Healthcare staff from Norfolk and Suffolk NHS Foundation Trust (NSFT) have returned from their first eye-opening trip to Africa to help in the battle against superbugs.
The Trust was specially chosen to work with colleagues at a rural hospital in a poor region of Ghana, as part of an international bid to tackle the rising global threat of drug-resistant bacteria.
NSFT Chief Pharmacist Esther Johnston is leading a multi-disciplinary team of pharmacists, doctors and specialist nurses, who are working with staff at The Assemblies of God Hospital in the small town of Saboba, in Northern Ghana, near Togo, for a year.
Esther, who has just returned from their first visit to the impoverished region where TB, typhoid, malaria and hepatitis C are rife, said: "Nothing quite prepares you for what you find on the ground."
She added: "We flew into Accra, the capital, which is quite modern and wealthy, took a flight to Tamale, then travelled by road for two hours and another hour along an unmade road to get to the hospital.
"Many people in the outlying communities still live in adobes (mud huts) and there are animals wandering around the hospital perimeter and sometimes getting into the grounds.
"But we were given such a friendly welcome, and you can't help but admire how much the staff there do with so little.
"I'm pleased we have partnered with this hospital, rather than a large, well-funded state hospital in the big city, because it feels like we can make a real, positive difference here to people's lives."
Their first trip was focused on getting to know the area, the people, the hospital and the staff, so they could better understand the issues and start to work on solutions in partnership with local health workers. Esther was also able to bring along some pulse oximeters (which measure oxygen in the blood) for the hospital.
They also met local chemist shop owners, who were very supportive of the push to tackle overprescribing.
The big problem, however, is that in many low and middle-income countries antibiotics are seen by many people as a medicine of first resort, and they can even be bought on market stalls, which the team discovered for themselves as they explored the area.
Esther said: "There is a culture of expecting medication, especially antibiotics, when someone is unwell and, unfortunately, illegal and poor-quality antibiotics are readily available on market stalls. There's no knowing what's in them, and there's no advice on how much to take.
"We heard about mothers giving adult doses to their babies, for example. Not only is this useless and potentially dangerous, but at best will lower the child's natural defences.
"A lot of antibiotics are being used to treat dysentery and diarrhoea – but antibiotics have no effect on these illnesses.
"The message we hope to get across is that if you use antibiotics when you don't need them, they won't work when you do."
Elaine Thrower, NSFT's Lead Infection Prevention and Control (IPC) Nurse, carried out a review of infection prevention procedures with hospital staff and ran training sessions to help them reduce the chance of cross-contamination – thereby reducing the need for antibiotics.
She said: "The fundamental importance of access to clean water for drinking, washing hands and basic infection prevention measures was really brought home.
"I enjoyed doing the training, the nurses were fantastic at getting involved and I look forward to continuing to work with the IPC link and hospital matron."
She added: "This project is as important to us here in the UK as it is to the people of Ghana because antibiotic resistance is a serious concern and bugs don't respect borders. By working alongside our colleagues in Saboba, we ensure antibiotics remain effective for everyone."
The team will return to Saboba in November - after the rainy season, when the area becomes an island - when they expect to focus on improving understanding of antibiotics use among the communities served by the hospital, meeting tribal elders and other key influencers.
As the people there live in an oral culture, they are looking to work with local musicians to get the message across through song.
Esther added: "Of course, we're not going to solve the problems in a year, but this is just the beginning. Already we have raised the profile of antibiotic use, just be being there, and we hope to continue to offer support long after the project is over."
The partnership includes occasional visits to the hospital, although much of the support is being provided via Skype, phone and email.
The NSFT team is working with Samuel Odonkor, General Manager, and Jean Young, Paediatric Surgeon, at the hospital, and Samrina Bhatti, Chief Pharmaceutical Officer's Clinical Fellow at Specialist Pharmacy Service.
Mr Odonkor said: "It is our expectation that this project will serve as a landmark in our effort at curbing the abuse of antibiotics and its consequent effects within this district and surrounding communities.
"The partnership with NSFT is still at its infant stage. However, the engagement so far has been very promising and the indication is that, as we continue to work together, we will achieve a great deal for local people while contributing to global efforts.
"Esther and her team were very enthusiastic and interested in understanding the issues and how they can be resolved. From our discussions, we realised that several approaches and strategies will have to be adopted since the issue about the use and abuse of antibiotics is multifaceted and very complex. We look forward to the next visit."
Factfile 1 – The Antimicrobial Stewardship (AMS) scheme
The Commonwealth Partnerships for Antimicrobial Stewardship (AMS) scheme selected 12 projects to run across Ghana, Tanzania, Uganda and Zambia – and a project led by NSFT's Pharmacy team is one of them.
One of the aims of the project is to reduce the overprescribing of antibiotics, which is blamed for the increase in antimicrobial resistance and the rise of so-called superbugs – bacteria which are immune to antibiotics.
The aim overall is to improve AMS practices through raising awareness, improving protocols and developing tools that will reduce the spread and increase of antimicrobial resistance, using training packages, videos, etc.
The scheme, managed by the Tropical Health and Education Trust with support from the Commonwealth Pharmacists Association, is funded by the Department of Health and Social Care's Fleming Fund to support partnerships between UK health institutions with strong records in antimicrobial stewardship, such as NSFT, and their counterparts across four African Commonwealth countries.
The aim of stewardship is to help contain and control antimicrobial resistance by 2040, bringing improvements in healthcare to people across Africa and delivering global benefits.
Factfile 2 - The hospital
The Assemblies of God Hospital, Saboba has an inpatient capacity of more than 100 beds, including paediatric, women's, maternity and men's wards, and an operating theatre. It also offers diagnostics (x-ray and ultrasound), eye care, outreach services, laboratory services, ambulance services, primary and mental health services, neonatal intensive care (NICU), antenatal and postnatal services, pastoral care and counselling, social welfare, blood transfusion, TB control services, HIV/AIDS antiretroviral care, reproductive and child health services.
Factfile 3 – Facts and figures
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