Anaesthesia in Developing Countries

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Anaesthesia in Developing Countries November 2012 Course Report Kampala, Uganda The Oxford ADC course, now in its thirty-first year, continues to be popular with consistent demand for the targeted

1 Anaesthesia in Developing Countries November 2012 Course Report Kampala, Uganda The Oxford ADC course, now in its thirty-first year, continues to be popular with consistent demand for the targeted training it offers. The overriding aim of the course is still to stand in the gap between the training and experience of delegates from developed world countries such as the UK, and the pathology, equipment, drug and broader changes experienced when they visit the developing world as volunteers. This focus for anaesthetists is consistent with the increasing drive among the aid and development community for appropriate training, clinical governance and accountability to the people they serve. Course content this year included: concepts, use and maintenance of a variety of old and new draw-over systems, new developments in draw-over machine and oxygen production technology, use of ketamine and halothane, challenges in paediatric, obstetric anaesthesia and critical care in Africa, as well as broader topics including difficult clinical decision-making, skills in cross-cultural teaching and training, electrical and gas safety, psychological challenges and the practicalities of arranging voluntary and/or paid work overseas. Of particular benefit were the sessions led by local faculty members, which focused attention on trauma epidemiology in Uganda, the experience of those who receive short-term volunteers at their hospitals, and the observational visits to two local hospitals. The opportunity to join with Ugandan medical professionals and understand issues from their perspective is of enormous benefit in this training course. As usual, the variety of experience among the delegates led to opportunities for useful networking and sharing of expertise. We had attendees from the UK, the Netherlands, Sweden, the US, Australia and faculty from the UK, Kenya, and Uganda, at stages from post-final FRCA trainees through to consultants peri-retirement. Feedback remains overwhelmingly positive, with an example of the comments given below: I have found this an absolutely brilliant experience, providing plenty of food for thought and practical information [Would you recommend this course to a colleague?] I would recommend this course without reservation YES! YES! YES! YES! Already did

Very grateful thanks are due to the faculty who make their time and expertise available to teach and train on a broad variety of topics; especially popular this year were the lectures given by a new

2 Very grateful thanks are due to the faculty who make their time and expertise available to teach and train on a broad variety of topics; especially popular this year were the lectures given by a new faculty member, Dr. Sarah O Neill, on her experiences with MSF, obstetrics and looking after the volunteer s mental health. Their continuing commitment of time, energy and finance (most fund their own attendance) makes this course possible. We are particularly grateful to Dr Sarah Hodges, our co-director in Uganda who tirelessly offers her time and energy in coordinating transport, accommodation, hospital visits as well as teaching. Additional thanks are due to the American Recreation Association who house us for the course. Their wonderful hospitality is always appreciated. Thanks also go to the Nuffield Division of Anaesthesia administrative team who work hard behind the scenes before the course to ensure things run smoothly. The staff at Mulago and Nsambya hospitals welcome us warmly and we very much appreciate the time they take from their busy day to speak with delegates. Links continue with the other courses world-wide to mutual benefit, and we note that the next Developing World Anaesthesia one-day course will be held in Bristol in April As demand remains high, we anticipate the next five-day ADC course will be held in Kampala in November Information about this will be posted to the NDA website nearer the time and can also be requested from Niki Andrew at Niki.Andrew@nda.ox.ac.uk. Dr Hilary Edgcombe (Course Director and administrator, Oxford) Dr Jeanne Frossard (Course Director, UCLH)

3 Faculty Dr Catriona Bentley (Birmingham, UK) Dr Catriona Bentley is a senior trainee in anaesthesia on the West Midlands Rotation, UK. She recently spent 11 months completing out-of-programme experience in Kampala, Uganda. I was based at CoRSU, an elective plastics and orthopaedics hospital mainly for children. I also spent time at Mulago National Referral Hospital where I enjoyed some obstetrics as well as general surgical cases. During the year I travelled to Kagando Hospital and St Mary s Hospital, Lacor. Both of these are rural settings which gave me a great opportunity to experience draw over equipment and anaesthesia in a resource poor environment. Throughout the year I was able to meet with local anaesthetists sharing ideas, and delivering some teaching sessions. This is my third course as faculty on the ADC course, a course which was extremely helpful in preparing me for my OOPE. Dr Mike Dobson (Oxford, UK) Dr Mike Dobson first got interested in the third world as a medical student in Nepal, whither he returned midtraining 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 Hilary Edgcombe (Oxford, UK) Dr Hilary Edgcombe is a consultant anaesthetist at Oxford University Hospitals, Oxford. Her UK practice includes anaesthesis for transplant, oculoplastic and trauma surgery. She also has clinical and teaching experience in a number of countries in sub-saharan Africa, including Zimbabwe, Zambia, Malawi, Sierra Leone and South Africa. She is Course Director together with Dr Jeanne Frossard for the well-established course, "Anaesthesia in Developing Countries" based in Oxford and Uganda, now in its thirty-first year. This course aims to train and equip anaesthetists from developed world countries who plan to work and / or teach in developing world environments, in order to maximise their usefulness in such endeavours. Dr Jeanne Frossard (UCLH, UK) I am a consultant anaesthetist at UCLH NHS trust in London. I have been involved in this course for ten years. I also lecture on the global outreach course in Canada. I have been a lecturer for clinical officer refresher courses in Rwanda and Mozambique. I am especially interested in trauma management and have been on the faculties for setting up Primary Trauma Care in Rwanda, MSF Belgium, China, Iraq, Jordan, West bank and the Gaza strip. I have worked twice in Sarajevo during the siege with an NGO called HAMD. I have also worked twice with the ICRC in a war surgery hospital on the Kenyan/ Sudanese border. 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 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 recently awarded the Pask Certificate of Honour by the Association of Anaesthetists of Great Britain and Ireland. Dr Olive Kobusingye (Kampala, Uganda) Dr Kobusingye is a trauma surgeon and injury epidemiologist based in Kampala, Uganda. She has experience in the design and implementation of injury surveillance systems in low income settings and a special interest in designing interventions for the prevention of traffic injuries as well as the development of appropriate training for clinical care of the injured in under-resourced settings. Positions held include Lecturer, Department of Surgery, Makerere Medical School, Secretary General, Injury Prevention Initiative for Africa from 1999, and first Director of the Injury Control Center-Uganda, a research based initiative conducting applied research in injury prevention and control. Dr Kobusingye established the first hospital trauma registries in Sub-Saharan Africa and has also worked with the WHO in Congo and Zimbabwe.

