sudan Stroke Partnership
• NIHR Global Health Research Group on Improving Stroke Care in India – University of Central Lancaster
• Improving Stroke Care in Vietnam – Royal College of Physicians and North East and Red River Delta Region Health System Support (NORRED)
• Finally some bunch who call themselves the Wessex Ghana Stroke Partnership!!!

The morning was concluded with an update on the Tropical Health and Educational Trust by Peris Thuo.

Thank you to all our inspiring morning speakers – Peris, Sarah, Allan and Sara.

After a good (and well needed) lunch we turned up the heat (literally!) and were led through a hugely constructive facilitated session by Fleur Kitsell from Health Education England – Wessex. Group discussions were held around the topics of competencies/training, influencing and measuring impact in stroke care in LMICs. The debates were thoughtful and meaningful and left a lot of us with much to think about!! It was wonderful to hear the similarities, differences, positives and negatives that each of the projects has encountered and some mutual learning was definitely undertaken.

Having rounded up the discussion and made some promises to meet again at the UK Stroke Forum in the winter, and in Cornwall next year it was time to say goodbye and ride off into the sunshine!

We hope that some of the discussions will be written up and published in a stroke journal at some point in the future so we can disseminate our learning further!

That leaves me to say a MASSIVE thank you to Julia, Louise and Claire who did most of the organising from the Wessex end and the ever amazing Fleur who appears to be able to facilitate anyone to do anything!!

Here’s to the same amount of sunshine in Truro next year!

- Amelia

Of training and dust

So we are back in Ghana! After an unfortunate and long delay at Heathrow Amelia flew into Accra on Tuesday 29th May – just – it was heading to 30th by the time the plane landed. Brilliant to see Kodwo and be whisked off to the luxury of Dean’s.

It was lovely to walk back on the ward to see all the old faces and the hustle and bustle of stroke care going on as normal at Korle Bu. I did not have time to even sit down before I was in the back of a car and on my way to Ridge (now Greater Accra General Hospital) to observe the Korle Bu team delivering the well-established communication and continence teaching.

Having spent the rest of the week catching up on the project progress to date it was great to have Keri and Liz arrive on Saturday night. Following my own experience I was not at all jealous that they had both been bumped to business class!!

Back to hard work on Sunday – in a taxi to Labadi Beach Hotel to do some serious debriefing and preparation for the week ahead – along with a bit of R&R!!

Accra has been particularly dusty – but this was relieved by torrential rain on Sunday and then again on Thursday – but this has only briefly disrupted the wonderful sunshine.

It has been a wonderful week spending time with the Korle Bu team and supporting them to spread the word of high quality stroke care across Accra. The training that has been undertaken with staff at Ridge and La General Hospitals is bearing fruit with improved care and positioning noted at both hospitals. The most notable element of the week has been the enthusiasm and drive of all the staff involved in the project.

Along with some administrative work to ensure that the project is on track all of us have enjoyed catching up with old colleagues as well as meeting new friends all in the pursuit of top class stroke care.

Calling all Stroke partnerships!

As part of our current Health Partnership Scheme Grant, we are planning a UK based 'networking and sharing event'; specifically aimed at UK partners who are part of stroke-related projects with low or middle income countries.  The exact programme is in progress - but we are increasingly aware of a number of projects that are focussing on stroke care, and are sure that there is a lot we could learn (and possibly take forward) together.

The event is likely to be in the Winchester area (to be confirmed very soon), with a provisional date of Sat 30th June.

If you are interested in attending or would like more information please contact Julia at jnm1g12@soton.ac.uk or Tweet/DM us on @WGStroke!

End of January/February 2018 visit

The positivity of the first few days continued into our second full week.  Firstly we had a very friendly and enthusiastic welcome at La Hospital, who are really looking forward to upskilling the staff who treat their busy throughput of stroke patients.  Back at Korle Bu we had a fantastic time with the team filming and audio recording all the content we needed for the training videos.  It was great to do something a bit out of the ordinary for all of us, and the enthusiasm and acting skills of everyone who took part blew us away!  Thank you so much to all the patients, staff, relatives and members of the public who agreed to be filmed.  Also thank you to the photographer Andy Rapkins, who fitted in so well on his first time in Ghana.  We will look forward to sharing the videos as they are completed over the next few months.

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January 2018 visit - first post

Sarah and Julia are delighted to be writing this blog post from our guest house in Accra, following the first couple of days of our first visit of 2018!  Everyone has been very enthusiastic about the new project, and it has been lovely to catch up with the team at Korle Bu.  We have already been to meet some of the team at Greater Accra Regional (Ridge) Hospital, one of the two hospitals who will be working with the Korle Bu team over the next year to develop new stroke-skilled clinical leads.  We were impressed with the facilities at the newly-built hospital, and were pleased that the staff were so engaged and keen to get started.  We are looking forward to visiting La Hospital next week and meeting the team there.

We are off to the airport tonight to collect Louise and Andy (a videographer), as the other focus of the next week will be working with the Korle Bu team to film footage and audio for our new short stroke education videos.  These videos will be accessible to anyone via the internet, and aim to reinforce the key messages for each of the 8 Core Skills.  It should be a fun week; some of the team are getting ready for their close-up…and others will spend most of the week in hiding!