Evaluation of the cooperation project between Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana and Clinical Pathology, University Hospital of North Norway (UNN), Tromsø, Norway

Background:
In January 2005, the Department of Pathology, KATH had not been able to provide  any surgical pathology service for the last year because of lack of qualified personnel,  technical break-down of laboratory equipment, and lack of funding. Reports on specimens sent to outside laboratories took up to 6 months and more. This was particularly problematic for the Oncology Department, which mostly had to choose treatment for their patients without a pathological diagnosis. Head of the Oncology Directorate KATH, Baffour Awuah MD, met prof. Helge Stalsberg MD, UNN at an International conference and asked for help. With material and financial support from KATH and UNN and financial support from NORAD and discussions with KATH staff and leadership, a 5-year plan aiming at the ‘Rebirth of the Pathology Department’ was worked out. The main program ran 2005-2010, with the final element completed in 2014.

The main elements of the program were:

• Until pathological diagnoses could be made at KATH, histological slides produced at KATH from 10 – 16 surgical pathology cases were sent to UNN each week for diagnosis.
• Altogether five medical technologists from KATH visited UNN for periods of 2 weeks to 3 months to train in histotechnology, cytology, immunohistochemistry and frozen sections
• These visits were each followed by visits by 1-2 consultants and 1-2 bioengineers from UNN to KATH to assist in the establishment of the respective activities.
• Two Ghanaian doctors trained 4 years for the specialty of pathology at UNN, except autopsies, which they largely did at KATH during one month each year 2007-2010.
• To supervise their autopsy training, one consultant from UNN visited KATH for 4 weeks each year,
• Three high-quality microscopes for two viewers and one conference micoscope for six viewers, some essential pathology handbooks, two packages of knives, scissors, forcepses and other small items for autopsy, laboratory equipment and antibodies to about 10 of the most used analyses for manual immunohistochemistry were provided.
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Purpose/objective:
The purpose of the report was to evaluate the results obtained, the adequacy of the measures taken, the attitude of the hospital leadership and involved staff towards the project and possible similar future projects, the experience of involved individuals from both hospitals with the project, and the importance of the support from NORAD and each of the two hospitals.

Methodology:
A questionnaire was distributed to involved staff of both hospitals and hospital leaderships, in different versions to different personnel groups. The answers were summarized by project leader.  One consultant UNN pathologist responded to a given list of questions concerning the status of the KATH pathology department on the last UNN visit to KATH in April 2014.  Further comments by project leader.

Key findings:
• KATH has had a surgical pathology service from 2006 and a fine needle aspiration cytology service from 2008. Immunhistochemistry, frozen section service, and cervical smear cytology with screening are established.
• Two Ghanaian doctors have completed pathology specialty training at UNN and have taken positions as senior specialists at KATH.
• As results of the project in combination with other contributions, the KATH Department of Pathology is now a modern pathology department with six pathologists, gives full pathology service to KATH and a few other hospitals, and has started training of new pathologists. The doctors contribute significantly in teaching at the Medical School of Kwame Nkrumah University of Science and Technology in Kumasi and are involved in research projects.
• All measures were considered either ‘very important’ or ‘important’ and adequate parts of the project by the great majority of both UNN and KATH personnel involved.
• The extra workload of the UNN doctors and laboratory personnel was mostly moderate, but individually varying from none to marked. The contribution of the two KATH doctors to the daily routine work at UNN was seen as greater than or at least equal to the extra workload from guiding and supervising them. 
• UNN director and staff unanimously agreed that the project was within the frame of  what the hospital should be involved in, and the great majority indicated that they were ‘very likely’ or ‘likely’ to support future similar projects.
• The substantial support from KATH, UNN, and NORAD were all considered essential to the realization of the project
• The main problematic issue of the project was that the Ghanaian doctors trained at UNN without a Norwegian medical license and therefore could not apply for specialist recognition in Norway.  The reason for this decision was primarily practical and the wish to start their training as soon as possible without waiting for a time-consuming authorisation process, but it caused unforeseen difficulties for their full specialist recognition in Ghana.
• Major challenges for the KATH department are maintenance and repair of laboratory equipment and formal recognition of more pathologists as competent to educate further pathologists (At present only one of the two trained in Tromsø who also passed the British specialty exam, is recognized)

Recommendations:
A broad attention to all aspects of the department’s activity, including both education, some essential material support, personal contacts and mutual visits, as well of the KATH initiative to seek help and the substantial support from both UNN, KATH, and NORAD were essential for the good results.

Comments from the organisation, if any: