SAFE Obstetrics and Lifebox Courses

So, here I am sat on a train going to the airport in a role reversal of a week ago. Yes a fleeting visit for an interview. Which went well and was worth the trip back. And in the grand scheme of things a quick flying visit isn’t much of a big deal is it? And sitting on a train and then a plane back for 24 hours isn’t a big deal for me – I mean its not that long is it? Especially as can I sit and contemplate what getting a ‘proper, grown up’ consultant post means for me...

 Does it mean stability and seeing more of my family and friends? (that’s a definite plus)

Does it mean I need to move into a house and a get a garden?

Or maybe a new pair of trainers, or a shiny new toy or a garage to keep them in (or both!) ….

Or maybe a new T.V…. (Ok, I know its retro. I WILL get a new telly!)

But actually as I’m sat here thinking about these things the minutes and the hours while away. Tick tock, tick tock, tick tock and yet in countries where low-resources abound they are not thinking of TV’s or new bikes or houses or gardens even. They are likely to be thinking of their families and friends though and still the clock goes on ticking. And with each beat of it’s ticking another mother dies. In fact every two minutes that clock hand moves it signals the death of a woman to pregnancy or childbirth-related complications. That’s too high. That’s WAY too high. And these are facts – check out the stark figures www.who.it

 And to compound issues when these women come to theatre for an anaesthetic they are often dealt with by non-anaesthetists (who incidentally are often very skilled) but who haven't had any teaching or training in these cases for years, or ever even. And worse still there are an estimated three quarters of a million operating theatres all over the world that don't use even the most basic monitoring of oxygen levels during anaesthetics - this creates the high death rates and the chances of dying under anaesthetic is close to a 100 times more likely in these situations.

So what is happening to try and make those stats better? There are loads of different organisations and people working in low-resource settings that are doing amazing things to try and improve this.

But on a more global level the AAGBI (Association of Anaesthetists of Great Britain and Ireland) and also by the WFSA (World Federation of Societies of Anaesthesia) and the WHO (World Health Organisation) have been instrumental in trying to decrease the gap not only in basic monitoring but to improve outcomes by making anaesthesia and surgery safer.

The AAGBI have also been instrumental in their support of the development of not only the Lifebox course (concentrating on the important problem of monitoring oxygen saturations/levels in patients during anaesthetics and actually supplying the machine to do so for candidates to take back to their respective hospitals as well as covering the WHO Surgical check list) but also that of SAFE Obstetrics (Safer Anaesthesia from Education which focuses on recognising and managing obstetric emergencies in a low resource setting) and delivering these courses throughout the world.

 Zambia is no different and have started running the 3 day SAFE Obstetrics and also the one day Lifebox course (check out the lifebox page on www.lifebox.org ). 

And so, whilst I was away in Wales the third course was run in Lusaka, Zambia. The first (which I was lucky enough to teach on) was also in Lusaka and the second down in Livingstone. Though I was gutted not to be there I've been kept in the loop of what's been going on and thought it merits talking about!

Both courses are really interactive with a fantastic mix of lectures, small group teachings with scenarios, discussions and workshops which focus on recognising and managing the most common causes of maternal deaths and also by concentrating on using the WHO safe surgery checklist. Although I'm not a huge fan of checklists - this is a MUST use in all situations and proves to be lifesaving day in day out as well as encouraging good communication and parity between all members of a theatre team such as nurses, surgeons, anaesthetists, auxillaries, porters and ODP's (if you have them in these settings!) The session on neonatal life support and resuscitation is also a hugely important one as it ensures that care of the baby is also attended to with the care of the mother.

Jane a final year MMed teaching a small group workshop

Ushma - final year MMed teaching in a small group setting in the university skills lab

As you can see from the pictures the breakout sessions were done in small groups which allowed some change from the lecture hall. And this is due to the considerable organisation and logistical work done by David Snell and the great support and to-ing and fro-ing to the ministry by Wisdom Chelu. The University of Zambia allowed us to use the lecture hall, three classrooms and a skills lab to carry out the teaching which allowed efficient break out sessions to happen after main lectures were delivered. Thus everything ran really fluidly and was certainly a great environment for learning.

Simulation of patients and events is a hugely useful way of teaching how to deal with events by making the situation feel real. 

 Teaching was excellent not just by the MMeds but also by visiting UK faculty: Steve Brosnan and Corinna Matt both returning to teach for their third course (and who spent 3 months working at UTH when I was last here) as well as a few others that are already out here in Zambia such as the ZADP registrar (which is what I was doing when I was here last!) and a few new ZADP short term volunteers. But also the teaching was made easy by having delegates who were actively participating in the sessions and brought a lot of their own experiences to share with others with them. 

And once again the courses were an excellent success. For several reasons:

• 56 Further delegates have now been trained (mostly clinical officers who are non-physician/non-nurse) and return to the rural areas with their new skills

• This course was funded by the Zambian Ministry of Health (first two were funded by THET) which is a massive step forwards in promoting the sustainability and continuation of such great courses

• 22 more pulse oximeters have been distributed to further rural hospitals throughout Zambia (making anaesthesia and surgery safer)

• Zambian MMed students were delivering teaching on the course (as they have done previously which is now really increasing the sustainability and future teaching on the course)

  So all of this is heading in the right direction and by creating locally sustainable courses providing education and donating oximeters we are going some way to improving maternal and anaesthetic care in Zambia and moving us closer to Ban Ki Moon's  (Secretary General to the UN) oft quoted but important statement:

 “In the 21st Century, no woman should have to give her life to give life.”