Fellowship Elevates Colorectal Surgery in Ghana

In a joint effort, University of Utah Health, the University of Michigan, the University of Arkansas, and the University of Minnesota have established the first colorectal fellowship in Ghana in partnership with the Ghana College of Physicians and Surgeons (GCPS). The landmark collaboration aims to elevate access to specialty care while creating a model that can be adapted and implemented across the region.

With more than 33 million people and the Lancet Commission on Cancer predicting cancer cases will double in the next two decades in sub-Saharan Africa, the creation of the fellowship comes at a pivotal time.

Lyen C. Huang, MD, MPH, assistant professor of surgery at University of Utah Health, co-leader of the Huntsman Cancer Institute Colorectal Cancer Research Group and associate member of the Cancer Control and Population Sciences program, is one expert leading the charge to bring more specialized surgical care to Ghana.

“There’s often a tremendous stigma around diseases of the colon, rectum, and anus, but colorectal cancer can be prevented with appropriate screening and surgery for early cancer is often curative,” Huang said.  “Similarly, fissures, fistulas, hemorrhoids, and rectal prolapse can be debilitating, yet can be addressed with the appropriate medical treatment. By training surgeons in Ghana to address these diseases we can have a meaningful and measurable public health impact.”

Kwabena Agbedinu, MD, a general surgeon from the Komfo Anoyke Teaching Hospital (KATH) is set to be the first fellow to complete the program in June 2024, making him the first board-certified colorectal surgeon in Ghana.

The idea for the fellowship was born from a shared vision between the partner institutions and the Ghana College of Physicians and Surgeons to bring the highly specialized training practices from the United States to a program in Ghana. Together, the group began building the foundation for the fellowship in 2022 and launched the program in 2023. 

"This program couldn't have started without the dedicated collaboration of faculty in both Ghana and the United States,” Agbedinu said. "Their combined efforts have created a robust program designed to equip surgeons with the skills needed to manage complex conditions."

When the fellowship was announced, Agbedinu quickly seized the opportunity to apply, having long been interested in colorectal surgery. He had previously focused on general surgery, but recognized the need for specialized care and knew the fellowship would help him better serve his community.

“Our rate of cancer, and particularly colorectal cancer is rising, but there are few surgeons specifically trained to manage these cases in Ghana,” Agbedinu said. “When you have the right training for a specific condition, you can help give the patient the best possible outcome.”

Currently, few surgical fellowships exist in Ghana. With limited specialty training, general surgeons are often left to manage cases that would typically be managed by a dedicated unit in many countries, such as the United States. Additionally, with few surgeons in the region serving millions of patients, there is little time for advocacy to raise public awareness for complex medical issues. Agbedinu, with the support of the fellowship program coordinators, hopes to change that. 

"Education and early detection are crucial when dealing with a condition like colorectal cancer,” Agbedinu said. “My goal is to train more colorectal surgeons who can serve various regions across Ghana and all of West Africa, which will ensure better access to care and improve patient outcomes."

Agbedinu’s vision is one shared by the program, with Huang and his colleagues all hoping that each fellow who graduates will be able to train others, creating a snowball effect. The group plans to use this model in other key specialty areas, slowly creating a broad network of training programs with the aim of increased access to care.

“The key to success is our partnership with the GCPS,” Huang said. “Their leadership has set forth a vision for high-quality care by building training capacity in the country.”

Huang also explained that the ultimate goal is to develop a long-term relationship with GCPS, similar to the one established by Brad Rockwell, MD, who helped create the first hand fellowship in Ghana. Plans to establish programs for burn and breast cancer are already in the works. 

Agbedinu, who is set to complete his training in June 2024, is well on his way to helping the program see its aims come to fruition. He plans to build a colorectal unit when he returns to KATH at the end of 2024, as well as using his new skills to research better treatments, increase public awareness, and train more surgeons.

While the program is still young, both Huang and Agbedinu noted that the future possibilities for collaboration and expansion look bright. As more fellows train, more programs can be built, and more patients can receive care. 

"Training more surgeons and establishing specialized units across the country are essential steps for improving care," Agbedinu said. "We are just at the beginning, and the potential for growth is immense."