The Zambia Anaesthesia Development Project

44 Pages·2014·4.69 MB·English

Volume 14 Number 2
July 2014
ISSN 1472-8820
www.aagbi.org/international/international-relations-committee/world-anaesthesia-society
In this issue:
Critical Care in low UK anaesthetic trainees’ Operation Smile:
income countries perspectives on preparedness The Vietnam Mission
for global anaesthesia practice
High dependency care Prolapse Down Under in Nepal
in Ethopia The Zambia Anaesthesia
An opportunity to make
Development Project –
Florian R. Nuevo MD a difference
18months in…
WA
WORLD
ANAESTHESIA
World Anaesthesia
Society Travel Grant
The World Anaesthesia
Society is offering a grant
of up to £1000 for trainee
anaesthetists wishing
to work or teach in a
developing country
Application and award of these grants will be through the travel
grant system run by the International Relations Committee of
the AAGBI with two grants awarded each year.
Further information and application forms available at
www.aagbi.org
Printed and Distributed by:
COS Printers Pte Ltd: 9 Kian Teck Crescent | Singapore | 628875
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Welcome to
World Anaesthesia News
Welcome to our bumper summer issue of World Anaesthesia News. We Contents
have been blessed with so many quality articles that we have just had to
expand our waistline somewhat.
Editorial 3
We open with a report from the excellent inaugural World Anaesthesia
Society trainee day that was held at the AAGBI in February. This exciting,
Trainee anaesthetists in
overbooked seminar was a wonderful opportunity for trainees with the
the developing world –
inclination to go overseas to find out how to do it. A well-evaluated day, ended
where to go and how to
with a sociable drink and plans for a 2015 seminar. The Southampton Global
organise it’ - The first ever
Anaesthesia Conference was held just before Christmas and boasted a truly
trainee seminar for WAS 4
eminent faculty. Twelve different developing countries were represented
across the 41 delegates, 12 speakers, oral presentations and posters. The Southampton article 6
organizing committee from Southampton General Hospital lead by Ollie Ross
are to be commended and encouraged to turn this in to an annual event. Critical Care in
low-income countries 8
Critical care in the developing world may well be in its infancy, but with
inspiring protagonists such as Tim Baker and Tom Bashford it is rapidly High Dependency Care
climbing the agenda. We are fortunate to have articles from each of them, in Ethiopia 12
Tim Baker setting the scene and Tom Bashford describing his experience
and achievements in Ethiopia. UK anaesthetic trainees’
perspectives on preparedness
In a slight departure form the typical WAN article, we have an interesting
for global anaesthesia
survey from John Kinnear and Preea Gill highlighting that whilst developing
practice 17
world anaesthesia is an aspiration of many trainees in the UK, only a few
feel prepared for the daunting challenge. This reinforces the importance and
The Zambia Anaesthesia
usefulness of seminars such as those already mentioned, and demonstrates
Development Project –
how the World Anaesthesia Society is perfectly placed with the links and
18months in… 21
expertise to help and support. Four leading projects are examples of ‘how
to do it’. Emma Lillie gives us an insightful update to the first 18 months The ‘Anaesthesia in
of the Zambia Anaesthesia Development Project (ZADP), Jildou van der Developing Countries
Kaaij provides a very descriptive account of the ‘Anaesthesia in Developing Course Experience 25
Countries’ course run by the Nuffield Department of Anaesthesia, Shilpa
Reddy writes about her Operation Smile experience, and Marissa Ferguson Operation Smile:
discusses the work of Australians for Women’s Health. All of that, plus a The Vietnam Mission 30
profile of Florian R. Nuevo MD, Chairman of the WFSA Executive Committee
2008 – 2012, and an introduction to the charity Safe Anaesthesia Worldwide. Prolapse Down Under
in Nepal 33
We are sure that you will agree that there is something inspirational for
everyone in this issue, and if anyone should ask you what the World
Florian R. Nuevo MD 36
Anaesthesia Society does just hand them this copy of WAN!
An opportunity to make
Finally, we ask for more articles, correspondence and letters, and urge you
a difference 38
not to miss the World Anaesthesia Society session on Wednesday 17th
September at the AAGBI annual conference in Harrogate, which will be
Useful information 40
chaired by Isabeau Walker and will feature Iain Wilson and Eoin Harty.
