My name is Dr Fredrick Mate. I have just completed my mission in Ghana where I was the UK-Med/UK EMT member deployed with the World Health Organization (WHO) to offer technical support to the Ministry of Health (MOH) Ghana on COVID-19 preparedness and response plans. It was meant to be a one month mission but due to the ongoing need was extended for four months.
My career spans 11 years which is a mix of working with the government of Kenya, international NGOs and academic institutions in Kenya. This rich experience working in different healthcare contexts has been very important in my mission in Ghana.
When I arrived in Ghana, the country had not yet reported any person testing positive for COVID-19.
The mission started by joining the WHO country office COVID-19 team – one of five sub-teams which formed the Public Health Emergency Operations Centre team under the Ministry of Health (MOH). The teams were broken down into five thematic areas: Coordination; Laboratory Systems; Surveillance; Risk Communication and Social Engagement; and Case Management and Infection Prevention and Control (IPC).
As the first National COVID-19 case management and IPC team we started with three members: two members from WHO and one person from MOH. Our tasks included identifying and preparing treatment and isolation centres, developing guidelines, standard operating procedures, protocols and training different health care professionals in the management of people with COVID-19.
There was a need to increase the size of the national case management team and different healthcare personnel at the national levels were co-opted. This expanded team was tasked with the initial assignment of developing a national guideline on case management and IPC.
At this time of the year in February, the WHO had released a handful of guidelines but, being a new virus, no information was readily available. As the technical support person, I had to find other authentic sources to develop guidelines from. The American Centre for Disease Control and Prevention (CDC) had modified the guidelines from an earlier SARS and MERS outbreak and I used this to prepare the first draft guidelines at our three-day workshop. Getting information on COVID-19 was a challenge and I’d like to recognise the support of Lizzi Marmont and Lina Echeveri from UK-Med who shared new technical guidelines as they were released.
With the guidelines ready and training materials in place, this expanded team became the national case management trainers. First, we trained key staff workers in the critical areas: airport health workers and ambulance teams. Then staff members in the country’s first two facilities set aside to be isolation and treatment centres. The Ridge Hospital had a bed capacity of four and Tema Hospital a bed capacity of ten. At the Ridge hospital the training consisted of case management, IPC and the third day was to be a simulation exercise. On 12 March 2020, the third day of our training, the country reported the first two cases of COVID-19. This changed the training from a simulation exercise to a response activity.
There was little time to carry out nation-wide training, so the next training involved 150 rapid response team members drawn from all 16 regions in Ghana. They were trained as Trainer of Trainees so they could cascade training in the regions and districts across the country. The national case management team continued managing patients and carrying out training within Greater Accra Region where the first cases were reported and which has remained the epicentre in the country.
By the time I left, the number of treatment and isolation centres had increased from the initial two centres to 71 across the country. And using the trainer of trainee members to cascade the training, more than 3,500 healthcare workers were trained in case management and IPC across the country.
One of my key responsibilities was to regularly update the national case management guidelines with the new technical guidelines that were released by WHO. By the time I left, I had updated the draft guidelines four times and the final draft was then printed by WHO for distribution and shared with all the teams across the country. The WHO was able to support the MOH both financially and technically to carry out countrywide supervisory support visits to many of the treatment centers. At least 64 treatment and isolation centres across the country were visited, in which the teams were advised on improving their health systems based on the guidelines and the experiences we had acquired running the national treatment centres. This was an opportunity for me to tour Ghana and view the vast natural resources that the country has, from gold mines, oil, cocoa farms, palm oil plantations, natural forest and coconut farms that covered the countryside.
I happened to be the only member from UK-Med/UK EMT deployed for this mission. This would look like a challenge but my previous experience working and studying with different people from multicultural backgrounds enabled me to navigate this easily. My experience with international NGOs helped me to integrate with WHO staff and my experience working as a ministry official made it possible to understand the working of teams from MoH. The challenges I faced were mostly minor and were mostly due to the slow nature of the MoH teams taking actions. Sometimes it involved the individual character of the person responsible and this required taking time to understand the person and know how to go around them to take action without any conflict. It required time to understand people you are working with more than to expect to be understood. The other advantage is that the members of UK-Med based in the head office were always available. Therefore, in as much as I was the lone UK-Med member in Ghana, there was a team which was in contact on a daily basis and on needs basis. This included Tess Williams (operations), Lizzi Marmont and Lina Echeverri (technical), Jak Dyehouse (financial), Holly Smith and Alison Mee (communications), among others.
My personal challenge was with food. Most of the food eaten in Ghana is similar to what we eat back in Kenya. However, it was always cooked with chilli pepper – even in the hotels. But when the hotels closed down due to low business and I had nowhere to eat – this became a blessing. I was able to get an apartment with a kitchen which was 200 meters from a food market. I was able to prepare my own food with no pepper. Ease in adaptability was key to adjust to the environment.
Even though – due to work and restricted movement – I was not able to tour the country, my experience in Ghana was memorable. I integrated with teams, made friends and they told me when I left I was now a fully-fledged Ghanaian and gave me a local name, Fredrick Kwame-Mate.
For more on our Ghana programme visit our web page: