REPORT ON DISTRICT ROTATION AT AKOSOMBO

INTRODUCTION
The District Clerkship is to introduce students to the types and management of medical problems seen in district hospitals and also learn the administrative problems of running the hospital. To learn about various issues affecting health care at the district level.
The district rotation started from 14th June, 2011 to 3rd July, 2011. We were attached to the Volta River Authority Hospital in Akosombo.
Volta River Authority Profile
The VRA was established in 1961 under the Volta River Development Act, Act 46 of the Republic of Ghana with the core business to generate and supply electricity. As a result of the Authorities operations, riverine communities were displaced therefore the need for community development initiatives by the VRA.
The VRA runs hospitals at Akosombo, Aboadze and Accra. The hospitals serve VRA staff, neighbouring communities and corporate bodies.
The VRA administers local authority functions in accordance with Legislative Instrument 42 of 1989 in Akosombo therefore Akosombo Township is not under any Traditional Council or District Assembly.

Asuogyaman District Profile
Akosombo is a sub district of Asuogyaman District. Asuogyaman District is one of the twenty one districts in the Eastern Region of Ghana. Until its creation, the area forms part of the former Kaoga District Council whose capital was Somanya. It covers a total estimated surface area of 1,507 square kilometers and constitutes 5.7% of the total area of eastern region and ranking the 10th largest district in the region with its capital at Atimpoku.
The District is bordered to the North by the Afram Plains District to the South by North Tongu District West by Manya Krobo District, to the East by South Dai District. The vegetation of the District is a mixture of Forest, Semi-Forest/Re-growth and Savanna.

Physical Characteristics
The topography of the District is generally undulating, with the following highlands – Tatabum, Krobo Kyei Bulu, Adomi and Kpegyei. The main water bodies include the Volta River and Lake, River Adabo, River Opotoku, the Baware, Anyinase River and the Bubuakan. Indeed it is on account of the fact the major settlements are located on either side of the Volta Lake that the name Asuogyaman was adopted for the District (“Asuogya” – Water and “man” – state).
The mean annual rainfall is about 1130mm with a bimodal distribution and a maximum daily amount of about 67mm. The period May-June constitutes the major wet season, with the minor wet season occurring during the period September-November. Annual temperature is about 28C with average maximum and minimum being 37C and 19C respectively.
The vegetation of the District is a mixture of Forest, Semi-Forest/Re-growth and Savanna.

Economic activities
Farming constitutes the main economic activity of the majority of the people, with maize, cassava, and plantain being the major crops. Fishing is also done mostly by the Battors. Banana is grown for export as well as exotic vegetables (e.g. green pepper). These ventures (banana and vegetables) are undertaken by private companies. Manufacturing, commercial and service activities are also carried out mostly in Akosombo, with the Akosombo Textiles Limited, Volta Hotel, Volta River Authority and Volta Lake Transport Company Limited being the main operatives. Akosombo also houses the most viable market in the District.
The Asuogyaman District has vast potentials for investment particularly, in the area of tourism, agriculture and industry.
Traditional Administration in Asuogyaman District is centered on chieftaincy as practiced by its constituent ethnic groups – Akwamus, Anums and Bosos. The Akwamus are of Akan stock whilst the Anums and Bosos are of the Guan stock.

Tourism
The potentials include the following:
 Beautiful landscape and scenery along the Volta River and Lake.
 Extensive lake shores for development of beach resorts.
 Small islands located in the Volta Lake especially in Atimpoku.
 Water transport and river sport in the lake.

Agriculture
The potentials are in the areas of:
 Suitable soil and abundant water for cultivation of exotic vegetables for both domestic consumption and export, and farming generally.
 Fish farming, oyster and lobster production.
 Conducive vegetation and available water for livestock farming on a large scale.
 Existence of a 3-Star Hotel at Akosombo and other motels at Atimpoku.