WAS application form 43
Sarah O’Neill and Gordon Yuill
Editors
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14.2 WORLD ANAESTHESIA NEWS | 3
Trainee anaesthetists in the developing world –
‘where to go and how to organise it’ - The first ever
trainee seminar for WAS
Dr Anjana Prasad, Dr Christine Sathanathan and Dr Arani Pillai
The RCOA states that it ‘strongly and Trainee Opportunities in the
supports trainees taking time out developing world.
of training to widen their clinical
Speakers highlighting trainee
skills and knowledge’. Trainees are
experiences were Dr Preea Gill,
now grasping more opportunities
Dr Nur Lubis and Dr Melissa
to work in the developing world.
Dransfield. They described exciting
However, finding out how to
and varied times away from
organise this work and what
training and gave a taster of some
opportunities are available is not
of the opportunities available.
easy. The aim of this seminar was
They explained the problems
to focus on the trainee and answer
encountered and benefits gained
the key questions - how do you
from working in the developing
organise time out of training and
world as a trainee.
what opportunities are there for
trainees with various organisations? The organisation section was led
by Dr Lila Dinner - Training Program
Fully booked to the point of over- Director from the North Central
subscription with some delegates London School of Anaesthesia and
unfortunately being turned away, Dr Jo James from the RCOA. They
the seminar seems to have explained the process of applying
been a long-awaited event and a for time away from training and the
successful one too. Eighty-two origins of the module in ‘Developing
percent of attendees who provided World Anaesthesia’ respectively.
feedback rated the seminar as Both speakers stressed the
‘excellent’. Some of the comments importance of involving the RCOA
also indicated this: ‘thanks so much early in the application process
– exactly what I wanted’, ‘fantastic and advised on early planning as a
seminar’ and ‘very informative’. priority to making time away easier
There was a diverse line up to achieve.
of speakers and the day was Representatives from the Tropical
divided into 3 sections -Trainee Health and Education Trust
Experiences, Organising time away, (THET) presented the results of
4 | WORLD ANAESTHESIA NEWS 14.2
the global collaboration survey, and how to get involved. It was differences between training
collating anaesthetic projects in clear that organisations differed in regions in terms of support for
the developing world and listing their aims and needs. Some were training in the developing world
them for future volunteers. Dr Ben very welcoming of trainees and though this will hopefully change!
Gupta also joined us to give us a others required more experienced Discussions continued well into
taste of some of the equipment and doctors. Some focused on short the evening over flavoured beers
drugs available (and not available!) term missions but others looked at at a nearby pub - conversation
in resource poor countries. He also longer-term partnerships. The idea and beverages were enjoyed
highlighted the courses available to of sustainable, ethical volunteering responsibly by all!
trainees before they leave the UK was a common theme.
Acknowledgements and thanks to
for the developing world.
The day was packed with the events staff of the AAGBI and
Our last section was a sequence information from speakers who our fantastic speakers.
of talks from a few organisations were both enthusiastic and
including Medecins Sans realistic about trainees working in Thanks to the popularity and
Frontieres, VSO, Operation Smile, the developing world. We were success of the event, it will be
Mercy Ships and the Ugandan fortunate to be so kindly treated by running again next year. Details
Maternal and Newborn hub. This the staff at the AAGBI with great will appear on the AAGBI website
was a full session which gave some food and hospitality. The delegates and will be emailed out to WAS
examples of organisations that enjoyed sharing experiences and members.
would accept trainee volunteers tips. It was clear that there are
14.2 WORLD ANAESTHESIA NEWS | 5
The Southampton Global Anaesthesia Conference
Zoë Smith1, Liz Shewry2, Louise Bates3, Namartha Thiagarajan, Ollie Ross4
1 ST3 Trainee, Southampton In recent years there has been support a discussion forum for
General Hospital growing support for education and experiences, and enable networking
training in anaesthesia in resource- and collaboration on different
2 Locum Consultant, Southampton
General Hospital poor settings. UK trainees in projects in an affordable and
particular are actively encouraged friendly manner.
