July 2017

Treatment and Recovery:
Global Perspective from a Hubert Humphrey Fellow

Samuel Cudjoe Hanu, M.S., IPAS
Psychiatric Nurse
Accra Psychiatric Hospital
Accra, GHANA

A dream comes true
1995, I was in secondary school and president of the Interact Club of Accra Academy, Ghana, a junior service club of Rotary International. We had an opportunity to travel to the United States to attend the World Scholar Athletics Games in Rhode Island. I really wanted to attend, but I knew that our club could not afford to send me, nor could my parents.

Twenty-two years down the lane, in March 2017, I was a Hubert H. Humphrey Fellow on my way to Rhode Island to attend the Addiction Technology Transfer Network Meeting as a special guest. And in May, I participated in the 2017 graduation ceremony for the Virginia Commonwealth University, with a Master of Science from the International Program in Addiction Studies (IPAS), jointly operated by Virginia Commonwealth University (VCU), Kings College in London, and the University of Adelaide in Australia.

Here's the story of my journey.

Training as a psychiatric nurse
After completing my secondary school education in 1996, I attended a Nurses Training College in Accra.
While completing my internship at Korle Bu Teaching Hospital, the premier teaching hospital in Ghana, I asked a patient on admission for advice on my next move academically. He recommended that, as a psychiatric nurse, I could specialize in addictions since it is an uncharted field in Ghana. That was the ‘aha’ moment for me.

After earning my diploma as a Registered Mental Nurse (RMN), I began practicing as a psychiatric nurse at Accra Psychiatric Hospital, in 2001. At one point, I served as the deputy (assistant) ward in charge of one of the largest wards in the hospital. The ward had more than 300 patients, and about half had diagnoses related to alcohol and drugs. Many of the hospital staff members also had issues with alcohol and drugs. I remember one staff member in particular who was admitted to my ward with alcoholism and went through withdrawal “cold turkey.” Worst of all, this person never had the chance to talk to a drug counselor and finally succumbed to alcoholism.

Sadly, this is the story of many people struggling with alcohol use disorder in Ghana.

I was reassigned to head the medical ward of the hospital, which also doubles as the detoxification unit of the hospital for males. We treated several patients who were withdrawing from alcohol but some, unfortunately, we lost. I saw the effects first-hand.  

Substance Use Services in Ghana

These stories highlight the problem of alcohol and other substance use disorders in Ghana. Additionally, while Ghana has laws on drunk driving, police lack the resources to enforce these laws. Restrictions on alcohol advertising, especially during prime time, are poor. Children sing along to alcoholic advertisements, and it’s not uncommon for them to be sent out to buy alcohol for adults or for themselves. Drug testing is not common, and the most frequent drugs of abuse in Ghana are alcohol and marijuana. Other drugs are also becoming a source of concern.

 

 

According to the country profile for Ghana, published as part of the World Health Organization (WHO) ATLAS 2010 global report on substance use disorders:
  • No epidemiological data are available on SUDs in Ghana
  • There is no substance abuse policy and law
  • Drug courts are not available
  • 70 percent of treatment is in mental health institutions
  • There is no budget allocation for SUD treatment and prevention
  • Less than 10 percent who need treatment receive it

Recovery in Ghana


A few years back, Alcoholics Anonymous or Narcotics Anonymous meetings were non-existent in Ghana, but they are becoming more available. At the Accra Psychiatric hospital where I work, AA meetings are held once in a week, and these meetings do not have strong support from the staff.

Recovery Africa has helped to bring 12-step and other types of recovery to Ghana. President and Chair Dan O’Laughlin has been very instrumental in establishing a rehabilitation center and recovery activities in Ghana.

 

The Hubert H. Humphrey Fellowship Program

Following advice from a consultant-patient, I searched, found and applied to the International Program in Addiction Studies (IPAS) which offers a unique master’s degree program that makes use of distance education. With support from the Ghana Education Trust Fund (GETFund) and the program itself, I became a graduate student of these three reputable international universities at the same time.
After becoming exposed to all the new knowledge in addictions, I embarked on advocacy for reforms in Ghana.

Realizing my interest and the advocacy I was doing, a doctor who was by then doing her residency at my hospital, Dr. Ruth Owusu-Antwi, recommended that I apply for the Hubert H. Humphrey Fellowship Program. After a long and laborious screening process, I was selected to join 168 professionals from all over the World for a ten-month graduate program at various universities in the United States.

And what a time to be in the U.S.! To observe the US election at close range and the freedom Americans have to assemble and demonstrate to express their views; the opioid epidemic and efforts to address it, and the release of the Surgeon General’s report, Facing Addiction in America.

Conclusions

The Hubert H. Humphrey fellowship provided the practical knowledge that I can apply in my work. What I have learned will help me implement evidenced-based addiction services for the people of Ghana.

My key messages include:

  • Addiction is a primary, progressive, chronic brain disease, comparable to conditions such as asthma, diabetes, and hypertension, fraught with frequent relapses. It is never a moral failing on the part of the user.
  • Recovery activities must be promoted and an understanding that, detoxification is not treatment, but an opportunity to refer patients to long-term treatment.
  • AA/NA principles are effective and cheap and have great potential because the worldview of the Ghanaian makes it easy to relate to a “Higher Power.”
  • Families need support to understand the disease nature of addiction so they can better help their loved ones in treatment.
  • It makes economic sense to treat substance use disorders, since a dollar invested in treatment reduces health care and criminal justice cost by $4 and $7 respectively.
  • While resources are scarce, local resources can be harnessed to plan and implement prevention activities.

I was privileged to have worked with organizations such as the Richmond Behavioral Health Authority (RBHA) in Richmond, Virginia: The Healing Transitions in North Carolina: and the Willingway Hospital in Statesboro, Georgia.

My fellowship year had many highlights, including meeting with former President Jimmy Carter; NIDA Director Nora Volkow, and a host of other SUD treatment and recovery professionals, such as those I met at the ATTC Network meeting in March 2017. I also had the opportunity to travel to Belize in Central America and Canada to attend the NIDA/CPDD International Conference. Keeping the communication channel open for possible collaborations is a top priority for me as I prepare to return to Ghana.

My experience in U.S. has been a worthwhile learning adventure and would like to appreciate all who have played a role in making it happen.

Graduation, May 2017: To my left is Mr. Dennis Bussey of the James River Hikers Group of Richmond. To my right is Dr. Randy Koch, an associate professor and the chief Coordinator of the Hubert H. Humphrey Program at VCU and his wife, Diane Wresinski.