Living and working for several years in a middle-income country can be an effective means of improving healthcare.
James P. Murphy, MD, on behalf of the Humanitarian Efforts Committee
James P. Murphy, MDFor 15 years—from 2007 to 2022—I had the privilege of serving as an otolaryngologist-head and neck surgeon at Tamale Teaching Hospital in the northern region of Ghana. The area has one physician per 26,000 inhabitants. This long-term, on-the-ground commitment offered a profound lesson in humanitarian healthcare.
Living in Tamale and working full time at the hospital, I was able to support the care of common diseases by facilitating the replacement of broken equipment, the procurement of more modern equipment, and establishing an ear, nose, and throat residency program. During this period, the ear, nose, and throat clinic became consistent, with daily ward rounds and surgeries. An audiologist and speech therapist eventually joined the staff.
Medical Challenges and Clinical Innovations
Common otolaryngologic presentations in this area include children aspirating maize and groundnuts, injuries from road traffic accidents, and sepsis from tooth infections.
The pathologies we faced were often advanced and life-threatening. Foreign bodies were common, presenting even years after aspiration. The health clinics in the northern region do not have X-ray machines and even metallic aspirated foreign bodies were missed for long periods of time. Children who aspirated groundnuts or maize previously had to be referred to Komfo Anokye Teaching Hospital, 200 miles to the south. Indigent families did not have the means to travel and did not speak the local language in Kumasi; so, frequently the untreated children returned to their villages.
With donated ventilating bronchoscopes and optical forceps, we began removing obstructing foreign bodies in Tamale. Initially, the nurse anesthetists were hesitant—fearful of the high risks involved. However, after witnessing the first few successful interventions and the relief of families with their healthy infants, they became our most vocal advocates. Word spread, and soon we were receiving referrals from across northern Ghana and even from neighboring Côte d'Ivoire. Over 15 years, our team became adept with the procedure, saving countless young lives.
Victims of road traffic accidents, the leading cause of death for Ghanaians under 30, arrived daily with deep and extensive facial and head injuries. Our ability to provide immediate, complex reconstructive surgery earned the respect of the hospital staff and the gratitude of patients and their families. This sustained effort was formally recognized with an award from the Tamale Metropolitan Council.
Building Capacity and Training
Another significant accomplishment was the establishment of an otolaryngology residency program, certified by the Ghana College of Physicians and Surgeons. A Ghanaian otolaryngology colleague who worked with me petitioned the Ghana College of Physicians and Surgeons to recognize us as a residency program. We were approved for first year training and usually had two trainees per year. Six of our residents have now gone on to complete their training in Kumasi or Accra.
The operating microscopes and microdebriders that were brought to Tamale Teaching Hospital required more than delivery. Instruction in their operation and maintenance was crucial, and teaching surgery using these modern tools took time and patience. The staff needed to observe ear, sinus, and laryngeal procedures repeatedly before gaining confidence. Even with proper instruction, equipment breakage was inevitable. Replacing, repairing, and importing donated equipment through Ghana customs consumed one-third of my time and required developing local contacts. The staff had no experience in doing this, and so we learned together.
In time, the otolaryngology clinic began to meet daily and only closed when all the patients were seen. We instituted daily ward rounds with the nurses and physicians. Elective surgical cases were scheduled twice a week, and emergencies were treated as soon as possible. We were in the theater four times a week. The Ghanaian National Health Insurance was accepted as payment for operations and clinic visits. No other payments were collected.
We also began holding general weekly grand rounds. The initial grand rounds had six in attendance, but eventually grew to 100. Having consistent weekly scientific meetings required a lot of work. A scheduled speaker might call the night before, saying circumstances had required him to be miles away. If I was unable to find a backup speaker, I often gave a lecture myself.
Sustainability and Future Impact
I was able to live and work in Ghana with financial support from my personal funds, a stipend of $500 a month from The Catholic Medical Mission Board, and a monthly collection from a New Jersey Catholic church. After working for five years in Tamale, I began to receive a Ghanaian physician salary and was even paid retroactively. The funds covered my food and the rental of a comfortable house, but not the additional expenses of fees for medical licenses both at home and abroad, Ghana residency permits, purchase of supplies and the maintenance of my family home in the United States. It was manageable living in rural northern Ghana.
The work in Tamale now continues to grow through a partnership with AMPATH NYU Ghana, supported by the Leona M. and Harry B. Helmsley Charitable Trust and Eli Lilly and Company. Their model, which places healthcare workers in-country for three-year rotations, exemplifies an effective strategy for providing consistent, high-level care.
The health of the population in low- and middle-income countries cannot be improved solely by healthcare workers. Clean water access, affordable housing, adequate nutrition, sanitation, energy infrastructure, and safe transportation remain fundamental prerequisites for population health. Lack of these basic living conditions continue to cause disease with which healthcare workers cannot compete.
It is impractical for most to spend several years living and working in a low- or middle- income country. However, philanthropists, corporate heads, foundations, and leaders in both worlds can encourage and support the few who are able. Such efforts can be effective.
For those considering spending several years in a low- and middle-income country, they should be part of a team, healthy, and well trained. They must also have perseverance as well as family and financial support. The countries that benefit from hosting physicians from high-income countries are often in debt, with many obligations. Their budgets allow only for essential basic health support. In 15 years, our otolaryngology department did not receive any equipment from the hospital administration. When patients were unable to pay for computed tomography (CT scans) or antibiotics, the physicians and nurses sometimes helped to defray the cost.
The concept of “brain drain” is well known. Why not a brain drain from high-income countries to low- and middle-income countries? A few dedicated professionals from high-income countries can invest years of their lives to build capacity, share knowledge, and leave behind a system that is stronger and more self-sufficient than the one they found. The impact of such an investment can be immeasurable.
James P. Murphy, MD, is the 2025 recipient of the Distinguished Award for Humanitarian Service, recognizing his extraordinary 15-year commitment to improving healthcare in northern Ghana. His sustained presence at Tamale Teaching Hospital—establishing vital services, training local physicians, and treating thousands of patients—exemplifies the transformative power of long-term humanitarian medical service. Award recipients will be acknowledged at the upcoming AAO-HNSF 2025 Annual Meeting & OTO EXPO℠.
James P. Murphy, MD
