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Much has been said of the paucity of ENT Services in Africa [1]. Whilst Ghana has always been at the forefront of healthcare in Sub Saharan Africa, its ENT and allied services were somewhat suboptimal in the 1980s. This article, co-authored by Professors Johan Fagan and David Howard, outlines Professor Emmanuel’s Kitcher’s amazing career. He is a British-trained Ghanaian ENT surgeon whose determination and experience in establishing a training department at Korle Bu Hospital can yield lessons for his colleagues worldwide.

 

Professor Emmanuel Kitcher.

 

Prof Kitcher was the first doctor to commence postgraduate training in otolaryngology at the Korle Bu Teaching Hospital in Accra in 1987. He started his postgraduate rotations in general surgery and related surgical specialties, as was the requirement for the West African College of Surgeons’ (WACS) postgraduate training programme in otolaryngology.

Thereafter he secured one year of postgraduate training in otolaryngology at the University College Hospital Ibadan, Nigeria, following which he passed the Part One (WACS) examination. Together with the WACS Primary exams, this gained him exemption from the Primary examinations of the Royal College of Surgeons of Edinburgh, UK; an important advantage as we will see in a moment.

Following his return to Ghana from Nigeria, he was faced with a difficult problem, as his senior consultant who was to mentor him had a stroke and was unable to oversee Emmanuel’s further training, thereby destroying any opportunity to train in otolaryngology in Ghana. As is usual with Emmanuel, he was undeterred! He set about obtaining further training in the UK which he commenced in 1992 at the Department of Otolaryngology, Glasgow Royal Infirmary. Initially Emmanuel was only a supernumerary trainee but, with his customary dedication and enthusiasm during the nine months’ supernumerary attachment, he participated actively in the MSc in Otolaryngology training programme and became well-grounded in the foundations of otolaryngology.

“Emmanuel supports residents at every opportunity to present at meetings, local and national and to undertake research from the very beginnings of their training”

The local consultants recognised his potential and he secured an SHO training position at the Gartnavel General Hospital in Glasgow with a rotation to the Royal Hospital for Sick Children where he gained further training in paediatric otolaryngology. Within two years, he obtained the FRCS in Otolaryngology at the Royal College of Surgeons of Edinburgh in 1994, following which he obtained the Fellowship of the WACS in 1995. These exam successes and his continuing application in his everyday work were recognised by the UK consultants and, in the same year, he gained admission to a higher surgical training programme as a Visiting Registrar in Otolaryngology under the North Eastern Deanery in the UK. This three-year higher surgical training was based at the Freeman Hospital, Newcastle upon Tyne and the Royal Sunderland Hospital, Sunderland.

 

Prof Kitcher in front of the Korle Bu Hospital.

 

Following the conclusion of his full-time senior UK training, Emmanuel returned to Ghana in 1998 and was appointed as a lecturer at the University of Ghana Medical School and Honorary Consultant in Otorhinolaryngology/Head and Neck surgery at Ghana’s premier teaching hospital, the Korle Bu Teaching Hospital in Accra. He worked closely with the then head of ENT who strongly supported his vision for postgraduate training and Emmanuel began to develop ENT training and service provision in Ghana. Emmanuel was subsequently appointed the Head of the ENT/Head and Neck Department at the Medical School and Korle Bu Teaching Hospital in 2002.

Over the past 20 years, he has pursued his vision of developing the department at the Korle Bu Teaching Hospital and increasing ENT services throughout Ghana. Emmanuel is an astute and extremely able administrator, alongside his clinical skills and, with his colleagues, he developed the infrastructure in the older part of the hospital that now houses an excellent outpatient clinic with 10 furnished consulting rooms, which greatly improved the quality of ENT services in the Korle Bu Hospital. Emmanuel is a cheerful, gentle, but persistent fundraiser who considers his requests for funds from every aspect and he garnered support from government in the provision of OPD and theatre equipment.

The OPD clinic was fitted with four new treatment units including Hopkins Rod telescopes, flexible endoscopes, cameras, microscopes and equipment for teaching and learning. The ENT department is currently one of the best equipped centres in West Africa. It has a large workload and handles a wide variety of emergency and elective ENT/head and neck conditions requiring complex surgical interventions with excellent outcomes.