Industry
The District has comparative advantages for location of industry in the following ways:
 Existence of inland port at Akosombo, for river transport between the South and the North of the country.
 Easy access to power from Akosombo and Kpong Hydro-Electric Power Plant.
 Proximity to Tema, Accra and Lome.
 Large deposits of clay for brick and tile industry.
 Large deposits of talc at Anum and Boso.

Traditional Administration
Traditional Administration in Asuogyaman District is centered around chieftaincy as practiced by its constituent ethnic groups – Akwamus, Anums and Bosos. The Akwamus are of Akan stock whilst the Anums and Bosos are of the Guan stock.
Each of the ethnic groups has a hierarchy of chiefs headed by a paramount chief followed by divisional chiefs, and village chiefs.
Thus the District has three Traditional Councils – Akwamu, Anum and Boso Traditional Councils, each headed by the Paramount Chief and made up by the Divisional chiefs.
The presence of significant Krobo and Ewe settler groups makes the District greatly heterogeneous.




ACTIVITIES
AT THE HOSPITAL
MORNING MEETINGS
The team participated in the daily routines of the doctors; we attended morning meetings to discuss cases admitted by the doctor on duty the day before. On Thursdays, there was either a presentation by a Representative from a Pharmaceutical Company or by a member of the medical team of the hospital.
GENERAL WARD ROUNDS
There were general ward rounds on Fridays and we participated in the ward rounds. We asked questions and shared our opinion on cases presented.
THEATRE
During our period of stay, Motec Life UK, a team of professionals committed to Orthopaedic and Trauma care visited the VRA hospital in Akosombo and we took the opportunity to join them in theatre for various Orthopaedic surgeries (mainly knee and hip replacement surgeries). We had presentations and lectures by members of the team. The team was led by a graduate of UGMS, Dr. Paul Ofori-Atta.
VISIT TO VARIOUS UNITS
A. Pharmacy – In the Pharmacy unit, the head of the Unit Mr. Eric Borbi introduced us to the process of drug procurement and the activities that the unit does like storage of drugs, drug preparation and dispensing of drugs.

B. X-Ray – The X-Ray unit of the VRA Hospital offers other services like Ultrasonography and ECG in addition to the various X-ray services offered.

C. Resources Unit – The resources unit has the records department. We had a session with the Hospital Bio-statistician, Mrs. Okaibea. We were taken through the type of data collected from patients. Mrs. Okaibea stated that the hospital is in the process of computerizing its system of data collection and processing.

D. Laboratory – The Laboratory department offers services in Haematology, Biochemistry and Parasitology. It also serves as the Blood Bank for the hospital.

E. Reproductive And Child Health Unit – We visited the unit and familiarized ourselves with the activities of the unit. We were however unable to join the unit on an outreach because the time coincided with another program on our schedule.

Most of these were done in the first week of our stay.

