AnaesthesiainDevelopingCountriescourse,November2017

Coursereport

ContextofthecourseTheOxfordAnaesthesiainDevelopingCountriescourse(ADC)existstoimprovethequalityandsustainabilityofoverseasworkdonebyanaesthetistsfromtheUKandotherhigh-incomecountries.Manysuchclinicianshavehadexcellenttrainingandexperienceintheirhomesystemsbutrightlyperceiveagapbetweenthisbackgroundandtheskillsandknowledgetheymayneedinadifferentsetting.ADC(startedinOxfordbyDrMikeDobsonin1981)isafive-daycoursefocusedonmeetingthisneedinavarietyofways.Itremainsthecasethatmanyanaesthetiststraveltocountrieswithverydifferentresources,toworkaspartofclinical,teachingandresearchprojectsinawidevarietyofcontexts.Globalawarenessofmassiveurgentneeds(suchastheHaitiearthquake)andofthechallengestoeffectiveinternationalassistancecontinuestogrow.Inaddition,theburdenofuntreatedsurgicaldiseasehasrecentlybecomeahottopicofdiscussionamonginternationalagencies,particularlyrelatedtotheLancetCommissiononGlobalSurgerywhosefindingswerepublishedin2015.

ThusADC,incommonwithonlyahandfulofothercentresworldwide,providesfocusedhigh-qualitytrainingbothonclinicalaspectsofworkinginresource-poorsettingsandotherchallengesthattheoverseashealthworkermayface.Uniquelyamongthesecentres,ADCisdeliveredinUganda.Thisaffordsopportunityforfirst-handexperienceofanAfricanhealthcaresettingandmuch-valuedcollaborationwithfacultyfromanumberofAfricancountries.

November2017ADC

Thecoursewasheldbetweenthe13thand17thNovember2017,basedattheMtElgonHotelinMbale.ItwasaccreditedbytheRoyalCollegeofAnaesthetistsfor20CPDpoints.17delegatesattended,fromtheUK,Denmark,theNetherlands,NewZealandandtheUS.Therewasaspreadofexperiencefromtraineesthroughtoperi-retirementconsultants,andabouthalfhadsomepriorexperienceworkinginlowormiddleincomecountries.Teachingwasdeliveredinavarietyofformatsincludinglectures,seminars,interviews,paneldiscussions,hands-onskillssessionsandhospitalvisitstoCUREHospital(anNGOhospitaldeliveringpredominantlypaediatricneurosurgicalcare)andMbaleRegionalReferralHospital(agovernmentreferralhospitalservingabout4

millionpeople).Asalwaystherewerealsomanyopportunitiestotalk,networkandreflectonlearninginformally‘aroundtheedges’oftheformalprogramme.WewereonceagaindelightedtowelcomeaninternationalfacultywithrepresentationfromtheUK,Kenya,ZambiaandUganda.FundingwasprovidedforthosetravellingfromwithinAfrica,andtherestofthefacultyweregenerouslyself-funding.Detailsoffacultyandtheirbackgroundareprovidedasanappendix,asisthedetailedprogramme.

Wearepleasedtoreportthatcoursefeedbackremainsconsistentlypositive;delegatesunanimouslystatedthattheywouldrecommendthetrainingtotheircolleaguesandindividualsessionswereratedveryhighly.Asalways,particularlyvaluableweretheopportunitiestolearnfromandnetworkwithfacultyanaesthetistsfromwithinAfrica,whowereabletoexplainanumberofissuesfirsthandandalsodiscusstheirexperienceofworkingwithoverseasvolunteers.WearegratefultoMaryMungai(KenyanRegisteredNurseAnaesthetist),DrNaomiShamambo(Zambia),DrFredMusanaandDrFredBulamba(bothfromMbale,Uganda),whogaveuptimetojoinusandteach.Weoweagreatdebtofthankstothosewhomakethecoursepossible,inparticular:DrSarahHodges(Uganda)fororganisationatKampala,DrAdamHewitt-Smithwhoorganisedtheconferencefacilities,hotelbookingandhospitalvisitsinMbale,aswellasteachingonthecourseitself,thewholefacultywhoworktogethertoprovideauniqueandhigh-qualitycourse;theMtElgonHotelfortheirexcellentfacilitiesandwelcome,theOxfordUniversityHospitals,NuffieldDepartmentofAnaestheticsandNuffieldDivisionofClinicalNeurosciences(OxSTAR),andInterface,fortheircontinuingadministrativesupport.ThisyearwasMikeDobson’sretiringcourse.Mike’sconceptionofthiscourse,hisdirectionofitfornearly30years,andhisconsistentlyinspiringandenjoyableteachingonit,willbegreatlymissed.WeweredelightedtobeabletopresenthimwithabookcontainingmessagesandgoodwishesfromADCfacultyanddelegatespastandpresent,andwishhimtheverybestforthefuture.Demandforthistrainingisconsistentlyhigh,andwehopetobeabletoofferadditionalcoursesinfutureyears,incollaborationwithourfaculty.Itisouraimtocontinuetoprovidehigh-calibretrainingtoanaesthetistswishingtoworkoverseas,andthustoimprovethequalityandsustainabilityoftheirworktotheultimatebenefitofpatientsinthemajorityworld.DrHilaryEdgcombe(OxfordCourseDirector)

