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2013
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•212• Chapter 18 Conclusion E.Q. Archampong The revelation that has emerged from the exercise of preparing this manual is the tremendous information base and the fount of technical expertise currently available in the Department of Surgery. However, the concern that strikes any observer must be the challenges of access to these assets. It is evident that with the exception of the paper on the elimination of childhood blindness, which is the product of an on-going project, most of the contributions have emanated from retrospectively collected data in respect of ad hoc stand-alone studies, without clear evidence of continuity in the immediate future. This can not be a dependable means of building the knowledge base of the Department or the institution as a whole. The situation is the result of the paucity of sustainable research projects with appropriate funding. Clearly, if periodic audit studies can yield so much information, it is exciting to imagine how much could be produced through systematic and comprehensive studies based in the Department. The outcome of the project on elimination of childhood blindness in Ghana is precise information on the causes (bilateral and unilateral) of childhood blindness in the target populations in the Greater Accra and Eastern regions, and what has been achieved, using the team approach strategy, by way of prevention through scientific presentations , public lectures including radio and television interviews and interventions through drug therapies and operations by surgical teams. The project is now in Phase 2 with collaboration between WHO/Lions Club International and the Ghana government, future interventions are expected to be extended to the rest of the country. The study has emphasized the need for continued advocacy nationally and internationally to ensure availability of funding which is the prerequisite for sustainability. The two papers on breast lesions are timely, given that breast cancer is the commonest female cancer in Ghana and Africa as a whole. •213• Noise Pollution at Work Place and Health Implications Evidence has been adduced that global developments in management of breast cancer have led to better patient management in Ghana. These include the use of multidisciplinary teams (MDT’s) in the formulation of plans. This constitutes the basis for best practice in the management of the disease. There is evidence for the extent to which these practices are being incorporated in breast cancer management in the two main treatment centres in Ghana. Unfortunately, mammographic screening has not yet taken root in Ghana because of resource limitation; however, the proposal for clinical breast examination, breast self-examination and opportunistic screening has been strongly recommended. Tripple assessment, i.e. clinical examination, imaging procedures and tissue sampling, remains the basis for diagnosis. The challenge for Ghanaian surgeons currently, is the development of methods for taking a biopsy of non-palpable breast lesions. Advances have been noted in all the treatment modalities i.e. surgery, radiotherapy, chemotherapy and hormone therapy. Biological therapy in the treatment of patients with HER2 receptor over-expression is available but the outcome is often hindered by the high cost of treatment. It is reassuring that breast cancer management in Ghana has kept pace with global developments. The young age of the breast cancer patient in Ghana, attendant socio-cultural differences and prevailing financial limitations indicate significant modifications in the approach to management of the condition in the country. The study of benign and pre-malignant breast disease has also revealed significant increase in ductal carcinoma in situ and this carries a higher risk of invasive carcinoma. It should therefore be treated appropriately to prevent this progression to the disease. There is an urgent need for investment in the work of the Breast Cancer Clinic and activities of the MDTs in response to the apparent increased breast cancer incidence in the country. The papers on acute appendicitis, peptic ulcer disease (and complications ), gastrointestinal tumours and obstructive biliary disease all point to the rising incidence of these lifestyle related diseases in the Ghanaian population, and call attention to the need for health education on healthy eating habits, regular exercise and need for stress •214• Chapter 18 control in socio-cultural activities. The striking observation from these studies is the close resemblance of the natural history, diagnosis and management of these conditions and their complications to the presentation in Western countries. The principal difference is the poorer outcome of management, which stems from delays in presentation and the prevailing resource limitation in the developing world. There would never be enough resources for...
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Current Challenges with their Evolving Solutions in Surgical Practice in West Africa: A Reader