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Have a Dream and Persevere

Sally-Ann Ohene from Accra, Ghana, has successfully defended her PhD thesis “Assessing Components of the TB Care Cascade in Ghana” at the University of Amsterdam. She was supported on her PhD journey since 2013 by the leader of the Epidemiology team at KIT, Dr Mirjam Bakker. Here she gives us a look at what drives her, what she learned, and what’s next.

I graduated from the University of Ghana Medical School in 1994 with a bachelor‘s degree in Medicine and Surgery before qualifying as a Paediatrician and an Adolescent Medicine Fellow with the American Board of Pediatrics. I also obtained a master’s in Public Health from the University of Minnesota in 2004. Since my return to Ghana, I have been working with the World Health Organization on HIV, tuberculosis (TB), neglected tropical diseases, and non-communicable diseases, including mental health and public health emergencies.

Why are you interested in global health?

I want to be part of a movement that aims to improve the health of everyone on the planet.

We need a greater focus on promoting health and preventing diseases and ill health rather than trying to cure ill health and diseases after they have occurred. The healthier we are, the more productive we will be in reducing poverty and its associated negative effects.

Why did you chose to study TB?

My interest in TB stems from the desire to join others in finding solutions to end the TB epidemic. Despite being a curable disease with effective medicines, TB remains a major global health challenge infecting around 10 million people annually and killing around 1.5 million.

In my home country of Ghana, only a third of the estimated 44,000 TB cases each year are identified and referred for treatment. To break this cycle, we have to come up with ways of finding and treating these missing TB patients.

What are the key things we can learn from your research?

  1. By using existing structures and staff to administer simple screening tools covering common TB symptoms, presumptive TB cases can be identified among outpatients attending general, HIV and diabetes clinics, contacts of TB patients, and in those in mining communities.
  2. The health system needs to be strengthened to make testing accessible and available to presumptive TB patients and with more sensitive TB testing equipment.
  3. As people living with HIV are more likely than others to become sick with TB, a stronger collaboration between the HIV and TB programs is necessary to provide integrated care and improve treatment outcomes.
"The healthier we are, the more productive we will be in reducing poverty and its associated negative effects."

What was the eye-opening finding in your research?

I found that by leveraging existing structures, such as outpatient staff, and without the need for many extra resources, many missed TB cases can be found among those who have already sort care at clinics for one reason or another.

What did you find the hardest?

Combining the PhD with my full time work and other family (I have 3 sons!) and social responsibilities was tough, but I learned that it is good to have a dream and persevere even when it seems the end is not in sight – God will crown your efforts.

What support did Paul Klatser provide?

Prof. Paul Klatser (former head of KIT’s Department of Biomedical Research) was my supervisor. Paul not only introduced me to Mirjam, but was also a strong supporter and he never gave up on me. He always encouraged me even though it took quite a while to complete my work. His feedback was always clear and to the point, which helped me see exactly what was needed to address the gaps in my research. I am so grateful to him.

How did Mirjam help you?

Mirjam was my co-supervisor From the very beginning, she arranged for an intern to come from the Netherlands to Ghana to support me with data collection. Despite her busy schedule, she provided great ideas, valuable feedback, and useful insights on my write-ups. She was meticulous in her comments and also helped with feedback to journal reviewers. Mirjam played a vital role in my PhD journey, and I appreciate her very much.

What are you going to do next?

For now, I am savouring this important moment and the amazing journey I went on to get here. I have not made concrete plans, but there are various options to explore, including venturing into academia. The sky is the limit.

“Supervising Sally-Ann was a great journey. She was keen to learn and always took my feedback seriously. As she is a very nice person, it was always a pleasure to work together on papers together. Three very interesting things were combined in this thesis: evaluating interventions to understand whether and why they were successful (or not) in reaching the desired outcome, the TB care cascade, and my special interest in Ghana as it is where I started my career in Global Health.”Mirjam Bakker

The full thesis ‘Assessing components of the TB care cascade in Ghana’ is available here.

Promoter Paul Klatser (left), Andy, Sally-Ann and Mirjam after a successful defence.