Preparations a go-go!

Another reason for me being in Zambia on top of working at UTH is to collect follow up data on both the SAFE Obstetrics and Lifebox courses that we conducted over the past year. These include one a year ago and one 6 months ago. The idea is to contact and visit the course participants to see how much they have remembered and how they have instituted the course into their everyday practises and also to hear their stories and gain their feedback about the course too.

  So where does one start with this task.... Well of course there is a list of names and places. Most of these mean nothing at all until visualized fully. However having seen the extent of the geography covered (each pin denotes a candidate that is working in this area that has attended a course) it is impressive that there is this spread of (hopefully) well trained individual anaesthetic practitioners throughout Zambia. Bearing in mind that most of the anaesthetics in Zambia are conducted by clinical officers (non doctors, non physicians who have literally trained from school for three years as a general clinical officer before spending a further 2 years training to do anaesthesia). They are really the crux of anaesthetic delivery Zambia wide. The map, however was also a sobering sight as this really is not an easy task to try and tackle fitting all of these places in especially with the poor road infrastructure but always keen for an adventure I signed up for the task! 

Candidate from courses home hospital base map 

 As well as sorting out where to visit I've had to sort out an array of paperwork. Follow up questionnaire's to see what the recall is like. Questionnaires to see how the course has affected practise/changed practice/had an impact (or not). Questionnaires to see how the equipment is functioning and if there are any faults that need to be repaired or attended to and questionnaires finding out how the hospital is supplied and how delivering an anaesthetic in that particular hospital is carried out. All in all it involves a considerable amount of paperwork! I have had to invest in a 'filing' system such is the extent of the questionnaires lest I travel to the border of Tanzania and forget the very piece of paper I needed!

The multicoloured foolproof filing system....

But paperwork isn't all I am having to sort out. As part of the SAFE Obstetrics there was a skills station to undertake - randomly selected from CPR, Neonatal life support, rapid sequence induction and seizures. These are also being re-tested (I'm using tested in a soft way here. Its not so much a test but its a repeat of the skills that was tested previously pre and post course to see whether the retention of knowledge remains at either 6 months or a year). So that essentially means I am carrying a large blue bag which houses not only a baby but a decapitated head and a dismembered body. I do hope the regular police checks by the road side are not too thorough checking through bags!!! I dont think my Nyanga is quite up to explaining all this lot below!

Dummies and equipment for skills testing

So, there we go. I think I'm ready. In fact I know I'm ready and have been for a few weeks! Unfortunately at present I am having to use an attribute that I am not synonomous with: Patience! In fact it is something working overseas continually teaches me. When I was working in the Antarctic we had the saying "Hurry up and wait". That basically covered most things but especially the 5 days of getting up each morning in the Falklands with your bags packed ready to get on the plane to the Antarctic only to be told the weather window wasn't right or the wind was wrong or something and then you'd down tools, do something else and repeat the next day.... Similarly here. The wait for the official letter from the Ministry of Health (with the signature and stamp on it) to allow us to do the follow-up. Now we have to wait for the go ahead for transport and visitations and a few other 'technical' problems.... So, I am patiently waiting.... Honestly, I am!!!

But meanwhile, I am still working in UTH and feeling lucky that we have some of the Lifebox donated pulse oximeters ( the yellow box in the picture) that is placed on the finger/toes of the patient to allow recording of the oxygen levels and also the heart rate. It is used in the recovery area in UTH as we have oximeters attached to the monitors in the theatres. We are really fortunate, in some hospitals they depend on the pulse oximeters in theatre for monitoring and it's a sad thing to think that in some places they don't even have one in the hospital at all.  It is also highly useful as it is portable so can be taken to a ward situation if there is an emergency and it also has different sized probes for child or adult sized fingers!

Lifebox monitor in use on a child in the recovery 

I am also trying to promote the use of the WHO Surgical Safety checklist at UTH during my time in theatre. This is to increase not only communication and teamwork but also making surgery safer as we ensure the correct patient is operated on. The correct procedure is carried out, the correct equipment is available (crucial to check out here). It allows any difficulties to be highlighted to the team and is basically a pretty easy list to rattle through before starting each case. Getting buy in from staff and surgeons is proving just as difficult here as it is in the UK at times, though having returned I am buoyed by the fact that there are pockets that are making positive noises about it from both sides of the table (anaesthetists and surgeons). So there is hope!

WHO Surgical Safety Checklist hanging from one of the theatre lights to encourage use

So basically at the minute i am chomping at the bit to get out and see what's going on in the rest of Zambia. I hope that there will be further updates on this project soon!