Anaesthesia  in  Developing  Countries  course,  September  2015    

Course  report    

 Context  of  the  course    The  Oxford  Anaesthesia  in  Developing  Countries  course  (ADC)  exists  to  improve  the  quality  and  sustainability  of  overseas  work  done  by  anaesthetists  from  the  UK  and  other  high-­‐income  countries.  Many  such  clinicians  have  had  excellent  training  and  experience  in  their  home  systems  but  perceive  a  gap  between  this  background  and  the  skills  and  knowledge  they  may  need  in  a  different  setting.    ADC  (started  in  Oxford  by  Dr  Mike  Dobson  in  1981)  is  a  five-­‐day  course  focused  on  meeting  this  need  in  a  variety  of  ways.      It  remains  the  case  that  many  anaesthetists  travel  to  countries  with  very  different  resources,  to  work  as  part  of  clinical,  teaching  and  research  projects  in  a  wide  variety  of  contexts.  Global  awareness  of  massive  urgent  needs  (such  as  the  Haiti  earthquake)  and  of  the  challenges  to  effective  international  assistance  continues  to  grow.  In  addition,  the  burden  of  untreated  surgical  disease  has  recently  become  a  hot  topic  of  discussion  among  international  agencies,  particularly  related  to  the  Lancet  Commission  on  Global  Surgery  whose  findings  have  recently  been  published.      Thus  ADC,  in  common  with  only  a  handful  of  other  centres  worldwide,  provides  focused  high-­‐quality  training  both  on  clinical  aspects  of  working  in  resource-­‐poor  settings  and  other  challenges  that  the  overseas  health  worker  may  face.  Uniquely  among  these  centres,  ADC  is  delivered  in  Kampala,  Uganda.  This  affords  opportunity  for  first-­‐hand  experience  of  an  African  urban  healthcare  setting  and  much-­‐valued  collaboration  with  faculty  from  a  number  of  African  countries.    September  2015  ADC  

   This  course  was  held  between  the  21st  and  25th  September  2015,  based  at  the  Makindye  Club  and  conference  centre  in  Kampala.  It  was  accredited  by  the  Royal  College  of  Anaesthetists  for  20  CPD  points.  15  delegates  attended,  from  the  UK,  Norway,  Finland,  Kenya,  the  Netherlands  and  Australia.  There  was  a  spread  of  experience  from  trainees  through  to  peri-­‐retirement  consultants,  and  about  half  had  some  prior  experience  working  in  low  or  middle  income  countries.      

 

 

 

Teaching  was  delivered  in  a  variety  of  formats  including  lectures,  seminars,  interviews,  panel  discussions,  hands-­‐on  skills  sessions  and  hospital  visits.  This  year  delegates  had  the  opportunity  to  visit  CoRSU  Hospital  (where  drawover  anaesthesia  was  demonstrated),  Mulago  and  Nsambya  hospitals.  As  always  there  were  also  many  opportunities  to  talk,  network  and  reflect  on  learning  informally  ‘around  the  edges’  of  the  formal  programme.        