“He also established an audiology training centre in 2005 which provides comprehensive audiological services in Ghana”

Emmanuel has additionally acquired equipment required for ENT training and service provision through collaborations with overseas partners who have donated valuable equipment to the hospital. Recently a CO2 laser was donated to the department by the Rhinology and Laryngology Research Fund of the UK, organised by David Howard and Valerie Lund, making it only the third country in Sub-Saharan Africa to offer transoral laser microsurgery. Nowadays Dr Kenneth Baidoo is Emmanuel’s right-hand man and recently became Clinical Head of the Department. He is the initial main user of the CO2 laser.

Emmanuel has truly spearheaded the training of ENT postgraduates for Ghana. He has personally attracted medical students and young doctors to the department for postgraduate training in ENT by his wonderful example and enthusiasm. Emmanuel supports residents at every opportunity to present at meetings, local and national and to undertake research from the very beginnings of their training. He has initiated multiple research projects and is credited with several scientific peer reviewed publications. The Korle Bu Teaching Hospital and its sister institution, the Komfo Anokye Teaching Hospital have, over the past 20 years, trained 25 ENT specialists. He has played a leadership role as Chief Examiner for both the Ghana College of Physicians and the West African College of Surgeons.

 

CO2 laser being received by Dr Keeneth Baidoo.

 

Emmanuel continues to facilitate subspecialty training of young consultants in head and neck surgery and in rhinology/skull base surgery at the University of Cape Town in South Africa through strong collaborations and support from Professor Johan Fagan. Dr Baidoo is a wonderful example of the support that Emmanuel has given to all his residents over the years. Dr Baidoo trained with Emmanuel and then was encouraged and supported to undertake a Karl Storz Head and Neck Fellowship at the University of Cape Town in South Africa. Another of his young specialists, Dr Kafui Seayroh, recently completed a Karl Storz Rhinology/Skull Base fellowship with Prof Darlene Lubbe in Cape Town.

The list of Emmanuel’s achievements continues as he also established an audiology training centre in 2005 which provides comprehensive audiological services in Ghana. This required developing a curriculum for an MSc Audiology training programme at the University of Ghana in 2011. Currently Ghana has trained 17 of its own audiologists.

He also played an advocacy role and facilitated infrastructure development for a speech and language therapy service and establishment of a speech and language therapy training programme at the University of Ghana, with the first batch of 12 therapists qualifying in 2018. Importantly, positions are now being created for them in Ghana’s hospitals.

If that wasn’t enough, Emmanuel further facilitated training of ENT theatre nurses and ENT nurses for the Korle Bu Teaching Hospital and attracted mentorship by overseas specialists who visit the department at least once a year to support training and transfer skills to local staff. Emmanuel’s great friend ,David Howard,has been teaching there regularly for nineteen years. This programme has enabled the department to build both service and training capacity.

“He has built a department with his colleagues that is the equal of many in wealthy countries in Europe, the Americas and Australasia”

Emmanuel’s Professorship from the University therefore came as no surprise, as none could have been more deserving. He has also been honoured by many local organisations for his outstanding contributions to academia and service to Ghana.

Training remains the key to sustainable progress in medical services. Looking back on his career, Professor Emmanuel Kitcher leaves a great legacy for ENT/head and neck surgery in Ghana and West Africa. He helped to establish training programmes in otorhinolaryngology/head and neck, audiology and speech and language therapy. By investing in subspecialist training of his young protégés, and through collaborative efforts of local and international partners, he has taken ENT training and service provision to a remarkably high level in Ghana. He has built a department with his colleagues that is the equal of many in wealthy countries in Europe, the Americas and Australasia.

Emmanuel’s personal contributions and phenomenal progress are an outstanding example illustrating the multiplier effect of providing a good postgraduate training to one doctor outside his/her country who then returns home and leads in the training of others in their country; in Emmanuel’s case, the incredible continent of Africa.

 

References

1. Fagan JJ, Jacobs M. Survey of ENT services in Africa: Need for a comprehensive intervention. Global Health Action 2009;2(10).

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CONTRIBUTOR
Johan Fagan (Prof)

MBChB, FCS (ORL), MMed, University of Cape Town, Cape Town, 7925, South Africa.

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CONTRIBUTOR
David Howard

Korle Bu Hospital, Accra, Ghana.

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