Phyiso Corner: Report on the Pelvic Health Unit, Physiotherapy Department at Korle Bu Teaching Hospital, Accra, Ghana

The Pelvic Health Unit of the Physiotherapy Department, Korle-Bu Teaching Hospital, was created in 2018, with help from the Foundation for International Urogynecological Assistance (FIUGA). The vision for establishing the Pelvic Health Unit was to provide physical therapy as a support service for urogynecologic conditions.

The department was approached at the outset by Dr. Kareem Mumuni (faculty in the Ob Gyn Department) and Dr. Gabriel Ganyaglo (charter fellow of the Urogynecology Fellowship and also in the Ob Gyn Department) with a request to bring on board physiotherapists for the holistic management of urogynecological cases in the hospital.

The Department was excited at the opportunity to extend its wings in that specialty. Two therapists were then selected to undergo training in Pelvic Floor Rehabilitation with FIUGA. The training was done over a period of two years. Each year, two physiotherapists from FIUGA visited the Korle Bu Physiotherapy Department at separate times in the year.

During these visits, the selected physiotherapists were taken through pelvic floor assessment, treatment, and management. Continuous professional development workshops were also organized for the Ghana Physiotherapy Association during these visits. Also, presentations introduced the specialty to the urogynecology Department of the Hospital. FIUGA also donated some items to help in the rehabilitation of pelvic floor dysfunctions, including a pelvic model, dilators, lubricants, electrical biofeedback device, weighted vaginal cones, books and many more.

IUGA has granted the physiotherapists involved in pelvic floor rehabilitation access to literature and webinars, including the IUGA International Symposium on A Multidisciplinary Approach to the Prevention and management of Pelvic Floor Dysfunctions in March 2021. IUGA is also facilitating membership for the physiotherapists involved.

Strides Made Since 2020

Running of OPD Clinic with the Urogynecology Team

Since the first FIUGA-support physiotherapist visited Ghana, a physiotherapist has been incorporated into the Urogynecology Outpatient Clinic where clients who required the input of physiotherapy were easily helped. The Department is grateful to Dr. Ganyaglo who strongly recommended that a physiotherapist sits in to consult with him at the same time. This has allowed the physiotherapist to get first-hand information about the patient and has greatly facilitated the easy and smooth transfer of clients to the Pelvic Health Unit for further physiotherapy management when the need arises. The clients are very appreciative of this approach as they view it as a continuity of care.

Extension to the Management of Male Pelvic Floor Dysfunctions

Following the visit of the last FIUGA-support physiotherapist, Kendra Erven, the Pelvic Health Unit extended its services to the Urology Department of the Korle Bu Teaching Hospital. Referrals for both inpatient and outpatient are now received at the Pelvic Health Unit with cases ranging from incontinence post radical prostatectomy to premature ejaculation, etc.  The Unit hence receives referrals from both the Urology and Gynecology Departments.  

Plans for Further Training Outside the Country

As was done for the physicians, consideration was given to sending at least one pelvic floor physiotherapist to a well-established center in a high-income country for exposure. Although one of the visiting physios had offered free boarding and lodging for two weeks, the plan was hampered by visa, return air ticket and ground transport costs. The additional layer of COVID-19 meant this plan had to be postponed or abandoned.

Challenges

The Need for Further Training

The need for further training and access to more skill development cannot be over emphasized. The past few years have revealed the need and vast potential of Physiotherapy Management in Pelvic Floor Dysfunctions in the country. Opportunities for knowledge and skills enhancement should be explored.

Thanks to FIUGA, many therapists here in the country have had some basic introduction to Pelvic Floor Rehabilitation through the workshops organized over the last two years. However, more work needs to be done to reach out to more therapists across the country.

Appreciation

The Pelvic Health Unit is grateful to FIUGA for the role it played in its establishment.

Special thanks to:

• Gabriel Ganyaglo and Kareem Mumuni, who paved the way for the start of the novelty.
• Ganyaglo, who opened the door of his consulting room and made a way for the Unit to be part of the weekly Gyne Clinic.
• The Gyne and Urology Departments which continue to refer cases and show interest in the development of the Pelvic Health Unit.
• Maureen Brennan, Cristiane Carboni, Clara Karoliussen, and Kendra Evern (visiting physiotherapists through FIUGA) for their time with the team here, for volunteering their time to travel all the way here to impact the lives of many. Thank you for staying open and accessible even after departure and allowing the Unit to continue to contact you for your opinion on challenging cases and to seek your input.