3 ST4 Trainee, Southampton
to work in developing countries to
General Hospital From these beginnings the 1st
gain out-of-programme experience
Southampton Global Anaesthesia
4 Locum Consultant, Southampton and support the development of
General Hospital Conference was born. With 12
international health links between
different developing countries
5 Consultant Anaesthetist, low-income countries and NHS
represented across the 41
Southampton General Hospital departments. Developing world
delegates, 12 speakers, oral
anaesthesia fellowships, specific
presentations and posters, the
training programmes and a
conference promised to be an
variety of educational material are
exciting new event. It was held in
becoming more widely available.
the Hilton Hotel, Chilworth on 19th
In Southampton, a group of
December 2013 and organised by
anaesthetists with an interest in
a committee from Southampton
developing world anaesthesia
General Hospital lead by Dr Ollie
recognised the need for further
Ross.
education and dissemination
of information regarding global The day kicked off with Dr Malvena
anaesthesia projects. We wanted Stewart-Taylor, a Consultant
to share ideas, provide information Anaesthetist at Southampton
regarding how anaesthetists at General Hospital who gave an
different levels might become excellent talk on the Afrikids
involved in overseas initiatives, programme she runs in Ghana.
“Excellent idea to get people together and share ideas and
experiences. Really informative, enjoyable and valuable”
6 | WORLD ANAESTHESIA NEWS 14.2
This is a fine example of share a mutual goal and are often Ed Fitzgerald from Lifebox also
the delivery of sustainable developed first, good partnerships travelled down from London to talk
improvements in health and tend to be built on trust and to people about the Lifebox pulse
healthcare in a developing country. respect, often take longer to oximetry donation programme
She emphasised the importance of establish, but are essential for which has been successfully
partnerships, the potential benefits success. incorporated into many of the
of working within a framework, projects discussed during the
Dr Keith Thomson, who has vast
and also the personal benefits conference. In the afternoon, we
experience working for Mercy
of such work to those directly heard from Dr Ollie Ross who
Ships in West Africa and organising
involved, and to the NHS in terms discussed log frame analysis and
anaesthesia and midwifery
of leadership skill development. highlighted the benefits of logical
project planning based on his
extensive experience working on
training nurse anaesthetists in
Nepal. The group was then divided
and three practical sessions ran
simultaneously. These included
the use of anaesthetic equipment
She was followed by Dr Phil conferences throughout Africa, designed for the developing
McDonald who shared his wealth then discussed the benefits of world, Glostavent and UAM
of experience as Medical Director running shorter-term educational anaesthetic machines and ketamine
for Operation Smile and how this initiatives. These typically involve anaesthesia. One of these sessions
led to setting up an educational link identifying the educational needs was purely to allow discussion
with Jimma University in Ethiopia. in a country and planning a 3-day regarding the opportunities available
The Jimma link is a programme conference around them. UK at different levels of training and
which commenced in 2012 when trainees and consultants deliver to allow the exchange of ideas and
one of us was fortunate to have teaching sessions and attendees information. As a grand finale to
the opportunity to pilot the initial travel from surrounding hospitals. the day, we were honoured to have
programme. It is now in its second Some come from particularly the opportunity to listen to Dr Rola
year and allows trainees from far-flung hospitals in order to Hallam presenting her awe-inspiring
KSS Deanery to work at Jimma receive training. We were also work with Hand in Hand for Syria
University and in the Department privileged to be joined by Dr Jo which incorporated graphic material
of Anesthesiology as “Visiting James from the Royal College from her Panorama documentary on
Lecturers” (VLs) for 3-6 months of Anaesthetists who gave an the Syrian conflict.
during their higher training years. extremely informative overview on
“Please repeat this
VL’s have been involved in training how developing world anaesthesia
BSc level student anaesthetists, might fit into training – an very worthwhile
writing a postgraduate syllabus for invaluable session for trainees.
