Events & Opportunities
Anaesthesia in a low resource setting:
A global anaesthesia trainee experience
Kudakwashe Mawondo
Dr Kudakwashe Mawondo
ST5 Anaesthetics Registrar
Global Anaesthesia Enthusiast
William Harvey Hospital
Ashford
KSS Region
Mobile: 07375 660 262
Twitter: @thebzardoctor
Instagram: @thebzardoctor
Website:
www.theBZARdoctor.com
23.1
In fields that require selflessness
and voluntary service, it can be
easy to lose sight of the intended
beneficiaries and become overly
focused on personal fulfilment.
As an overworked and underpaid
professional, I sought time out
of my training with an Out Of
Programme Experience (OOPE),
in a job I believed would be
both fulfilling and rewarding.
Having been raised in resource-
constrained Zimbabwe, I was
determined to offer my skills
wherever needed and undertake
voluntary work solely for the
purpose of giving back, without
expecting anything in return.
And so began my pursuit of
global anaesthesia expertise,
with a six-month stint at Bugando
Medical Centre, a 950-bed
tertiary referral hospital located
in Mwanza, Tanzania, the second-
largest city situated along the
southern shore of Lake Victoria. I
deliberately selected this low- to
middle-income, resource-poor
region as a new challenge, both
to learn from the highly skilled
local workforce and to share and
exchange knowledge and skills.
My objective was to promote
safer anaesthesia practices
through education and training.
My initial job description was
simple and focused solely on
mentoring one resident or trainee
to develop their skills and achieve
self-sufficiency in the field of
anaesthesia. I was not burdened
with any other obligations or
mandates, such as conducting
audits or quality improvement
projects, which allowed me
the freedom to contribute
in a manner that I deemed
appropriate. Consequently,
WORLD ANAESTHESIA NEWS | 47

during my initial two weeks, I
enjoyed the balmy weather while
identifying opportunities where I
could be of assistance.
As a trainee from a developed
nation, I was abruptly confronted
with the harsh realities of
inadequate resources and the
ensuing unsafe practices that it
can generate. This experience
humbled me, as I was inspired
by my colleagues’ unwavering
optimism in the face of adversity.
Anaesthesia and intensive care
were managed by four physician
anaesthesiologists (consultants).
Nurse anaesthetists, who had
completed a one-year course
after their nursing degrees, with
varying years of experience,
primarily conducted theatre
cases. One of the physician
anaesthesiologists was
responsible for addressing
issues that arose in all thirteen
theatres, including assisting
with the most complex cases. I
had arrived hoping to teach and
share the wealth of knowledge
I had acquired thus far. I found
myself very quickly shifting from
‘master’ to apprentice.
On a national level, the field
of anaesthesiology receives
48 | WORLD ANAESTHESIA NEWS
less recognition as compared
to other specialties. Although
surgeons generate revenue,
the anaesthesiologists provide
support services. Patients
typically have to bear the
expenses of their surgeries
themselves, or utilise state or
private insurance policies if
available. Including the cost
of anaesthesia in such cases
could render an emergency
surgery unaffordable for most
individuals. It is unacceptable for
any individual to have to make
the choice between providing for
their family or paying for a life-
saving operation. Regrettably, for
many individuals, this choice is
not even feasible. Consequently,
some patients delay seeking
treatment, or resort to more
affordable traditional remedies
that may not provide adequate
care. As a result, when these
patients eventually present at
a medical facility, they often
have advanced diseases, or
are critically ill, to the extent
that even simple tasks like a
haircut become impossible.
Nevertheless, as medical
professionals, we endeavour to
provide the best possible care
for these patients, as the very
least we owe them is our best
efforts. Throughout my tenure,
I was afforded the opportunity
to participate in diverse aspects
of clinical anaesthesia, ranging
from administering and teaching
anaesthesia to leading simulation
sessions and developing
emergency protocols. I had
the privilege of working with
multiple specialties, including
burns and plastics, paediatrics
and neonatology, thoracics,
orthopaedic and trauma surgery,
neurosurgery, ENT, obstetrics,
and gynaecology. At various
times, I assumed the position of
“troubleshooter of the day,” a
role that enabled me to exercise
my leadership and management
skills by circumspectly managing
several operating rooms,
remedying issues within my
capacity, and promoting safer
surgical practices.
In my first week at Bugando,
I was confronted with a two-
day-old newborn who required
emergency surgery for bowel
resection and ileostomy creation
due to intestinal atresia and
ischaemic bowel. Despite the
complexity of the procedure
and the precariousness of the
situation, we worked tirelessly,
driven by the hope for a
positive outcome. Although
the recovery process proved
to be challenging, this whole
experience ignited my interest
in paediatric anaesthesia, which
became the focus of my clinical
time at the hospital. Over time,
I grew increasingly confident in
handling paediatric emergencies,
leading anaesthesiology for a
range of procedures, including
laparotomies, colostomies,
anorectoplasties, debridement of
severe burns as well as cleft lips
and palates. I was also involved
in complex neonatal cases,
such as the repair of tracheo-
oesophageal fistulae and pyloric
stenosis. This experience further
affirmed my desire to pursue
paediatric anaesthesia.
While I was in Tanzania, I had
the opportunity to perform and
teach different types of regional
anaesthesia blocks, such as
subarachnoid spinal block, caudal
23.1