We  were  once  again  delighted  to  welcome  an  international  faculty  with  representation  from  the  UK,  US,  Kenya,  Zambia  and  Uganda.  Funding  was  provided  for  those  travelling  from  within  Africa,  and  the  rest  of  the  faculty  were  generously  self-­‐funding.  Details  of  faculty  and  their  background  are  provided  as  an  appendix,  as  is  the  detailed  programme.    We  are  pleased  to  report  that  course  feedback  remains  consistently  positive;  delegates  unanimously  stated  that  they  would  recommend  the  training  to  their  colleagues  and  individual  sessions  were  rated  very  highly.  One  also  commented  that  they  expected  this  training  to  help  their  developed  world  practice.  As  always,  particularly  valuable  were  the  opportunities  to  learn  from  and  network  with  faculty  anaesthetists  from  within  Africa,  who  were  able  to  explain  a  number  of  issues  first  hand  and  also  discuss  their  experience  of  working  with  overseas  volunteers.  We  are  grateful  to  Mary  Mungai  (Kenyan  Registered  Nurse  Anaesthetist),  Dr  Naomi  Shamambo  (Zambia),  Dr  Janet  Tumukunde  and  Dr  Daniel  Obua  from  Mulago  Hospital,  who  gave  up  time  to  join  us  and  teach.  Other  particular  highlights  of  the  course  included  a  powerful  presentation  by  Dr  Rola  Hallam  on  her  work  in  Syria  and  a  presentation  by  Dr  Tony  Roche  on  the  ethics  of  aid.    We  owe  a  great  debt  of  thanks  to  those  who  make  the  course  possible,  in  particular:  Dr  Sarah  Hodges  (Uganda)  whose  example  and  teaching  is  always  appreciated  enormously,  and  without  whom  the  practical  delivery  of  the  course  would  be  far  harder;  the  whole  faculty  who  work  together  to  provide  a  unique  and  high-­‐quality  course;  the  Makindye  Club  for  their  excellent  facilities  and  welcome,  and  the  Oxford  University  Hospitals,  Nuffield  Department  of  Anaesthetics  and  Nuffield  Division  of  Clinical  Neurosciences  (OxSTAR),  for  their  continuing  support.      

Observing  drawover  anaesthesia  

KRNA  Mary  Mungai  and                          Dr.  Naomi  Shamambo  

 

 

Demand  for  this  training  is  consistently  high  with  consistent  over-­‐subscription  and  waiting  lists,  and  we  hope  to  be  able  to  offer  additional  courses  in  future  years,  in  collaboration  with  our  faculty.  It  is  our  aim  to  continue  to  provide  high-­‐calibre  training  to  anaesthetists  wishing  to  work  overseas,  and  thus  to  improve  the  quality  and  sustainability  of  their  work  to  the  ultimate  benefit  of  patients  in  the  majority  world.        Dr  Hilary  Edgcombe  (Course  Director  and  organiser)  Dr  Jeanne  Frossard  (Course  Director)        

 

 

Appendix  1:  course  programme    

Mon 8:30 Welcome and housekeeping: course ethos HE 9:00 Anaesthesia around the world and in Uganda JF/SH 9:30 Resource challenges I: oxygen sources around the world MD 10:15 Resource challenges II: using ketamine wisely JF 11:00 Coffee 11:30 Resource challenges III: Halothane (and ether) MD 12:00 Clinical practice: Obstetric challenges BG 12:45 Hospital visits: briefing HE 13:00 Lunch

14:00 Where there's no machine... using drawover apparatus and vaporisers HE (lead)

15:45 Tea 16:15 Clinical practice: Trauma and disaster challenges BG 17:00 Personal story I JF 17:30 END

Tuesday 8:30 Hospital visits I: CoRSU and Nsambya JF, MD, RC, SH, JJ, NS

13:00 Lunch 14:00 Syrian conflict RH 15:00 Where there is a machine... using drawover machines MD 15:45 Tea 16:15 Kenyan View / KRNA programme MM/JJ 17:15 Personal story II RN 17:45 END

Wednesday 8:30 Hospital visits II: Mulago and Nsambya JF, RC, BG, GD, MM, HE

12:30 Lunch 13:30 Aid models and ethics TR 14:30 Clinical practice: Paediatric challenges A H-S 15:15 Tea

16:00 Ugandan viewpoint GD, TR, DO, JT

17:15 Personal story III RC 18:00 End Thursday 8:30 Your health: physical wellbeing JJ 9:15 Resource challenges IV: electrical and gas safety RN

9:45 Clinical practice: Communicable disease and the anaesthetist / surgical burden of disease HE/NS

10:30 Coffee

11:00 Decision making challenges RC, BG, HE, NS, JF, JJ

13:00 Lunch (A4)

14:00 Workshop: maintaining equipment (general), vaporiser insides, cleaning and sterilisation, using blood

MD, RN, BG, JF, JJ

16:00 Tea 16:30 Your health: psychological wellbeing RC

 

 

