Teddy Totimeh, a neurosurgeon at the Greater Accra Regional Hospital in Ghana, wants to improve the state of critical care and infectious disease treatment in his country by opening a privately funded acute care center. The 2016 Eisenhower Fellow is a published novelist and poet as well. He joined the Knowledge at Wharton show on Siriux XM channel 111 to talk about his efforts to improve critical care in his country.
An edited transcript of the conversation appears below.
Knowledge at Wharton: Where did the idea to build this type of a center come from?
Teddy Totimeh: I am a neurosurgeon by profession, and one of the big things that prevented me from being effective when I finished training was the availability of critical care. One of the issues that struck me was the fact that there’s a lot of leadership talent in the private sector, and not as much leadership and administrative talent in the public sector.
But the infrastructure investment into the things that we need for critical care was [focused more on] the public sector because that is where you can manage the risk. Whereas, in the private sector, there’s not much happening as far as critical care is concerned. So, the aim of my project is to uncouple some of the infrastructure and expertise from the sub-optimal management ability in the public sector and couple it to the already known talent in the private sector, and see how it functions.
Knowledge at Wharton: What is the state of critical care facilities in Ghana?
Totimeh: It definitely needs addressing. Ghana’s critical care burden is mainly in the public sector because it has to be afforded, right? But the thing is, the investment of the country over the years has been more towards basic care rather than critical care. Now when you combine it with not really managing the facilities well, then it means that social impact is limited. So even though it exists, when you actually need it, the number of beds available is limited.
“In the private sector, there’s not much happening as far as critical care is concerned.”
Knowledge at Wharton: The idea to partner with the private sector can be effective in a wide range of areas, including health care.
Totimeh: Right. Ultimately, if this nucleus that we are trying to build functions, then we are going to be encouraging entrepreneurs, investing more into medical care and more into the high end of critical care.
The thing is, in Ghana, private investments into health care have been more into ambulatory care because that’s where the outcomes are predictable. But increasingly, we are having big private companies that are having to pay medical evacuation bills. And usually, the destination for medical evacuation in Ghana is either in the public sector or outside the country.
Knowledge at Wharton: What is the size and the scope of services for the facility that you would like to build?
Totimeh: The initial plan is to build a nucleus, and it’s a proof of concept mainly. We are having a small critical care center, about 10 beds. Because I am a neurosurgeon, we are pairing it with the neurosurgical theater, which will generate the initial traffic for the critical care center. This sort of starts the process going and keeps traffic in. Then, we intend to have a [program that will work on a] subscription basis for the beds in critical care.
The initial aim is [to serve] companies that are already paying significant amounts of money to medical evacuation companies but do not have destinations in the public sector and have to transfer patients out for critical care. Once that nucleus functions, we will upscale, and once we have bigger hospitals with more money, then it becomes more available to the general public.
Knowledge at Wharton: Is the subscription idea a model you think can work and be beneficial for health care and for critical care in general in Ghana?
Totimeh: It is because we have to start small. Starting big brings issues about how we can afford it, how we can keep it going. The thing is to start lean, to start with a critical care center that will have traffic in because of procedures that we are doing. Ultimately, these companies are paying money to medical evacuation companies — we can bite a bit into that market, right?
Knowledge at Wharton: You’re looking at it from the perspective of getting the first facility up and running, having a level of success and then replicating it in other cities within Ghana.
Totimeh: Right, and within West Africa because it’s the same picture across West Africa.
Knowledge at Wharton: The Ebola outbreak a few years ago sparked concern about critical care in West Africa. When you have something that massive, you’re talking about a need for coverage over several countries, not just one specific area.
Totimeh: The thing about such responses is the dependence and big capital injection. This [calls for] massive resources that we would have to depend on the outside world for. But the thing about starting with a nucleus like this is that we are able to grow [by starting] small, and it generates the local ability to support such an industry.
Knowledge at Wharton: How serious is the concern of infectious disease in Ghana and that part of the world?
Totimeh: As far as infectious disease is concerned, it’s covered in some ways because we have ambulatory care taking care of it. When disease needs critical care, that is, when buddy systems cannot function and you need something to take over their functions for a period to improve survival, that is where the issue is.
“The investment of the country over the years has been more towards basic care rather than critical care.”
We’re a very young country. About 50% of the country is under 20 years old. So, we have a high incidence of traffic accidents and people with brain injuries from traffic accidents. The burden for critical care is high.
Knowledge at Wharton: Where do you then look for the investment to build these types of facilities? Is it coming from within Africa or elsewhere?
Totimeh: Growing slowly, we can manage to get enough resources from inside the country. But capitalizing is where we would need some support from the outside. What this fellowship grants me the ability to do is to consult people in the industry. That is, people who are already doing great things in critical care. It also allows me to consult people in the hospital administration part of it. I am also meeting entrepreneurs. I am meeting people who have links to philanthropy. The main aim during the fellowship is not to raise funds, but to raise capacity. It gives me the chance to start this with a very deep network that would be essential for the future.
Knowledge at Wharton: What’s the time line for this project?
Totimeh: Next year is my time limit for putting up the first center, the first nucleus that is working. We’re going to hire a lean core of full-time staff, and we would have volunteer staff and part-time staff. Ultimately, over the next 10 years, I am looking at bringing up bigger centers.
Knowledge at Wharton: Being part of this group of Eisenhower Fellows, I would think that the ideas tend to flow. You probably are meeting people that have similar ideas that may work with what you are trying to do.
Totimeh: I am meeting people who make my ideas seem small. I mean, they make me feel like my dreams are small because I have listened to some of the things that people are doing already and want to do. It’s a very inspiring group to be part of.
