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Faculty Scholarship

Spring 2012

Investigating and improving medical education and library resources at the Tamale Teaching Hospital in Northern : a case report.

John Chenault University of Louisville, [email protected]

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Original Publication Information This article was originally published in Kentucky Libraries, volume 76, number 2, Spring 2012.

This Article is brought to you for free and open access by ThinkIR: The University of Louisville's Institutional Repository. It has been accepted for inclusion in Faculty Scholarship by an authorized administrator of ThinkIR: The University of Louisville's Institutional Repository. For more information, please contact [email protected]. FEATURE KENTUCKY L IBRARY A SSOCIATION

INVESTIGATING AND IMPROVING MEDICAL EDUCATION AND LIBRARY RESOURCES AT THE TAMALE TEACHING HOSPITAL IN NORTHERN GHANA: A CASE REPORT

BY JOHN CHENAULT

REFERENCE DEPARTMENT, KORNHAUSER HEALTH SCIENCES LIBRARY, UNIVERSITY OF LOUISVILLE

BSTRACT suggested Dr. Sagoe contact me to see if I This article discusses a service-learning trip I could be of assistance. took in the summer of 2011 to conduct a series of consultations and workshops for Dr. Sagoe’s invitation gave my library the librarians, administrators, faculty, and students opportunity to participate in a unique interna- at Tamale Teaching Hospital (TTH) and the tional service project. It also opened the door University of Development Studies (UDS) in for a new service component for library liaison Northern Ghana. The visit was organized in work with the School of Public Health – and support of a series of programs and collabora- possibly other schools and departments on the tions that have been ongoing for several years medical campus – in the area of outreach between the University of Louisville (U of L) services and support for international health School of Public Health and Information initiatives and programs. I followed up with Science (SPHIS) and TTH and UDS. The Dr. Sagoe via email to get additional informa- goal of the visit was twofold: to provide a tion about his goals and objectives for the site series of training workshops to improve the visit and the training workshops. In planning research, database, and digital skills of clini- the program for the trip, I wanted to make cians, faculty, and students; and to conduct a sure it would be appropriate to local needs. I needs assessment and gather data to develop also did not want to create false expectations grant proposals to acquire financial support for as to deliverables and outcomes. There is a education, training, and information needs of small but growing body of literature on how to the teaching hospital and schools of nursing conduct international medical trips, and how and medicine. to build library capacity in Africa. I consulted both sets of literature for guidelines and best INTRODUCTION practices. In a recent article by Suchdev, et In June 2011, I received an invitation from al., I found a simple model for short-term Dr. Ken Sagoe, CEO of the Tamale Teaching service-learning initiatives that identifies Hospital, to travel to Tamale, Ghana for con- seven areas of focus: (1) having a clear mis- sultations with him and his team and to con- sion, (2) collaborating with the local commu- duct a series of library training workshops for nity, (3) educating the service team and the students, physicians, faculty and staff at TTH local community, (4) making a firm commit- and the affiliated medical and nursing schools. ment to serve the needs of the community, The invitation came after a May 2011 visit to (5) promoting and engaging in teamwork, (6) Tamale by faculty and graduate students from having a goal to build and sustain capacity, the U of L School of Public Health led by and (7) developing a method for periodic Associate Professor Dr. Muriel Harris. Dr. evaluation of service effectiveness and out- Harris and her team spent two weeks at TTH comes (317). The importance of cultural sen- conducting research to develop a program to sitivity and good communication also cannot reduce maternal morbidity and mortality, a be over-emphasized when traveling abroad to major problem in the region and throughout teach, train, and conduct research. And it is Ghana. In the course of gathering data and also essential to determine what other part- information for the research project, Dr. nerships and collaborations are ongoing or Harris identified a number of deficits in forthcoming to avoid duplication of efforts library resources, materials, and training, and and services or other redundancies in environ-

