By Jacqueline French, MD
(2010) I just returned from Ghana where I was a member of a team from the International League Against Epilepsy whose mission was to train health care workers (doctors, nurses and health officers) about epilepsy treatment. It is difficult to say who learned more, the healthcare workers in Ghana or our group. While we were able to teach them about different types of seizures in adults and children and the effects of antiepileptic drugs, they informed us about the realities of epilepsy care in under-developed countries. Making a diagnosis is a different exercise when there are only two EEG machines, three Neurologists and one MRI scanner for a country of 23 million people. Even those resources are only available at a price and are only accessible to a few after a daylong journey on difficult roads.
Video-EEG monitoring is non-existent. Compounding the difficulties are the myths and stigma surrounding epilepsy. Most people who have epilepsy never get to the doctor – they are directed by their families or their tribal chiefs to religious healers. Epilepsy, if diagnosed, is cared for by psychiatrists and mental health workers and, when a diagnosis is made, the only available antiepileptic drugs for the majority of the population are Phenobarbital, Phenytoin (Dilantin) and Carbamazepine (Tegretol). To top it off, drug supply is inconsistent or at times non-existent. Having a seizure also carries additionally risks in light of the fact that the majority of people cook over open fires, which increases the likelihood of severe burns, and many fetch water from the rivers leading to a risk of drowning.
Our trip was intended to initiate a long-term effort to improve the lives of people with epilepsy in Ghana and other under-developed countries. It will be a long road, but we hope that at the end of, we will have made a meaningful difference.