Minutes from LSA Meeting 30 th November 2017
‘Broadening Horizons – Working Outside your Comfort Zone’
Drs Will Gauntlett, Annette Davis and Paul Jameson,
The meeting was opened by the President, Dr Clare Howard, who firstly announced the sad death of one of the society’s members, Dr S. Jagadeesh, a former Consultant at Warrington Hospital. She then introduced the first speaker, Dr Will Gauntlett.
Dr Gauntlett began talking about his experience in South America working with Safer Anaesthesia through Education (SAFE). He explained his motivations with the Shape of Training review trying to produce generic consultants with little to distinguish them and the current lack of opportunity in Mersey for out of programme training (OOPT). He described his previous experience working abroad in Australia with the learning and confidence it had given him.
He described the aim of SAFE which was trying to fulfil in part, the WHO Millennium goal 5 of reducing maternal mortality from 1990 to 2015 by 75% by improving obstetric anaesthetic practice. He described the structure of the 3 day simulation based course and the topics covered such as post-partum haemorrhage, anaesthesia for Caesarean Section, pre-eclampsia and eclampsia and obstetric trauma. He then went on to discuss his own experience firstly in Medellin, Columbia in 2014 and then latterly in Honduras in 2016. He described the consequences on his own outlook and practice increasing his enthusiasm for simulation based training.
He concluded his talk with some messages. Firstly, opportunities like these are always available if you seek them out. He thought that that places would be very competitive but only 7 people had applied from the whole of the UK. Secondly, the benefits that these short breaks can give trainees, are often greater than the time spent on them. Allowing trainees to undertake them is a very motivating experience and should be encouraged. Finally, he gave examples of other trainees who have undertaken brief attachments both in this country and abroad.
The next speaker, Dr Annette Davis described the background of her work in anaesthetising children with congenital heart disease. The incidence throughout the world is 8/1000 births. The burden is higher in low and middle income countries because of higher birth rates. She also described the vast differences in care throughout the world with one paediatric cardiac surgeon/3.5m in Europe and North America compared with 1/6.5m in South America, 1/25m in Asia and 1/38m in Africa. Consequently 90% of children throughout the world do not have access to adequate care. Consequently, they often present late with Pulmonary Hypertension. In developing countries there is also a higher incidence of acquired disease such as from Rheumatic Heart Disease, endocarditis and schistosomiasis.
Dr Davis described some of the NGOs based in the UK and America set up to help these children and her involvement with them. She described a typical mission of 1-2 weeks with the planning and intensity of work. She discussed her experience firstly in Mozambique where acquired cardiac disease was a bigger problem than congenital. Surgical options were however limited because, for instance, valve replacements weren’t possible because of lack of post-op anticoagulation. This contrasted with her experience in Belarus where there was a purpose built hospital and education and training of local staff was as important as the surgery itself. The range of surgery was similar to the UK however the challenges were much greater. For example, language issues were difficult with drug names as well as communication with local staff.
Dr Davis found a similar challenge in Siberia where paediatric practice was limited because of low numbers however because of its isolated nature, these patiente still needed to be treated locally. She described the differences in practice with some of the local traditions. Upto date knowledge was not always easy to acquire because of a lack of CPD material and inadequate training in an isolated place. She found that changing local practice was not always that easy because of these. However the locals were very hard working and enthusiastic and she had managed to change some aspects of local practice such as local starvation rules, monitoring and some aspects of safer practice. She also commented on the resourcefulness of the local staff.
She concluded by summarising her own gains from these experiences. These had given her greater confidence, humility and had changed her own practice. It had also given her greater insights into risk management and team building and above all established friendships throughout the world.
The final speaker was Dr Paul Jameson who spoke about his involvement in Operation Smile. He began by stating that 2 billion people had no access to safe surgical care. 1 in 750 births were associated with a cleft abnormality. This defect could be readily treated by day case surgery. He described his personal motivations for undertaking this work. These included a wish to be challenged because these missions could be chaotic requiring flexibility and resilience as well as hard work. Rising to the challenge and educating others in the process could increase a feeling of self worth and help to avoid burn out.
Dr Jameson described Operation Smile which had been established in 1982 and by 2015, it had 161 missions in 121 sites in 30 countries. The cost of each case was £150-200 and the expectation was that surgery took one hour for a cleft lip and 90 minutes for a cleft palate with a 15 minute turnaround time for anaesthesia. He spoke about a typical mission which used 6 anaesthetists and surgeons and one paediatrician working around 5 tables. There were local surgeons and anaesthetists in the teams but their quality was variable (as could be that of the international doctors). The aim was to have first world standards working in the third world. Indeed, he thought that their record keeping and quality assurance was higher than that commonly encountered in the NHS.
Dr Jameson described a couple of the missions in which he’d taken part, the first in Ethiopia with its very limited facilities and the second in Honduras with is major security issues. He commented on the good organisation preparing volunteers with plenty of information. He described the way that anaesthesia was organised with no ODPs and a typical anaesthetic for the approximately 130 cases that are undertaken in each mission.
He concluded by describing the local benefits of improving safe surgical and anaesthetic practice through education of local staff with the consequent benefits for the local population.
The meeting concluded at 20.30.
Ewen Forrest 01/12/2017