17:00 END Course BBQ Friday 9:00 Clinical practice: Airway challenges SH 9:45 Teaching and training overseas JJ 10:30 Coffee 11:00 Zambian view and the MMed programme NS 11:45 New technologies for remote areas: update 2015 RN 12:15 Clinical practice: Critical care challenges RC 13:00 Lunch 14:00 Trainees and overseas working seminar JJ 14:30 Preparing to go - practicalities and considerations JF / all 15:30 Close HE

 

 

 Appendix  2:  Faculty  for  ADC  2015  

 Dr  Rachael  Craven  (Bristol,  UK)  Dr  Craven  is  a  consultant  anaesthetist  at  Bristol  Royal  Infirmary.  She  has  a  wealth  of  experience  in  the  field  working  with  MSF  in  Syria,  Libya  and  Haiti  among  other  locations.  She  has  also  recently  managed  training  for  anaesthetists  on  the  UK  Trauma  Register  in  affiliation  with  UK-­‐Med.      Dr  Mike  Dobson  (Oxford,  UK)  Dr  Mike  Dobson  first  got  interested  in  the  third  world  as  a  medical  student  in  Nepal,  whither  he  returned  mid-­‐training  to  work  as  a  staff  anaesthetist  at  a  busy  mission  hospital.  Subsequently  he  has  taught  in  over  25  countries  in  Africa  and  Asia.  He  started  this  course  in  Oxford  in  1981,  directing  it  until  2009,  and  says  that  those  attending  the  course  have  taught  him  most  of  what  he  knows...  He  has  been  anaesthetic  advisor  to  the  World  Health  Organisation  for  20  years,  and  other  interests  include  Primary  Trauma  Care  and  TALC  (Teaching  Aids  at  Low  Cost).      Dr  Gerald  Dubowitz  (USA)  Dr  Gerald  Dubowitz  is  an  Assistant  Professor  in  Anaesthesia  based  in  San  Francisco,  USA.  He  is  a  founder  of  the  Global  Partners  in  Anesthesia  and  Surgery  (GPAS)  programme  and  director  of  the  Global  Health  Program  at  UCSF.  His  experience  includes  work  in  Nepal,  the  South  Pacific  and  Africa,  with  particular  links  in  Uganda.    Dr  Hilary  Edgcombe  (Oxford,  UK)  Dr  Hilary  Edgcombe  is  a  consultant  anaesthetist  at  Oxford  University  Hospitals,  Oxford  where  her  practice  includes  anaesthesia  for  transplant  and  trauma  surgery.  She  has  clinical  and  teaching  experience  in  a  number  of  countries  in  sub-­‐Saharan  Africa,  including  Zimbabwe,  Zambia,  Malawi,  Sierra  Leone,  Kenya  and  South  Africa.  She  is  Course  Director  together  with  Dr  Jeanne  Frossard  for  the  ADC  course.    Dr  Jeanne  Frossard  (UCLH,  UK)  Dr  Jeanne  Frossard  is  a  consultant  anaesthetist  at  UCLH  NHS  trust  in  London  and  has  been  involved  in  this  course  for  eleven  years,  as  well  as  lecturing  on  the  similar  global  outreach  course  in  Canada  and  on  clinical  officer  refresher  courses  in  Rwanda  and  Mozambique.  She  is  especially  interested  in  trauma  management  and  has  been  on  the  faculties  setting  up  Primary  Trauma  Care  in  Rwanda,  MSF  Belgium,  China,  Iraq  ,  Jordan  ,  the  West  Bank  and  the  Gaza  strip.  She  has  worked  twice  in  Sarajevo  during  the  siege  with  an  NGO  called  HAMD,  twice  with  the  ICRC  in  a  war  surgery  hospital  on  the  Kenyan/  Sudanese  border  and  also  with  MSF  in  Afghanistan.      Dr  Ben  Gupta  (Bristol,  UK)  Dr  Gupta  is  a  senior  trainee  in  Bristol,  UK  who  has  experience  with  MSF  in  Papua  New  Guinea  and  Jordan.  He  directs  the  UK-­‐based  one  day  course,  Developing  World  Anaesthesia.    Dr  Rola  Hallam  (London,  UK)  Dr  Hallam  is  a  consultant  anaesthetist  based  in  London  with  links  to  Syria  and  extensive  involvement  there  in  delivering  medical  aid  since  the  beginning  of  the  crisis.  She  has  considerable  experience  in  the  field  and  also  in  UK-­‐based  advocacy  through  Hand  in  Hand  for  Syria.  She  was  awarded  the  AAGBI  Pask  Certificate  of  Honour  in  2015.      Dr  Adam  Hewitt-­Smith  (UK,  Uganda)  Dr  Hewitt-­‐Smith  is  an  anaesthetic  registrar  from  the  UK  taking  time  out  of  his  training  to  work  in  a  busy  Regional  Referral  Hospital  in  eastern  Uganda.  He  qualified  in  2006  and  amongst  other  things  has  spent  four  years  as  a  Medical  Officer  in  the  Royal  Navy  working  alongside  the  Royal  Marines  in  Afghanistan  and  off  the  coast  of  Iraq.  His  interests  include  paediatric  anaesthesia  and  trauma  and  he  hopes  to  become  a  consultant  before  he  reaches  his  50th  birthday!    Dr  Sarah  Hodges  (Kampala,  Uganda)  Born  in  India  and  brought  up  in  South  East  Asia  and  France,  Dr  Sarah  Hodges  wanted  to  study  medicine  from  a  very  early  age  and  was  challenged  by  witnessing  the  inequalities  while  growing  up  in  Asia.  She  started  training  