16 KENTUCKY LIBRARIES • VOLUME 76 • NUMBER 2 GHANA ments with limited resources. In the case of SPHIS team’s approach to it will be discussed the Tamale Teaching Hospital, a major project below. As Dr. Harris gathered data and infor- REPORT is underway via financing arranged with the mation for the project, she also perceived the CONTINUED Netherlands to build a new wing and renovate need to increase library materials at TTH and the existing hospital facility. While this major its affiliate schools. Often libraries are an initiative has no immediate impact on our afterthought in such project planning, but Dr. plans to improve library resources, it will fig- Harris recognized the centrality of the library ure significantly in the long-term partnership as a resource for disease prevention, and med- and collaboration between TTH and the U of ical research and education. Upon her return L medical school. to Louisville, she identified the Elsevier Foundation’s Innovative Library Grant Taking into consideration the issues outlined Program as a potential source of funding and above, Dr. Sagoe and I agreed that the work- support for the Tamale library project. shops should focus on finding and using free I secured approval for the trip to Ghana from and open source materials and resources avail- Neal Nixon, the Executive Director of the able online for medical education and training. Kornhauser Health Sciences Library. I also This also included providing PubMed training applied for financial support from the travel for students, faculty and physicians. The fund of the University Library Faculty and the remainder of the agenda during the visit would U of L International Travel Program. On July be devoted to conducting a needs assessment 25, 2011, accompanied by my wife Gwendline to determine how to improve the resources of Chenault, I departed for a ten-day trip that the hospital, nursing, and medical school would take us first to , the capital of libraries. The needs assessment would guide Ghana, and then to Tamale in the Northern the drafting and development of grant propos- Region, our ultimate destination. als to solicit funding for additional library instructional workshops and the acquisition of In the sections of this article that follow I pro- library materials, resources, and equipment. vide general background information on Ghana and its Northern Region, and Tamale, I also met with Dr. Harris to be briefed on her the administrative capital of the Northern recent visit to Tamale and the research proj- Region. Since this is a report on a service- ect she and her team were designing for TTH. learning trip to Northern Ghana, I think it is Their plans called for the creation of a sus- useful to place the project within the larger tainable project that would assist care context of the nation’s geography and demog- providers and public raphy. In the second part of this article, which health specialists in will be published in the next issue of Kentucky developing interven- Libraries, I describe the activities that took tions to reduce the place during the visit, and conclude with a list morbidity and mortal- of the goals and objectives that developed ity of women and directly from the needs assessment and consul- children in the service tations, and that will form the basis for a area of the Tamale longer-term service project and collaboration. Teaching Hospital. Maternal and child BACKGROUND care are top priorities Ghana of the Ghana Health The Republic of Ghana is located on the Service, and also con- West Coast of Africa. It has a total land area stitute key goals in of 238,537 kilometers, and is bordered by the United Nations three French-speaking countries: Togo on the Millennium east, Burkina Faso on the north and north- Declaration adopted west, and Côte d’Ivoire on the west. Ghana by Ghana and 189 gained independence from Britain on March other member coun- 6, 1957, and became a republic in the British tries in 2000 Commonwealth on July 1, 1960. It was the (National first sub-Saharan African country to achieve Development independence from European colonial rule. It Commission). This has a multi-party democratic presidential sys- priority and the tem of government with an Executive

