From North Dakota to Ghana: Collaboration in EMS EducationBy Nora Vanni

August 28, 2015

Ron Lawler with his students in Accra, GhanaIn recent years, the North Dakota Army National Guard has partnered with the Ghanaian government to help develop military, security, and infrastructure. As part of a focus on improving disaster relief and healthcare, one element has been to further develop Ghana’s EMS apparatus. This spring, a group of EMS educators and administrators traveled across the world from North Dakota to lead two weeks of training in Accra, Ghana’s capital city. Among them was paramedic educator and friend of Fisdap Ron Lawler, who sat down with me to discuss his part in the most recent trip to Ghana.

Unique Partnership

About 1,100 EMS providers are employed with the Ghanaian International Ambulance Service, not counting some hospitals that have private EMS service. Currently, EMS in Ghana has almost no protocols or regulations.

The North Dakotan team worked with Dr. Joseph Akamah, an interventional cardiologist, and Dr. Ahmed Zachariah, director of Ghana Ambulance Services at the Ministry of Health, to help Ghana form effective EMS systems.

This past year, North Dakotan EMS educators trained 30 Ghanaian students in BLS interventions. This year, 30 students from 23 different EMS stations across Ghana participated in this spring’s course, which sought to teach the EMTs how to administer a National Registry-style practical exam to new students.

Ron recalled a conversation with one of the providers who runs a National Ambulance Service special operations unit that describes the socio-economic range in Ghana.. “There's a station in his hometown, and he said it's pretty much savannah. It's wide open. It's tribal; it's very poor. Your house is determined by how many cattle or how many goats you own. It's all the way from that to, you drive past a Deutsche Bank building in downtown Accra. So there's a huge range in living conditions."

Ron found that the use of idioms can pose a challenge when teaching an international group. In one station of the practical exam, the station leader said, “The patient is choking on a hot dog.” As the students ran the call, they clearly weren’t coming up with the right answers, so the station leader paused the scenario: “He's like, ‘We have to stop, timeout. Why aren’t you guys getting this? That he's choking on this hot dog?’ And they were like, ‘We don't know what a hot dog is.’ So he said, ‘Well, it's meat, about this long, with ground up stuff it in.’ And they said, ‘Oh, sausage!’” Ron explained. “And the station leader said, ‘OK, we'll call it a sausage.’”

Limited Infrastructure

For the written exam, the American educators administered the Fisdap EMT Readiness Exam.  Accessing the exam posed some challenges. The school had few computers and spotty Internet connectivity. Not only that, but due to a power dispute with Nigeria at the time, a number of cities across Ghana only had power for about 12 hours a day.

The limited digital infrastructure also has an effect on providers. Where most EMS outfits in the U.S. use digital record systems for patient care reports, Ghanaian providers don’t have that option. Even paper call sheets are a new addition to the system. When Ron asked one provider how he hands off to hospital staff, he responded, “Well, I tell her, and then I leave.”

Ambulances in Ghana are sparsely outfitted: Many are just a truck with a bed, and even those are in short supply. Some trucks have old monitors or other slightly more modern tools. However, because the EMS education apparatus is just being formed, the providers often don’t know how to use new healthcare technology on the odd occasion they do have access to it. “In the States, we complain about stuff while working the streets, like not having the right monitor or not having the patches we like. [...] When I think about what we have versus what they have, it's a huge difference,” he said. “When we're talking about test questions and a practical exam, we had to bring most of the equipment we tested them on with us. They hadn't seen some of it before.”

Street signage in Accra is limited, especially in the sprawling shanty towns on the city’s outer borders. To reach patients, EMS providers must be incredibly familiar with the city. After they’ve reached and loaded up their patient, finding a hospital with an open bed can be difficult. Ambulances aren’t equipped with radios, and emergency departments often won’t answer the phone.

One day, Ron was teaching the students about tourniquets. A student asked, “How long can you leave it on?” Ron clarified, "It's life or limb: You put it on, you leave it on, and you take them to a hospital. In rural areas, it might mean they lose the leg or the arm, but in an urban area here it should be fine." The students responded that it’s sometimes three or four hours before they can find a hospital that will accept their patient. Ron tells me, "I asked, ‘You mean rural?’ And they said, ‘No, in town.’ And I was like, ‘How does that happen?’”

Accra is home to both public and private hospitals. When providers bring a patient to a private hospital, hospital staff often won’t admit them if they’re not already an accepted patient. In these cases, the ambulance moves on to try the public hospitals. One public hospital might not have enough beds, so the EMTs will go to the next public hospital. Then they might find that the second public hospital has space for the patient, but the surgeon who could help the patient is at yet a different hospital, so they have to follow him there. That final hospital might once again not have space, and the search continues.

Future Plans

Moving forward, the partnership between the North Dakota National Guard and the Ghana Ambulance Service will focus more on the development of EMS operations. Ron hopes that in the future, the team will be invited back to lead an ALS course in Accra.

In the meantime, two of the graduated EMTs volunteered to travel to Fargo, ND later this year to earn their paramedic certification. They’ll be enrolled in Ron Lawler’s program at Sanford Health/FM Ambulance with the rest of the admitted paramedic students. They hope to bring their ALS training back with them to Ghana, perhaps along with a familiarity with the American hot dog.

Check out some of Ron's photos from the trip:

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Train Like You Fight! Learn the recipe for crafting a quality exam at one of Fisdap's testing workshops ›


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