 

 

in  anaesthetics  before  moving  to  Uganda  with  her  husband,  Andrew  Hodges  (a  surgeon)  to  work  with  CMS,  an  Anglican  mission  organization  in  Kagando  Hospital,  a  Church  of  Uganda  hospital  in  the  West  of  Uganda.  Following  a  brief  return  to  the  UK  during  which  she  completed  anaesthetic  training,  she  returned  to  Uganda  in  December  2004.  Since  then  she  has  been  involved  in  a  wide  variety  clinical  and  teaching  endeavours  at  a  variety  of  hospitals  in  Kampala  and  a  Associate  Director  for  this  course.  She  was  awarded  the  Pask  Certificate  of  Honour  by  the  AAGBI.    Dr  Jo  James  (Birmingham,  UK)  Dr  James  is  the  Bernard  Johnson  Advisor  for  the  Royal  College  of  Anaesthetists.  She  has  clinical  and  teaching  experience  in  a  number  of  countries  including  Iraq  and  Uganda.  She  also  has  a  wealth  of  experience  in  guiding  and  supporting  trainees,  having  been  College  Tutor,  Training  Programme  Director,  Regional  Advisor  and  an  FRCA  examiner  in  the  West  Midlands.    KRNA  Mary  Mungai  (Kijabe,  Kenya)  KRNA  Mary  Mungai  is  an  experienced  tutor  and  lead  KRNA  (Kenyan  Registered  Nurse  Anaesthetist)  at  Kijabe  Hospital,  Kenya.    Mr  Robert  Neighbour  (Diamedica,  UK)  A  former  aeronautical  engineer,  Robert  Neighbour  now  heads  a  medical  equipment  company  specialising  in  the  needs  of  the  developing  world.  Their  anaesthetic  machines  are  based  on  teaming  oxygen  concentrators  with  draw-­‐over  gas  delivery  systems.  He  is  a  tireless  supporter  of  anaesthetists  in  the  developing  world.      Dr.  Tony  Roche  (USA)  Dr  Tony  Roche  is  an  Associate  Professor  of  Anesthesia  at  the  University  of  Washington  in  Seattle,  USA.  He  is  involved  with  the  GPAS  collaboration  and  has  been  collaborating  for  several  years  with  the  Department  of  Anaesthesia  at  Mulago  Hospital,  Uganda.  He  is  particularly  involved  in  research  and  education  linked  with  obstetric  and  regional  anaesthesia.    Dr  Naomi  Shamambo  (Lusaka,  Zambia)  Dr  Shamambo  is  an  anaesthetist  in  Lusaka,  Zambia  with  first-­‐hand  experience  of  the  recently  developed  MMed  programme.  She  also  plays  a  key  role  in  the  Primary  Trauma  Care  project  in  Lusaka.