4 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 drawover gas delivery systems. He is a tireless supporter of anaesthetists in the developing world. Dr Mark Newton (Kijabe, Kenya) Dr. Mark Newton is an Associate Clinical Professor in the Departments of Pediatrics and Anesthesiology at Vanderbilt University Medical Centre. He is also faculty member of Vanderbilt Institute of Global Health and Director, Vanderbilt International Anesthesia (VIA) which is a global service, education, and research division within the Department of Anesthesiology, Vanderbilt, focusing on anaesthesia and ICU issues in low income countries. Dr. Newton has lived and worked in East Africa, Kenya for 13 years in anesthesia and ICU development, working with the Ministry of Health (Kenya) and the University of Nairobi since He has developed a Registered Nurse Anesthesia Training Program which includes curriculum development and Ministry of Health partnership in this development project. Dr. Newton functions clinically as the Chief, Department of Anesthesiology at Kijabe Hospital, Kenya, which is a national referral hospital and leader in education, surgical care/trauma, and ICU care in Kenya. Kijabe Hospital is the second busiest surgical and trauma hospitals in Kenya where surgical and anesthesia postgraduate training is ongoing at a high level. Dr. Newton has travelled extensively in Kenya, Southern Sudan, and Somalia while being involved in medical education and clinical service development in all three underrepresented countries. His wife, Sue, is involved in many development activities amongst the Masai women very close to their home in Kijabe. Married for 20 years, they raise five children, who have been raised in Kenya; we would now consider Kenya our home. Dr Sarah O Neill (Manchester, UK) Dr O Neille is a consultant anaesthetist at Salford Royal Hospital whose UK practice consists mainly of neuroanaesthesia, anaesthesia for orthopaedics, and pre-operative assessment. She has worked with Medecins Sans Frontieres in Nigeria, Libya and Yemen, and with Mercy Ships in Liberia. She has also taught on refresher courses for nurse anaesthetists in Liberia and Sierra Leone. Having attended the ADC course in Uganda in 2009 as a delegate, we are delighted that she is able to join the faculty this year. Dr Stephen Ttendo (Mbarare, Uganda) Dr Ttendo is Senior Lecturer and head of department at Mbarare Regional Referral Hospital and Mbarare University of Science and Technology, Uganda. He has extensive experience as clinician and lecturer, in particular being a sought-after speaker at international conferences. He has also been involved with a number of international collaborations with bodies including Harvard University and the AAGBI. He is previous President of the Ugandan Society of Anaesthesia.

5 Programme Monday 0830 Welcome 0900 Introduction: Anaesthesia around the world and in Uganda 0930 Oxygen sources 1015 Coffee 1045 Using ketamine 1130 Challenges: Paediatric anaesthesia 1230 Hospital visits briefing 1400 Where there s no machine: drawover circuits and vaporisers 1630 Challenges: Critical care 1730 The surgeon s view Tuesday 0830 Hospital visits I 1415 Where there is a machine: drawover machines 1500 Challenges: Airway management 1545 Tea 1615 Halothane and ether 1645 Hospital visits debrief 1700 Travelogue: MSF travels Wednesday 0830 Hospital visits II 1400 Challenges: Difficult decision-making 1630 Challenges: Looking after yourself 1700 Travelogue: the engineer s experience Thursday 0900 Challenges: Obstetric anaesthesia 0945 The receiving hospital s experience 1045 Coffee 1115 Electrical safety and supply 1200 Trauma care 1400 Workshop: maintenance, valves and blood Optional craft centre visit Evening Course BBQ Friday 0900 Psychology: adaptation and re-entry 0945 Teaching I 1030 Coffee 1100 Teaching II 1145 Guest lecture: Dr Olive Kobusingye 1400 Preparing to go: practicalities and considerations 1530 Course close

Higher Education Partnerships in sub- Saharan Africa Applicant Guidelines

Higher Education Partnerships in sub- Saharan Africa Applicant Guidelines Introduction Eligibility criteria Programme objectives Programme expectations Submission deadline Monitoring and evaluation Contact