17 KENTUCKY LIBRARIES • VOLUME 76 • NUMBER 2 GHANA Presidency elected for four years with a maxi- regions and social classes in Ghana, and is a mum of two terms. The parliament is elected major concern in developing countries across REPORT every four years, and the nation has an inde- the globe. Researchers have predicted “by CONTINUED pendent judiciary (Central Intelligence 2020, non-communicable diseases will cause Agency; Ministry of Health). seven out of every ten deaths in developing countries” (Boutayeb 192). This trend will Ghana is divided into ten administrative continue unabated until the health sectors in regions: Western, Central, Greater Accra, Ghana and other nations find ways to work Volta, Eastern, Ashanti, Brong Ahafo, cooperatively and internationally to develop Northern, Upper East, and Upper West. The and implement comprehensive interventions Northern Region, where Tamale is located, is and solutions. Ghana’s largest and comprises about 30% of the nation. The regions are sub-divided into There is an urgent need to develop efficient pre- 170 districts. Accra, the administrative and ventative strategies to halt the growing trend of political capital of the country, is located in CDs [chronic diseases] and NCDs [non-com- the south on the Atlantic Coast in the municable diseases] through the control of risk Greater Accra Region. According to prelimi- factors like smoking, alcohol, obesity, diet and nary results from the 2010 Population and inactivity, sexual contacts and environmental Housing Census, the Greater Accra Region factors in general. Considering the level of has a population of 3.9 million. The 2000 and poverty and the cost of prevention and manage- 2010 censuses list Ghana’s total population as ment of chronic diseases, the most affected 18.9 million and 24.2 million, respectively. countries are unable to cope with the burden of During the last decade the nation’s population disease. For health strategies to be successful, grew by 28.1% (Ghana Statistical Service). international solidarity and public-private part- The Akan constitute Ghana’s largest ethnic nerships are needed to tackle the problems of group (49 %) followed by the Mole-Dagbon shortage and lack of treatments, resistance, and (17%), Ewe (13%), and Ga/Dangme (8%) the need for new drugs, vaccines and diagnostic (Ghana Statistical Service, Ghana Health procedures (Boutayeb 197). Service, & ICF Macro). English is the “offi- cial” language of Ghana. Out of the estimated Urbanization, urban and rural poverty, low lit- 67 languages spoken in the country (which is eracy levels, and lack of access to medical care approximately the size of Oregon) nine others in rural areas are all factors contributing to have the status of government-sponsored lan- morbidity and mortality rates. Wealthier com- guages: Akan, Dagaare, Dagbani, Dangme, munities experience higher risks of chronic Ewe, Ga, Gonja, Kasem, Nzema (Ethnologue: diseases, but poor communities experience Languages of the World). higher risks of infectious diseases and a double burden of infectious and chronic diseases. The Agriculture accounts for roughly one-third of problems of disease and illness also must be Ghana’s GDP and employs more than half of understood and addressed taking into account the workforce, mainly on small farms and the way of life, beliefs, and taboos of people in holdings. The services sector accounts for rural communities. People living in remote 40% of GDP. Gold and cocoa production and areas of the country often rely on traditional individual remittances from abroad are major medicine, herbal remedies, and folk healers sources of foreign exchange. Oil production at for their primary care. Health care workers, Ghana’s offshore Jubilee field began in mid- whether Ghanaian or coming from abroad, December 2010 and is expected to boost eco- need access to information about the beliefs, nomic growth. According to the CIA World values, and attitudes of communities they Factbook, GDP per capita income (PPP) in intend to serve. This information generally is Ghana in 2010 was $2,500 (Central not available in medical libraries, but is found Intelligence Agency). among the local chiefs, traditional medicine practitioners, and midwives (Apalayine 367). Ghana has an underdeveloped and underuti- Despite these major public health issues and lized health care system, with high rates of challenges facing the Ghanaian government, mortality among its most vulnerable popula- progress has been made in recent years in tions. Ghana also faces a double burden of expanding access to health care, improving infectious and chronic diseases (Aikins 154). the quality of care, and providing health This double burden is polarized across all insurance. Recent government reports have

18 KENTUCKY LIBRARIES • VOLUME 76 • NUMBER 2 GHANA shown positive gains in reducing infant and line to Cape Coast and Elmina. During my maternal mortality (although the numbers of sojourn in the southern districts, and later, REPORT death still remain extremely high). after I arrived in the Northern region by CONTINUED Incremental increases over the last several plane, I did not encounter any significant decades in life expectancy for males and problems accessing the Internet via various females also have been reported in recent wireless networks. Connectivity generally was studies (Ministry of Health). According to stable, although uploading and downloading some analysis, however, government responses speeds varied significantly from location to to this crisis have not been comprehensive, location. The recent and ongoing upgrades in robust, or properly prioritized: the telecommunications infrastructure have […] medical, psychological, socio-cultural, eco- been especially beneficial to the growing and nomic and structural factors are all implicated robust mobile technology sector in the coun- in Ghana’s chronic disease burden. Yet concep- try. Personal Computers (PCs), however, still tual and practical responses to Ghana’s chronic are not widely available. According to the disease burden have been largely biomedical, United Nations, Ghana has approximately with primary emphasis on epidemiological and 1.07 PCs per 100 persons (United Nations clinical activities. Despite recognition of a grow- Statistics Division). The lack of access to ing chronic disease problem, chronic diseases electrical power in rural areas of the country are “neglected, constitute low policy priority means the number cited above is skewed and receive low interest from development part- toward Ghana’s cities and larger towns. But ners.” Ghana, like several African countries, is even in Tamale, the largest city in the yet to develop a chronic disease plan or policy. Northern Region with a population of more The current research, practice and policy situa- than 1.8 million, PCs are rare. tion regarding chronic diseases is detrimental to Ghanaian public health (Aikins 157). The history of library service and training in Ghana began during the era of British colo- Information communication technology nialism in the 1950s, at a time when the liter- (ICT) comprises an essential component in acy level of the country was estimated to be health surveillance, and health care provision, 9%. The Ghana Library Board, which is management and education. Data show the responsible for the nation’s public library sys- African continent lagging far behind the rest tem, operates and maintains the Accra of the world in Internet availability, access, Central Library, 13 regional libraries, 47 and usage. With a total population of 1 billion branch libraries, and mobile units that bring people, which constitutes 15% of the world’s books and services to rural areas across the population, the Internet Penetration Rate country. The Balme Library at the University (which corresponds to the percentage of a of Ghana (UG) in Legon is the largest population in a region or nation that uses the research library in Ghana. Its collections Internet) is only 11% (118 million users) in include 800,000 books and approximately Africa, as opposed to 33.8% for the rest of the 8000 journals. The University of Ghana also world. Ghana was one of the first countries in is the site of the nation’s largest medical Africa to achieve connection to the Internet. school and medical library, and has the only But with only 1.2 million Internet users cur- library and information science school in the rently, Ghana does not rank within the top country. The Department for Information and countries on the African continent. The Librarianship at UG offers a two-year program Internet Penetration Rate in Ghana is only that culminates in the Masters of Philosophy 5.2%, which represents 1.1% of African users of Information and Communication (Ghana overall (Miniwatts Marketing Group). Library Association).

