1. REHABILITATION MEDICINE PHYSICIAN TRAINING IN GHANA
Dr. Abena Yeboaa Tannor
MBChB, MSc.(Rehab), MGCP
Family Physician Specialist

2. A 45 year old obese widow with 4 children known hypertensive presenting with a
- CVA with right hemiplegia
- Urinary and stool incontinence
- swallowing difficulties
What usually happens?
Manage hypertension, feeding tube, urinary catheter, diapers, ?physiotherapy

3. Facts Disability is a stigma in Ghana
No Rehabilitation physician for the 10% of Ghana’s population with significant disabilities
Stroke and other neurological conditions, trauma related injuries, musculoskeletal conditions, paediatric disabling conditions etc.

4. Who is a Rehab Physician?
Also known as a Physiatrist
specializes in ‘function’, coordinating a multidisciplinary team which cares for patients medically, socially, emotionally and vocationally.
The core principle of rehabilitation is teamwork, as such it is multidisciplinary and requires diverse allied health professionals led by a physician specialist in Physical Medicine and Rehabilitation (PM&R) and NOT physiotherapy alone.

6. NO Rehab Medicine training program in Sub-Saharan Africa.
International Rehabilitation Forum
Ghana College of Physicians
Komfo Anokye Teaching Hospital partnership
to start a Rehabilitation Medicine Fellowship program in Ghana (LOCALLY DRIVEN with strong external support)

7. METHODS
A multifaceted online and in-person 2- year fellowship curriculum including research for Family Medicine specialists

8. Characteristics
Outside PRM specialists lecture weekly. Each topic requires;
a practical handout
independent reading
an on-line telemedicine discussion with the lecturer
an assignment
3 final examination questions submitted to the IRF
International visitors will provide hands-on skills training quarterly

9. Results KATH fully supported the plan and allocated a first trainee
The first eight months of training and two on-site PRM consultant visits have gone well
The Ghana College of Physicians’ Faculty of Family Medicine is preparing to submit this program for credentialing.

10. Discussion
The telemedicine sessions have permitted long distance rapid education and advice which will sustain the program
More PRM lecturers are needed for lectures and tutorials.
The fellowship also needs accreditation by the Ghana College of Physicians.
The training limits of a 2-year fellowship are acknowledged, however, after a decade, trainee experts who meet international standards will build a locally led fully developed PRM residency.

11. A 45 year old obese widow with 4 children known hypertensive presenting with a
- CVA with right hemiplegia
- Urinary and stool incontinence
- swallowing difficulties

12. Questions to ask/ Rehab review of systems
pre-morbid and current
thinking
speaking
walking
transfers
toileting
eating (e.g. swallow plus nutrition)
feeding (independence)
Dressing
Bathing
Oral facial hygiene

13. Work (what job, how long, employer)
Home care
Child care
Management of finances
Driving/public transportation
Social activities (church, entertainment, sports)
Home architectural barriers-stairs, doorways, etc.

14. Physical exam Screen Cognition speech and language depression
deep venous thrombosis
pressure sores
rectal control and sensation
contractures
Shoulder subluxation

15. Assessment patient’s rehab goal? Barriers to discharge
Factors that can worsen disability
Patient education
Family /caregiver education
Adaptive devices/mobility devices
Home modifications
Transportation
Finances
Return to work
School or vocational training
Social integration
Sexuality issues
What are the 6 month goals and what should be done?

16. Planning Diagnostics Medication changes
Therapy assessments/ MDT meetings
Dietary /feeding strategies
Bowel and bladder program
Management of sores, contractures
Nursing instruction
Counseling
Advise on tubes (e.g. urinary catheter, feeding tube)
Set Tentative Date of Discharge (TDD) in the record.
Family Conference
Follow-up

18. African governments need to acknowledge the societal cost of disability and invest in rehabilitation
Ghana has set the pace.