HVO Report - Anaesthesia Masters Programme, Addis Ababa University
Dr Nur Lubis, Anaesthetic Senior Registrar, London UK
7th May 2013-18th May 2013
Health Volunteer Overseas (HVO) is an American non‐profit organisation providing teaching to health professionals in developing countries aiming to improve global health through education. I was privileged enough to spent two weeks as a volunteer with one of their anaesthesia projects in Addis Ababa, Ethiopia.
Ethiopia is suffering from a shortage of qualified health professionals with less than 20 medical anaesthetists. The vast majority of anaesthetic service is provided by non‐medical anaesthetist who have completed a 3 year BSc degree without a nursing background. HVO in partnership with Addis Ababa University established a Masters Programme in 2010 to provide an opportunity to improve quality of care by bringing students up to date with current practice and provide additional clinical skills. Training and support is also provided to the local lecturers in view of having them independently run the programme in the future.
The Black Lion Hospital is the main referral centre for Ethiopia offering cardiothoracic, neurosurgery, ENT, urology, gynaecology, orthopaedics, paediatric and general surgery. The anaesthetic team consists of masters students working in pairs and a couple of BSc students whom they instruct. The students rotate through the different specialities. During my time there, they were covering gynaecology, urology and orthopaedic theatres. I focused on improving their skills in regional anaesthesia and discussed patient related topics including management of potential massive bleed, patient positioning, management of intra-op arrhythmias and haemodynamic instability, management of thyrotoxicosis and thyroid storm. It would be beneficial for future volunteers to know which theatres they will be assigned to so they can better prepare suitable equipment and teaching plans.
The students seemed confident and knowledgeable in certain areas but then struggle with a relatively simple task or anaesthetic management plan. Previous volunteer reports mentioned the lack of planning and preparation and I agree with this. I was there at the end of their masters programme and was expecting them to be slicker and more confident. Part of the problem was that the pre-op assessment was carried out in the holding bay or even in theatre. Reassuringly the students tells me that this was not their common practice as they would normally see their patients the day before but this system was not implemented in Black Lion Hospital. Overall I was still impressed by the students and find them to be better than the non-medical anaesthetist I have come across elsewhere.
I found the local consultant and resident anaesthetists to be friendly and engaging. They were willing to help the students if asked. They also have access to a nerve stimulator and glidescope and would share the equipment for teaching purposes. Additional drugs and equipment may also be kept in the theatre manager's office. For example we were able to get propofol for a specific case and fentanyl when 'officially' there were none available. However, volunteers should be familiar with using halothane (with no end tidal monitoring) and ketamine which is the main anaesthetic agents.
As I arrived at the end of the masters programme, the syllabus had already been covered. I was initially not given lecture topics for the weekly Friday morning didactic teaching sessions. I ended up delivering lectures on poisoning, burns and trauma management as well as mechanical ventilation at the students' request. They were preparing for their final examination and some wanted help with practice exam questions. The final exam was a multiple choice question (MCQ) paper. I was able to contribute to the bank of MCQs based on my lecture topics. The individual student evaluations given by the HVO volunteers was also taken into account.
Overall I had a positive experience. I not only contributed to the Masters Programme but have learnt tremendously from my experience. Teaching is my passion and I strive to improve my teaching skills. It was particularly challenging pitching at the right level to these knowledgeable students especially as English was not their mother tongue. I gained more exposure in using halothane which would benefit me in my future endeavour working in developing world. I learnt new techniques from the students including the use of neostigmine in neuroxial block. Although there are room for improvements I think this is essentially a good programme and would recommend it. I am grateful to SEA UK for awarding me the Myerson Award which funded my trip.
Teaching in the operating theatre
Keen students attending Friday didactic teaching session