Ghana is investing heavily in building and Ghana has a small cadre of highly trained improving telecommunications infrastructure librarians. Included in their ranks are a few to make broadband technology available who have published seminal research on nationwide. Broadband/ADSL was introduced librarianship in Ghana and in Africa in gener- in 2003, and there are now more than 140 al, and others who have been active interna- ISPs (Internet Service Providers) licensed to tionally. However, many challenges exist in operate in Ghana (Miniwatts Marketing terms of governmental support for librarians Group). During my trip in July-August 2011, I and library services and programs. And the spent a few days in Accra and made an excur- libraries themselves have not yet developed sion by vehicle along Ghana’s Atlantic coast- ways to network, share resources, and support 19 KENTUCKY LIBRARIES • VOLUME 76 • NUMBER 2 GHANA each other. The Ghana Library Association, Ashanti regions. In addition, 21% of females which is headquartered in Accra and has in Greater Accra have completed secondary REPORT about 400 members, summarizes the situation education or higher, compared with only 4% CONTINUED thusly: or less in the Northern, Upper East and Upper The Ghana Libraries have no catalogue con- West regions. High illiteracy levels compro- necting system which can feed the various mise the ability of public health officials to libraries with information on the stocks of the conduct health education campaigns to raise other libraries. There is no reciprocal agreement awareness about nutrition, disease prevention, which would allow the libraries to fall back on maternal and infant care, and wellness. The electronic catalogues of the libraries at home birth rate in the northern region also is far and abroad (Ghana Library Association). higher than the national average. Data provid- ed in the 2008 Ghana Demographic and Health The lack of an interlibrary loan system is also Survey Report indicate a single woman in the a major problem. But given the hazards of northern region gives birth to at least seven road transportation, it is doubtful the issue children before reaching menopause compared will be addressed anytime in the near future. to the average of four children per woman Declining government financial support, a nationwide (Ghana Statistical Service, et al.). governmental failure to view libraries as high The low level of women’s empowerment and priorities in terms of national development, control over their lives poses an additional and the loss of trained librarians to the private factor that complicates efforts to address and sector also are factors that have contributed to meet their health needs. In many instances the current condition and future prospects of men make the decisions about household Ghana’s libraries. healthcare practices, including decisions about the reproductive choices and practices of their Northern Region/Tamale wives or female partners. Any interventions The Northern Region of Ghana, which has a designed to deal with the problems of mater- total landmass of about 70,384 square kilome- nal and child morbidity and mortality there- ters, comprises approximately 30% of the fore must take into account the role and country stretching from east to west, with the authority of men. nations of Burkina Faso located to the East, and Cote D’Ivoire to the West. The Northern The Northern Region, like the rest of the Region also shares borders with Upper West country, faces major problems from malaria. and Upper East regions to the far north, and Additionally, anemia, pneumonia, meningitis, with Brong Ahafo and Volta to its south. It tuberculosis, typhoid fever, and hepatitis con- has a population of 2,468,557 persons (Ghana tribute to the double burden of chronic and Statistical Service). It is made up of twenty communicable diseases that challenge local districts, with Tamale as the administrative health care providers in a region with severely capital. The population is distributed in small, limited resources and access to health care. scattered settlements throughout the region The Tamale Teaching Hospital is the only ter- with more than 50% of the communities tiary care facility in the entire Northern being of less than 200 people and the rest Region. The burden of dealing with these being between 200 and 500. A limited net- immense public health and medical needs falls work of roads makes traveling difficult. In solely within its purview and mandate. addition, seven of the 18 districts that make up the region (East and West Gonja, West Tamale Teaching Hospital