OUTSIDE THE HOSPITAL
Water Treatment Plant
We were taken through operations at the water treatment plant first on the Mimic Board and later shown round the site.
Akosombo Management Committee
We met with the Town Manager and the Secretary of the Akosombo Management Committee (AMC) and learnt about the history of VRA and the need for the establishment of AMC, its mandate for operations and the local authority functions performed by AMC.
Meeting with the Health Servises Administrator, Director, Medical Superintendent and Hospital Administrator
We met with the Directors and Managers of the hospital who took us through the organogram of the VRA hospital, the mission and vision statements and values to be upheld by all workers as well as the organizational structure of VRA with particular emphasis on the Health Services Department. We learnt about the working conditions and appraisal system (Balanced Score Card) in use in VRA.
Hydro-Generation Unit
We were taken through the operations at the Hydro-generation unit in theory first and then sent round to appreciate the work being done every day. We learnt about the safety measures and protocols in place and efforts being undertaken to ensure safety of both humans and equipment at the unit.
Environmental And Sanitation Unit
After discussions with the environmental officer (Health Inspector) on the various subunits of the department, we were taken round to see the Oxidation Pond, the Slaughter House, Markets, Refuse dump site and the various housing units in the Akosombo township. Akosombo township is generally clean and the housing units are adequately ventilated. The township is generally divided into Community 1 and 2. A total of 72.6km of drains runs through the town for liquid waste drainage. The department also organizes health screening for food vendors and keeps a book with annual medical examination records of all food vendors in the town. The health inspector also visits bars and restaurants to ensure that the environment in which food is prepared and sold is hygienic.
Environmental Sustainability And Development Department
We visited the subunits; Public Health section in Akosombo, Dredging unit and weed control unit at Ada. Dredging of the Ada estuary is important in the control of Bilharzia as is the weed control program. Dredging deepens the river bed and makes it unfavorable for the snail vector of Bilharzia to thrive. Dredging also opens up the estuary which introduces saline sea water into the river. This also helps in controlling the parasite. Aquatic weed control done by the public health unit helps in eliminating the snail vector too. Weed control by VRA is mainly by the chemical method using Glyphosate but other methods like mechanical and biological means are also used. These are some activities the VRA considers as corporate social responsibility for the communities in which they operate in. These are riverine communities that have been affected by the construction of the dam.
District Health Directorate
We paid a visit to the director of health services for the Asuogyamang District, Dr. Engmann. She gave a profile of the district and the various functions and members of the District Health Management Team (DHMT). The team was introduced to the heads of the various units of the DHMT. We interacted with the staff to know activities carried out in their office on a day to day basis and also learnt about some of their challenges. In all our interactions, it seemed obvious that the major problem facing the district was that of staffing. The number of health professionals in the district is inadequate for the heavy load of work.
Some of the functions of the DHMT that she elaborated on are:
 Management of health in the district
 Planning and implementation of specific district health activities within the broad framework of national and regional goals
 Monitoring and evaluating health and health related activities in the district.
 Development and institution of health management information systems in the district
 Management of financial resources within the health sector in the district
 Human resource development of the health sector in the district

 
RECOMMENDATIONS
1. There should be more bins at the hospital area especially around the reception.
2. An ambulance at the hydro generation with a mini clinic to manage emergencies before transfer to the VRA hospital.
3. At the slaughter house, resting of the animals before slaughter should be enforced.
4. Efforts should be put into standardizing the slaughter house to further enhance provision of wholesome meat for the public
5. Residents of the township should be encouraged to separate their waste, so that final disposal of waste would be more efficient.
6. The refuse collection unit of the environmental health and sanitation department should be provided with more refuse trucks to make their work more efficient. The workers in the department should be encouraged to wear Personal Protective Equipment (PPEs).
7. Although the VRA is currently doing a lot of work in the prevention of bilharzia in the lakeside communities, more efforts should be put into provision of other sources of livelihood for these communities so that fishing would not be the only option available to them.
8. A lot more work needs to be done in the area of educating the surrounding communities and the nation at large on the symptoms and first aid management of febrile illnesses especially in children. This will ensure that morbidity is reduced and also workload on doctors will be reduced.
9. The ‘Onipanua’ medical boat should be continued as this would go a long way to provide medical services to the island communities.
10. A handset for the Power Line Carrier (PLC) in the Medical Students’ Hostel should be provided for easy communication with the hospital especially to aid in transportation of medical students.
APPRECIATION
Our deepest appreciation goes to God almighty for granting us this opportunity to study and keeping us safe.
On behalf of UGMS Korle Bu, we want to say a big thank you to the Volta River Authority and staff that made our stay a wonderful and educative one.
Particularly we want to say a big thank you to the Director of Health Services of VRA, Dr. (Mrs.) Acquaah-Arhin for putting necessary measures in place to ensure our comfort. We also want to thank Dr. Fiadoyor the medical superintendent of VRA Hospital, Akosombo.
We especially want to thank Mrs. Mercy Owiredu-Antwi, secretary to the director of health services for her warm welcome and hospitality. Also to the medical doctors; Drs. Ato Davies (clinical coordinator), Christian Addae, Boadu and Levi Nii Ayi Ankrah.
Our appreciation to the drivers and the kitchen staff.