postgraduate physician training in Prior to lunch Dr Ada Ejiofor gave conference. Should
anaesthesia, starting a recovery the most energetic presentation of
area, new guidelines, audit, the day on Diaspora support which (cid:71)(cid:72)(cid:192)(cid:81)(cid:76)(cid:87)(cid:72)(cid:79)(cid:92)(cid:3)(cid:71)(cid:82)(cid:3)(cid:76)(cid:87)(cid:3)
initiating the WHO checklist and was particularly well received.
annually”
targeting specific areas such as
Throughout the day, a friendly
ICU and obstetrics for further
festive atmosphere was cultivated
educational initiatives.
and delegates had ample As an organising committee
Dr Tei Sheraton, the Chair of opportunity to chat to speakers we were impressed by the
Trustees for Mothers of Africa and to each other during breaks overwhelming enthusiasm of
talked to us about what they have and over a civilised lunch. Dr delegates and speakers alike.
learnt about developing country We reflected that there may not
partnerships. Mothers of Africa have been support for hosting a
“Great for
is a medical educational charity conference such as this even five
that trains medical staff in Sub- networking and years ago, and are excited by the
Saharan Africa to care for mothers prospect of making it an annual
during pregnancy and childbirth. ideas on how to put event. We would like to extend
It was initiated in 2004 and now our thanks and gratitude to the
operates in Benin, Togo, Liberia projects together. World Anaesthesia Society for their
and Zambia. Tei discussed the generous support for the running
Superb conference
differences between relationships of this conference and to all those
and partnerships in establishing who contributed to making the
and very good
improvements in the provision of conference such a success.
developing world healthcare. We
value”
learned that whilst relationships
14.2 WORLD ANAESTHESIA NEWS | 7
A basic but effective ICU in a hospital in Tanzania
Critical Care in low-income countries
Tim Baker MB ChB1,2
1. Karolinska University Hospital, Critical Care can be defined as all hypoglycaemia can be life saving.
Dept. of Anaesthesia, Intensive care given to patients with serious Emergency triage and treatment
Care & Surgical Services and reversible disease. High-income for children in a hospital in Malawi
2. Karolinska Institute, Dept. of countries can afford resource- costs only US$1.75 per patient and
Physiology & Pharmacology, intensive and sophisticated critical has reduced hospital mortality by
Section for Anaesthesia & care but this is not possible in 50%. Oxygen therapy can cost less
Intensive Care / Health Systems low-income countries. So is critical than two dollars per day.
and Policy Research Group, Dept. care needed or feasible in such
of Public Health Sciences. Both Unfortunately, critical care in
settings?
Stockholm, Sweden low-income countries is often
The burden of critical illness is poor. Hospitals lack processes for
especially high in low-income prioritising and caring for critically
countries. Over 90% of global unwell patients. Life saving drugs
maternal deaths, child deaths, and equipment are not immediately
deaths from sepsis and deaths available. Staff training in the
from trauma are in these countries. management of critical illness
50% of child deaths in hospitals is uncommon, and Intensive
occur within 24 hours of arriving at Care Units are rare. Medical
the hospital. It has been seen that guidelines often lack relevance or
as many as one in four of medical are impossible to implement in
admissions is critically ill. resource-poor settings. Critical care
has not been promoted as it cuts
Critical Care need not be expensive
across traditional disciplines and
or difficult. Cheap treatments such
lacks policy advocates.
as adequate fluid resuscitation
to children with diarrhoea This article describes realistic critical
[email protected] and intravenous dextrose for care services for a district hospital
8 | WORLD ANAESTHESIA NEWS 14.2
The queue-based (non-) system of triage in a hospital in Tanzania
in a low-income country, focusing practitioners should be prioritised; IDENTIFYING THE RIGHT
on the hospital structure, routines a quiet place with good access to PATIENTS
and basic clinical management. radiology, laboratory and surgical Formal triage systems are
provision is ideal. ubiquitous in hospitals in many
THE HOSPITAL STRUCTURE parts of the world but in low-
Within the hospital, at least 1-2%
Critically ill patients arriving at income countries triage is often
of beds should be assigned for
hospital require quick identification absent or of poor quality. Queue
the critically ill. This means at least
and treatment. Formal triage based systems are common
4-8 beds in a 400-bed hospital.
systems at the entrance to hospital and can result in delays for the
An Intensive Care Unit (ICU)
should divide the patients into critically ill patients and less rational
can concentrate expertise and
urgent and routine cases and direct prioritisation of the hospital’s
resources. Staff should receive
the urgent cases to a resuscitation resources.
directed training in managing the
room or emergency department.