Mamprusi, Nanumba South, Gushegu, Karaga The Tamale Teaching Hospital (TTH) was and Tolon/Kumbunga) are accessible only by built and commissioned in 1974 to serve as a boat during the rainy season, as roads become regional hospital for the Northern Region of impassible making access to health services Ghana and a referral point for the Upper difficult, and in some cases nearly impossible West and Upper East Regions, which com- (Ghana Health Service). prise the northernmost areas of the country. According to the 2010 census, the three Females in the northern half of the country regions have a combined population of 4.1 (the Northern, Upper East, and Upper West) million. TTH, which is now a fully accredited are seriously disadvantaged. In these three tertiary level health care facility, is the only regions, more than one half to two-thirds of hospital available in this vast area that women have never been to school, compared encompasses more than 40% of Ghana’s land- to less than one-fifth in the Greater Accra and mass (when its neighboring regions are 20 KENTUCKY LIBRARIES • VOLUME 76 • NUMBER 2 GHANA included). Data from 2010 show 113,960 out- via support projects and programs provided by patient visits and 20,814 admissions. The hos- institutions and organizations from abroad REPORT pital has 341 beds for adults and 80 children’s (Renn et al.). CONTINUED beds. The occupancy rate of the hospital in 2010 was 74%. In 2008 TTH also became the TTH physicians, surgeons, and nurses cover main teaching facility for the School of five surgical specialties: Anesthesia, Medicine and Health Sciences of the Neurosurgery, Urology, Orthopedics and University for Development Studies (UDS). Endoscopy. They provide dental, ophthalmic In 2012 TTH will open a new wing and reno- and ear, nose and throat services and care, vate the existing hospital building to improve and in internal medicine they support an the facilities. The new construction and reno- intensive care unit, diabetic care, TB care, vation will increase the number of available STI (sexually transmitted infections) treat- beds, as well as upgrade its theatres, manage- ment and HIV care using anti-retroviral ther- ment information systems, and patient care apy. The hospital’s obstetrics and gynecology facilities (Renn et al.). unit provides antenatal, postnatal and VVF (vagina vesico-fistula) services. A recently TTH defines its mission as follows: “To pro- renovated and upgraded child health unit vide quality and affordable tertiary health care offers pediatric and neonatal intensive care for delivered by well-trained, highly motivated premature babies and newborns with anatomi- and customer-friendly professional health cal or other disabilities. staff.” It identifies its core values as: profes- sionalism, innovation, teamwork, collabora- TTH offers 24-hour outpatient services, and tion, people centeredness, integrity and excel- includes an Accident Emergency Center, and lence. A Board of Governors oversees TTH, departments of pharmacy, social welfare and and the Chief Executive Officer, Dr. Ken public health. The Public Health Division Sagoe, ensures the day-to-day management of offers services in reproductive health, envi- the hospital. The internal auditor and the ronmental health, child welfare, disease sur- directors of Pharmacy, Nursing, veillance, and nutrition. The Social Welfare Administration, Medical Affairs and Finance Department provides case management, focus- report directly to him. ing its work on patients with tuberculosis, AIDS/HIV, and sickle cell anemia. In addi- Between 2007 and 2010 there was a fourfold tion, the hospital administers a range of allied increase in doctors, and an almost doubling of health services that include laboratory, the nursing staff. Total hospital staffing pathology, blood bank, radiology, and physio- increased from 96 to 507 in the same time therapy. A public health research laboratory is period, with the largest single increase occur- located on the hospital grounds. ring in 2009. The large growth in hospital personnel brings with it a need to provide Patient treatment and consultations are pro- both continuing education and in-service vided in consultation rooms and open wards. training for all levels of staff. Some of this A few private beds in single rooms are avail- training is provided by other teaching hospi- able to patients. But many outpatient services, tals in Ghana such as Korle Bu and , antenatal and postnatal care, for example, are other educational institutions in Ghana, and provided in large open spaces with a few cur- tained off consultation rooms.

