Pam Lupo, CO, casts a five-day-old baby with a hyperextended knee.

The first two things you learn in Ghana are patience and to always carry your toilet paper with you. I visited Africa this April as a guest of FOCOS (Foundation for Orthopedics and Complex Spine). This international organization is dedicated to bringing state-of-the-art free and affordable care to those who are afflicted with spinal deformities and disorders.

There are 18 million people in Ghana, but only two practicing orthopedic surgeons and only about 20 orthotists and prosthetists. Our FOCOS team was composed of 20 orthopedic surgeons and a support staff. My role was to assess the orthotic and prosthetic services and to aid in patient care and clinical education.

When I arrived at the airport in Accra, the capital, the unfamiliar setting was exhilarating. Everyone brought medical supplies of one specialty or another, which presented some issues with customs. Some of us breezed through, while others had to "negotiate" permission to bring them into the country.

These patients were scheduled to receive surgery from FOCOS.

There is a calmness and easy pace in Ghana that doesn't mesh well with our American ways. Though we rose at 7 AM to head for the hospital, our driver didn't arrive until 10:30 AM. When we finally arrived at the hospital, I assisted Dr. Mendelow with clubfoot surgery for a three-year-old girl. The opportunity to assist such a gifted doctor is an experience I will not soon forget. Her foot is now without any detectable deformity, and I cast her for orthotics the following week.

O&P in Ghana

My primary goal was to seek out clinicians. I was informed that orthotists and prosthetists are called orthopedic technicians. By the third day, I was directed to a crowded section of town and a building that had a sign, "The Ministry of Health." I walked into a sparsely furnished room with a crushed velvet sofa that looked like it was from the 1950s, crutches leaning up against the wall, and a cabinet containing prosthetic devices. The man sitting behind the desk was Mr. Kodi, the director of Orthotic and Prosthetic Services. Initially, he was guarded and quite reluctant to speak with me. He explained later that many people had come before me who either had not kept their promises or had financial motives.

After some discussion, he sensed my genuine intentions and toured me through the facility, introducing me to the staff. The machinery was mostly from Germany and in quite good condition. However, the technology of the orthotic and prosthetic devices was of the late 1950s or early 1960s. It is apparent that Ghana is seriously lacking in the availability of supplies, materials, and ongoing education. Commercially made devices are nonexistent, and therefore the technical skills of the seamstresses and shoemakers are impeccable. A select few clinicians received their education in Egypt, Uganda, or Germany.

Pam Lupo, CO, prepares to assist with a surgery.

Before leaving, we made plans for me to return to the lab to share ideas and present one of my lectures on orthotics. I had confirmed that orthotic and prosthetic services were provided through five Ministry of Healthy facilities and four privately held facilities. There is no government or privately funded healthcare-only patients who are able to pay receive services.

The rest of the time was filled with filming surgery, taking inventory of supplies, visiting wards, assessing patients, and seeking clinicians. I made friends with patients, families, hospital staff, and strangers who were excited to meet an American. I constantly took pictures to share with everyone when I returned. While the pictures show the many images I wanted to portray, they couldn't begin to share the experience!

Disability Prevalent

What was most unexpected for me were the disabled persons we saw on every street corner. Polio strikes nine out of every 1,000 persons, and pediatric amputees are unbelievably prevalent. Children sell goods on the streets to help support their families. The children are often hit by cars, and there are no means of saving their limbs. Prenatal care is almost nonexistent, so birth defects are abundant. There is still the social stigma that disabled persons should not be seen in public. One can only imagine how many more are hidden in their homes and villages.

Wright & Filippis To Help Ghanaians

Wright & Filippis has committed to a five-year plan in education and patient care in Ghana. We will assist in the development of the Orthotic and Prosthetic Technician Program at the University of Ghana. W & F will partner with FOCOS and the Ministry of Health to develop their technology and knowledge. FOCOS has developed the Ghana Club Foot Program, modeled after the successful Uganda Club Foot Project. We will begin teaching and developing this program throughout the country. In addition, several of our suppliers have already donated parts and supplies as well as products unavailable in the hospitals. I have received very generous donations from PEL Supply, Becker Orthopedic, Camp Healthcare, DonJoy Orthopedic, Cascade DAFO, and Jobst, to name a few.

How quickly the 12 days passed. We saw patients at the Trust Hospital up to the minute we left. The halls were crowded with patients who heard we were coming-and there were still so many we couldn't help. We hastily evaluated patients for the care they would receive from the next returning FOCOS group. When my friend said it was time to leave, I broke into tears. I was eager to return home, yet it broke my heart to leave such an adventure.

My Outlook Changes

The night I returned, my daughter had a soccer game. When I sat in the stands, as I had so many times before, everything was somehow different. The waving American flag, the green grass, the bright stadium lights, and the haze in the air all seemed crisper. I drifted to the place I had been just a day before. All I could think of were the images and the faces I had left behind. Ghana is truly a land of extremes. The people are educated and not, the seasons are wet and dry, people have and have not. Leisure time was not something I observed Ghanaians enjoying. I never took for granted watching my children, but now it is a treasure.

The importance of material goods is different as well. Only now do I realize that items I once viewed as being "on sale" are equal to a month's wages in Ghana. When shopping, I pick up item after item, only to put it back because it doesn't hold the same enjoyment. It seems I don't need things like I used to. I was horrified at a recent dinner banquet where too much food was served and the uneaten food was discarded by the bucketfuls.

My experience has changed my outlook on life. I am told that these feelings will dissipate with time and I will welcome that-or will I? I have had some people comment that I am calmer since I have returned. I smile and think to myself, "I am on Ghana time."

For more information or if you would like to make a donation, contact Pamala Lupo, 248.829.8284 or plupo@wright-filippis.com. For more information on FOCOS, visit: http://orthofocos.org

Director of Orthotics Wright & Filippis Inc.