This is both clinically and cost critically ill, effective routines can Every hospital should have a formal
effective, as resources can be be set up and emergency drugs and triage system for new patients.
focused on those who have the equipment can be kept near the Triage should precede registration
most pressing clinical needs. patients who need them most. The processes and payment for
risk that an ICU could divert already services. As triage has the potential
The emergency department scarce resources from the rest of to save lives and reduce costs,
should be adjacent to the hospital the hospital can be minimised by it should be a prioritised activity,
entrance and triage area. There ensuring that it provides treatments with senior staff appointed where
should be resuscitation bays or and facilities consistent with the possible.
rooms for immediate treatments, rest of the healthcare system.
with emergency drugs and Where a separate ICU is not Triage must be quick and simple.
equipment always at hand. practicable, designating beds on Effective triage systems involve
Medical staff should be present a general ward as ‘critical care’ or vital signs, utilising derangements
or on-call 24 hours-a-day and, if ‘high dependency’ beds improves in physiological parameters
possible, senior staff should be medical oversight. Where resources as indicators of critical illness.
on-call for complicated or serious allow, hospitals can introduce a Identification of critical illness also
cases. Treatment rooms should ‘Rapid Response Team’. This is takes place after admission to
be spacious to allow a team a team of hospital staff trained in hospital. Such “ward-based triage”
of several health professionals critical care who may be summoned involves the regular assessment of
to work efficiently together to support the care of seriously ill clinical status in order to detect the
and communication between patients on a general ward. deteriorating inpatient.
14.2 WORLD ANAESTHESIA NEWS | 9
Postoperative patients can leave SIMPLE ROUTINES & CLINICAL list should be kept on the ward and
theatre in a critical state due to MANAGEMENT daily stocktaking and equipment
the effects of the surgery and Although hard evidence of effective testing by designated clinical staff
the anaesthetic. Many of these critical care interventions is lacking, should be carried out. Critically ill
patients have a good prognosis if it is clear that earlier treatment, patients should not be required
they are identified early and receive more intensive monitoring and to pay before they have access to
adequate critical care for a limited more goal-based systems have life-saving therapies and relatives
period of time. Indeed, many ICUs been beneficial. Increasing staff and staff should not need to leave
have begun as postoperative units. to patient ratios improves all of the ward to find or purchase the
these and may be the single most treatments. A recent survey from
The ICU should have well defined
important factor for successful Tanzania found that hospitals have
admission criteria. These criteria
critical care. Regular physiological good supplies of basic drugs and
depend on the facilities and
observations can identify disposable equipment, but that
expertise available but should
deterioration early and monitor the the routines for their storage and
be based on the hospital’s triage
success of interventions. Frequent availability for use in emergencies
systems. The goal is to admit the
assessment by medical staff is were lacking. Pulse oximetry, such
patients to the ICU who could
similarly important – twice daily as that promoted by Lifebox, is a
most benefit from the critical
ward-rounds of critically unwell valuable tool for the identification
care, i.e. those who have life
patients and 24 hour access to a and management of the critically ill.
threatening conditions and have
clinician should be routine.
a reasonable chance of recovery. The patient’s observations, received
Equally important are discharge The most effective interventions treatments and fluid balances
criteria. Those patients who have for the critically unwell patient should be regularly documented.
sufficiently improved and no longer are simple, but need to be carried This enables early recognition of the
require critical care, or those who out quickly. Emergency drugs and deteriorating patient, monitors the
are judged to be too severely ill equipment such as diazepam, oro- success of the care and reduces
to benefit from the available care pharyngeal airways, oxygen delivery errors in drugs prescription and
should be discharged from the ICU equipment, intravenous fluids and dispensing. Documentation can
to free up beds for other critically ill giving sets should be kept on the also be useful for quality control
patients. ward and always be available. A and audit. Basic hygiene routines
Pulse oximetry training
10 | WORLD ANAESTHESIA NEWS 14.2