Malaria was the number one cause of OPD (Out Patient Department) attendance in 2010, and has been the number one cause of death over the previous three years. In 2010, gynecological conditions accounted for the second-highest attendance in the OPD. Second to malaria, reducing morbidity and mortality related to maternal and child health remains a major priority and concern at TTH and nationwide. (See chart on next page.)

Staff in the obstetrics and gynecology depart- ment provide a range of maternal health serv- 21 KENTUCKY LIBRARIES • VOLUME 76 • NUMBER 2 GHANA Top Ten Causes of OPD Attendance REPORT Cases 2008 Cases 2009 Cases 2010 CONTINUED Malaria 16603 Malaria 17615 Malaria 17294 RTI 3109 Gyn. Conditions 2768 Gyn. Conditions 2102 Gyn. Conditions 2785 Pregnancy Related 2226 Other Oral Conditions 1971 Dental Conditions 2538 ARTI 1802 Acute ARI 1556 RTA 1890 Dental Conditions 1663 Hypertension 1230 Hypertension 1883 Hypertension 1598 RTA 1103 Diarrhea 1767 RTA 1448 Acute Urinary Tract 1087 Pregnancy Related 1554 Mal. in Pregnancy 1231 Acute Ear Infection 937 Vaginal Discharge 1444 Vaginal Discharge 1220 Pneumonia 716 Anemia 1100 UTI 1196 Diarrheal Diseases 685 ices that include antenatal care during preg- solicit advice. Mr. Mahama is from the nancy, and postnatal and well-baby follow-ups Northern Region and has been an active sup- following delivery for those who are able to porter of various service projects connecting reach hospital. The hospital offers emergency U of L with institutions and organizations in services and maintains contact with midwives Tamale. He informed us of key individuals we outside the hospital through cell phones. But needed to meet in Tamale and of other activi- serious challenges remain inside and outside ties and initiatives underway in the region. At the hospital in addressing the needs of women his request, we met again with him upon our prenatally, during delivery, and immediately return to Accra to brief him on what we post-partum (Gumanga et al. 105). accomplished in Tamale, before boarding our flight back to the U.S. The opportunities we University for Development Studies (UDS) had to meet with government officials and The University for Development Studies traditional chiefs during our trip was in keep- (UDS) was established in May 1992 to assist ing with Ghanaian protocols and cultural tra- in the educational, economic, and social ditions, but more indicative of the keen inter- development of Northern Ghana, in particu- est and commitment of the political and tradi- lar, and Ghana as whole. UDS is made up of tional leadership in supporting partnerships four campuses in the Northern Region, the that help the nation achieve its development largest of which is the Wa campus. The goals and objectives. University’s principal objectives are to address and find solutions to the environmental prob- We arrived in Tamale on Monday, August 1, lems and socio-economic deprivations that 2011 via a ninety-minute flight on Antrak have characterized northern Ghana and also Air Ghana. Air travel in Ghana is safe, effi- are found in rural areas throughout the rest of cient and well-organized. Travel by road, on the country. UDS offers a great opportunity the other hand, poses serious hazards and diffi- for partnerships and collaboration in research culties due to the poor condition of the high- and teaching for the Tamale Teaching ways. To reach Tamale by car, a distance of Hospital. The Tamale Campus hosts the only 433.15 kilometers (269.15 miles), would Medical School and the students in the med- have taken more than twelve hours given the ical and community health sciences programs. poor state of the roadways. The UDS Medical School trains physicians, nurses, and nutritionists, and offers Master’s After checking into our hotel, we went direct- programs in the social sciences, the biological ly to the Tamale Teaching Hospital to meet and laboratory sciences, and several doctoral with Dr. Ken Sagoe, the hospital CEO, and his degree programs. senior staff. Dr. Sagoe had prepared an agenda for our visit that included tours of the hospital, PROTOCOL VISIT AND the Nurses Training School (NTS), and the ARRIVAL IN TAMALE Medical School on the Tamale Campus of Prior to our departure from Accra to go to UDS located a short distance outside the city. Tamale, we met with Alhaji Aliu Mahama, The schedule also called for me to conduct the former Vice President of Ghana (2001- instructional workshops for the hospital physi- 2009), to discuss the purpose of our visit and cians during Grand Rounds, the administrators