KRNAMaryMungaiandDr.NaomiShamambo

Drawoverassembly

“ThebestCPDcourseIhaveeverdone,andalsothemostinspirational.”

Consultantcoursedelegate,2017

Coursefeedback

Appendix1:Courseprogramme

Mon 0900 Welcome&housekeeping 0915 Thecontext:Whatis“GlobalAnaesthesia”? 0945 Anaesthesiaaroundtheworld 1015 ResourcesI:Oxygensourcesaroundtheworld 1100 Coffee 1130 ResourcesII:Usingketaminewisely 1215 Clinicalpractice:Obstetricanaesthesia 1300 Lunch 1400 ResourcesIII:Wherethere’snomachine(drawovercircuits) 1530 ResourcesIV:Drawovermachines 1600 Tea 1630 ResourcesV:Electricalandgassafety 1700 Anaesthesia:TheviewfromUgandaTues 0830 Clinicalpractice:Airwaychallenges 0915 Yourhealth:physicalwellbeing 1000 Anaesthesia:theviewfromZambia 1045 Coffee 1115 Aid/Ethics 1215 Clinicalpractice:Traumaanddisasterchallenges 1300 Lunch 1400 Workshop 1530 Tea 1600 Clinicalpractice:Unfamiliarpathologies 1630 Yourhealth:psychologicalwellbeing 1715 HospitalvisitbriefingWeds AM HospitalVisitsI 1300 Lunch 1400 Clinicalpractice:Difficultdecisions(scenarios) 1515 Clinicalpractice:Paediatricanaesthesia 1600 Tea 1630 Receivingvisitors:howcanvisitorshelp? 1730 ResearchinLMICs(optionalseminaroverdrinks)

ThursAM HospitalvisitsII 1300 Lunch 1400 HospitalDebrief 1415 ResourcesVI:Procurement,halothane&ether 1515 TheviewfromKenya,SouthSudan,andSomaliland 1600 Tea 1630 Settingupanewservice-guestspeakerKathyBurgoine

1700 NewtechnologiesforremoteareasEveningCoursemeal

Fri 0930 Teachingandtraining:yourskillsandresources 1030 Clinicalpractice:Criticalcarechallenges 1115 Coffee 1145 Guestlecture:WynneAveling 1215 Traineeopportunitiesandoverseasworkingseminar(optional) 1300 Lunch 1400 Preparingtogo:practicalitiesandconsiderations 1500 Courseclose,certificates,MCQs

