From Ward to World: Saving lives in Ethiopia
Ethiopia has one anaesthetist for every 5.3 million people. Dr Tom Bashford won the Patient Safety Award from the Association of Anaesthetists for his work promoting safer surgery in Ethiopia
There are fewer anaesthetists in the whole of Ethiopia, a country of 85 million, than in the London hospital where I work. I feel there is a moral obligation on countries with so many trained health professionals to support volunteer work overseas. I recently returned from an out-of-programme career break (OOPC) during my core anaesthetic training, where I worked in a large public hospital in Addis Ababa, the capital city of Ethiopia.
Volunteering as a junior doctor in the developing world is challenging. There are difficult boundaries to negotiate to ensure you remain within the limits of your competence whilst being useful. I started my placement by reviewing the existing anaesthetic practice in the hospital against international standards. I then used this as a tool to plan a number of interventions that seemed likely to be both sustainable and carry a high likelihood of improving patient outcomes.
Volunteering as a junior doctor in the developing world is challenging. There are difficult boundaries to negotiate to ensure you remain within the limits of your competence whilst being useful
As a result of my work, five projects were implemented: anaesthetic pre-assessment, the WHO SSC, continuous pulse oximetry monitoring in recovery areas, improved observation protocols in recovery areas, and the development of a high-dependency unit (HDU). While this sounds ambitious, there are a huge number of charities aiming to work toward improving health internationally and one of the privileges of being a long-term volunteer is the chance to act as a conduit for these in a single institution.
One large problem I identified was that patients were dying or suffering brain damage on the wards because their oxygen levels were dropping and over-stretched staff weren’t spotting this until it was too late. I increasingly found that despite having been donated the necessary equipment (eg, pulse oximeters), many staff needed training in how to use the equipment effectively. We were able to confidently deliver this training.
I received support and funding from VSO, the Clinton Health Access Initiative (CHAI) Ethiopia, The Yale Global Health Leadership Institute, University College London Hospitals (UCLH) Charitable Foundation, Rotary International and the Lifebox Foundation. In addition we were given permission to use the Immediate Life Support Guidelines of the Resuscitation Council UK to prepare teaching aids and protocols. All the work was developed in conjunction with local staff leaders with the aim of making a lasting and sustainable difference to the working of the department.
Volunteering as a junior is daunting, but we should not underestimate the value of our training and skills. Long-term volunteering represents a chance to make a lasting difference while developing areas of your own practice that are hard to expand within the confines of the NHS training ladder. I would encourage new doctors to take up the challenge.