for paediatric patients, TAP blocks,
supraclavicular, interscalene,
axillary, and individual upper
limb nerve blocks. Fortunately,
the hospital had one ultrasound
machine that we could use with
22-gauge spinal needles as our
block needle. This experience
increased my proficiency in
regional anaesthesia, motivating
me to seek further education
by attending courses and
conferences.
A bespoke anaesthetic fellowship with the opportunity to gain insight in to either
PRE-HOSPITAL EMERGENCY MEDICINE or GLOBAL ANAESTHESIA.
PHEM
Gain insight into PHEM by
attending unique teaching
and simulation opportunities.
Develop skills during
supervised shifts with
regional Enhanced Care
Teams
For more information contact:
Anaesthesia & PHEM:
Global Anaesthesia:
23.1
In addition, I conducted
simulation training sessions
using a newly donated high-
fidelity simulation suite. I
facilitated various simulation
stations on topics such as
difficult intubation, hypoxia,
hypertension, high airway
pressure, anaphylaxis, cardiac
arrest, high spinal block, and
peri-operative haemorrhage.
These sessions targeted nurse
anaesthetists, students, and
registrars in anaesthesia. With
these same groups, I also
carried out teaching sessions on
anaesthesia in various formats,
including one-to-one during
theatre lists, formal lectures using
slides, group seminars, and skills
training sessions. The sessions
covered a range of topics from
the FRCA curriculum, including
basic and advanced airway
management, resuscitation, and
defibrillation.
My vision is to improve the safety
of anaesthesia in neglected parts
of the world, where it can be
shockingly unsafe due to various
pressures stemming from the lack
of investment and recognition
in the specialty. To achieve this, I
have set out several goals:
1. Establish a remote
mentorship program: I
believe that every physician
anaesthesia provider
Specialist Hereford Anaesthesia Remote and
Pre-Hospital Fellowship
ANAESTHESIA
Anaesthesia in a District
General Hospital; 3 tiers of on
call. 6 months anaesthetic
experience desirable.
Dr Katie White Kathryn.white@wvt.nhs.uk
Dr Becky Paris Rebecca.paris@wvt.nhs.uk
Dr Julian Chilvers Julian.chilvers@wvt.nhs.uk
should have access to an
experienced anaesthetist
for regular check-ins and an
open messaging system for
any queries they may have.
This would help improve their
knowledge and confidence,
ultimately leading to better
patient outcomes.
2. Develop a remote teaching
program: I would like to
create a curriculum focused
on the CANESCA program
to train more anaesthesia
providers in these neglected
areas. By doing so, we
can improve the quality of
anaesthesia care provided to
patients.
3. Host Zoom-based case
discussions: I believe in the
power of open and honest
sharing of knowledge,
which is why I would like
to create a platform for
anaesthesia providers to
discuss challenging cases
and learn from each other’s
experiences.
I welcome anyone who is
interested in volunteering or
needs assistance in organising
such initiatives to contact me
at any time. Together, we can
improve the safety and quality
of anaesthesia care in neglected
parts of the world.
GLOBAL
Prepare yourself with the
knowledge and skills for work
overseas with support from
experienced mentors. Attend
courses in global anaesthesia
and contribute to global
project work
WORLD ANAESTHESIA NEWS | 49
supporting anaesthesia in resource-poor settings
www.worldanaesthesia.uk
June 2023
ISSN 2756-1917

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