Appendix2:FacultyforADC2017

DrLindenBaxter(Oxford,UK)–registrarDrBaxterisanAnaestheticRegistrarintheUKwheresheiscurrentlyundertakinganacademicclinicalfellowship.Priortomedicaltraining,shespentayearinZambiawithhumanitarianprojectswhichinspiredhertotakea3monthclinicalplacementinUgandaasamedicalstudent.ShetookayearoutofanaesthetictrainingtoworkwithregionalhospitalteamsacrossMadagascaraspartofaMercyShipsfieldteam.DrFredBulamba(Mbale,Uganda)-consultantDrBulambaisapractisinganaesthesiologistinMbale,Uganda,workingprincipallyattheCUREhospital.Hehasinterestsinsimulation-basededucationandtheroleandtrainingofnon-physiciananaesthetistsinsub-SaharanAfrica.DrRachelCraven(Bristol,UK)-consultantDrCravenisaconsultantanaesthetistatBristolRoyalInfirmary.ShehasawealthofexperienceinthefieldworkingwithMSFinSyria,LibyaandHaitiamongmanyotherlocations.ShehasalsobeeninvolvedintrainingforanaesthetistsontheUKTraumaRegisterinaffiliationwithUK-Med.DrMikeDobson(Oxford,UK)–consultantDrMikeDobsonfirstgotinterestedinthedevelopingworldasamedicalstudentinNepal,whitherhereturnedmid-trainingtoworkasastaffanaesthetistatabusymissionhospital.Subsequentlyhehastaughtinover25countriesinAfricaandAsia.HestartedthiscourseinOxfordin1981,directingituntil2009,andsaysthatthoseattendingthecoursehavetaughthimmostofwhatheknows...HehasbeenanaestheticadvisortotheWorldHealthOrganisationfor20years,andotherinterestsincludePrimaryTraumaCareandTALC(TeachingAidsatLowCost).DrHilaryEdgcombe(Oxford,UK)-consultantDrHilaryEdgcombeisaconsultantanaesthetistatOxfordUniversityHospitals,Oxfordwhereherpracticeincludesanaesthesiafortransplantsurgery.Shehasclinicalandteachingexperienceinanumberofcountriesinsub-SaharanAfrica,includingZimbabwe,Zambia,Malawi,SierraLeone,KenyaandSouthAfrica.SheisCourseDirectorfortheADCcourse.DrJeanneFrossard(UCLH,UK)-consultantDrJeanneFrossardisaconsultantanaesthetistatUCLHNHStrustinLondonandhasbeeninvolvedinthiscourseforelevenyears,aswellaslecturingonthesimilarglobaloutreachcourseinCanadaandonclinicalofficerrefreshercoursesinRwandaandMozambique.SheisespeciallyinterestedintraumamanagementandhasbeenonthefacultiessettingupPrimaryTraumaCareinRwanda,MSFBelgium,China,Iraq,Jordan,theWestBankandtheGazastrip.ShehasworkedtwiceinSarajevoduringthesiegewithanNGOcalledHAMD,twicewiththeICRCinawarsurgeryhospitalontheKenyan/SudaneseborderandalsowithMSFinAfghanistan.DrJoJames(Birmingham,UK)-consultantDrJameswastheBernardJohnsonAdvisorfortheRoyalCollegeofAnaesthetistsuntilearlierthisyear.ShehasclinicalandteachingexperienceinanumberofcountriesincludingIraqandUganda.Shealsohasawealthofexperienceinguidingandsupportingtrainees,havingbeenCollegeTutor,TrainingProgrammeDirector,RegionalAdvisorandanFRCAexaminerintheWestMidlands.KRNAMaryMungai(Kijabe,Kenya)-KRNAKRNAMaryMungaiisanexperiencedtutorandleadKRNA(KenyanRegisteredNurseAnaesthetist)atKijabeHospital,Kenya.Sheisinvolvedintrainingnon-physiciananaesthetistsfromKenya,SouthSudanandSomaliland.

MrRobertNeighbour(Diamedica,UK)-engineerAformeraeronauticalengineer,RobertNeighbournowheadsamedicalequipmentcompanyspecialisingintheneedsofthedevelopingworld.Theiranaestheticmachinesarebasedonteamingoxygenconcentratorswithdraw-overgasdeliverysystems.Heisatirelesssupporterofanaesthetistsinthedevelopingworld.DrNaomiShamambo(Lusaka,Zambia)-anaesthetistDrShamamboisananaesthetistinLusaka,Zambiawithfirst-handexperienceoftherecentlydevelopedMMedprogramme.ShealsoplaysakeyroleinthePrimaryTraumaCareprojectinLusaka.DrAdamHewitt-Smith(Mbale,Uganda)–anaesthetistDrHewitt-SmithisaUKtraineewhohastakentimeoutofprogrammetoworkasananaesthetistinMbale,Uganda.Hehasextensiveexperienceinthelow-incomesetting.DrSarahO’Neill(Manchester,UK)-consultantDrO’NeillisaconsultantanaesthetistbasedinManchester,UK.ShehasexperienceinmultiplelocationswithMedecinsSansFrontieres,andhasjustreturnedfromYemen.