22 KENTUCKY LIBRARIES • VOLUME 76 • NUMBER 2 GHANA and faculty of the Nursing Training School, library service-learning project in a nation UDS medical students, and the hospital library struggling to develop its transportation, com- REPORT and IT staff. During the week that followed I munication, and health care infrastructures. CONTINUED provided sessions on PubMed, citation man- Becoming familiar with the settings in which agement software, open source materials for the service will take place – the geographic, medical and health education, and web tools demographic and technological contexts, and like Dropbox, Evernote, and LiveBinders that the social environment and institutional cul- can improve individual efficiency and produc- ture – is essential to service effectiveness and tivity. I also met with several physicians indi- success. To this end I have sought to inform vidually to discuss their research projects and librarians about the opportunities that exist to information needs, and with medical and nurs- provide international support to organizations ing school faculty and administrators about and colleagues in need of resources, training, instructional resources and materials. While I and professional development, and the issues was thus engaged, my wife, Gwendline and problems they will need to address. My Chenault, who is the personnel officer of the hope is that others will be inspired and pre- U of L Libraries, had a series of consultations pared to pursue similar endeavors. In Part 2 of with Samuel Akotuah Atweri, the Director of this case report, which will appear in the next Human Resources for TTH, to discuss human issue of Kentucky Libraries, I will discuss the resources policies, procedures, and records results of the needs assessment and consulta- management. Although not originally a part of tion with TTH staff, and the goals and objec- the planned agenda, she was drafted and put to tives we developed as a team. Thus Part 2 will work soon after Mr. Atweri was informed of provide a program model that can serve as a her area of expertise. guide for planning similar international serv- ice-learning projects and initiatives. In the first part of this case report I have out- lined some of the challenges that must be John Chenault confronted in designing and implementing a [email protected]

WORKS CITED Aikins, Ama de-Graft. “Ghana’s Neglected Chronic Disease Epidemic.” Ghana Medical Journal 41.4 (2007): 154-59. Print. Apalayine, Gamel B. “Information Needs and Sources of Primary Health Care Workers in the Upper East Region of Ghana “ Journal of Information Science 22.5 (1996): 367-73. Print. Boutayeb, A. “The Double Burden of Communicable and Non-Communicable Diseases in Developing Countries.” Trans R Soc Trop Med Hyg 100.3 (2006): 191-9. Print. Central Intelligence Agency. “Africa: Ghana.” The World Factbook. Central Intelligence Agency 19 December 2011. Web. 27 December 2011. Ethnologue: Languages of the World. “Languages of Ghana.” SIL International 2009. Web. 27 December 2011. Ghana Health Service. “Northern Region “ Ghana Health Service 2011. Web. 28 December 2011. Ghana Library Association. Ghana Library Association 2011. Web. 28 December 2011. Ghana Statistical Service. 2010 Population and Housing Census Provisional Results: Summary of Findings. Accra: Ghana Statistical Service, 2011. Print. Ghana Statistical Service (GSS), Ghana Health Service (GHS), and ICF Macro. Ghana Demographic and Health Survey 2008. Accra 2008. Print. Gumanga, S.K., et al. “Trends in Maternal Mortality in Tamale Teaching Hospital, Ghana.” Ghana Medical Journal 45.3 (2011): 105-10. Print. Ministry of Health. Ghana Human Resources for Health Country Profile. Accra: Ministry of Health, 2010. Print. Miniwatts Marketing Group. “Internet Usage Statistics for Africa.” Miniwatts Marketing Group 27 September 2011. Web. 28 December 2011. National Development Commission. “2008 Ghana Millennium Development Goals.” Ed. National Development Commission. Accra: Government of Ghana & United Nations Development Programme (UNDP) Ghana, 2010. 111. Print. Renn, Tanya, et al. “Reducing Maternal Mortality in Tamale, Northern Ghana: A Multifaceted Approach.” University of Louisville School of Medicine, 2011. 39. [Unpublished Report] Suchdev, Parminder, et al. “A Model for Sustainable Short-Term International Medical Trips.” Ambulatory Pediatrics 7.4 (2007): 317-20. Print. United Nations Statistics Division. “Millennium Development Goals Database.” (2011). Web. 28 December 2011. University for Development Studies. “Tamale Campus.” ICT Directorate 2011. Web. 28 December 2011.

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