World Anaesthesia Society

An interview with Rola Hallam

Working with Ebola

Developing World Anaesthesia Course - Bristol 2015

The Primary Trauma Care Foundation Chinese Project: 2010 - 2013

Kimilili, Kenya 2014. A Smile Train visit to a new hospital

Letter to the Editors

Ten frequently asked questions about the glostavent and draw over anaesthesia

July 2015 ISSN 1472-8820

www.aagbi.org/international/international-relations-committee/world-anaesthesia-society

Volume 15 Number 2

In this issue:

The World Anaesthesia Society is offering a grant of up to £1000 for trainee

anaesthetists wishing to work or teach in a developing country

Further information and application forms available at

www.aagbi.org

WAWORLD

ANAESTHESIA

World Anaesthesia Society Travel Grant

Application and award of these grants will be through the travel grant system run by the International Relations Committee of

the AAGBI with two grants awarded each year.

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ContentsEditorial 3

WFSA Update for World Anaesthesia News 4

An interview with Rola Hallam 6

Working with Ebola 10

Developing World Anaesthesia Course - Bristol 2015 13

The Primary Trauma Care Foundation Chinese Project: 2010 - 2013 16

Kimilili, Kenya 2014. A Smile Train visit to a new hospital 20

Ten frequently asked questions about the glostavent and draw over anaesthesia 23

Letter to the Editors 24

Useful information 25

WAS application form 27

Welcome to another issue of World Anaesthesia News. Here in the UK we are heading towards our summer holidays praying for a bit of sun and wondering where the first half of 2015 has gone! Julian Gore-Booth has given us an excellent update on the WFSA’s busy year so far ensuring improved patient care and access to safe surgery and anaesthesia. They have done some really influential work with the World Health Assembly to pass a resolution ‘strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage’, and also partnered with the International Committee of the Red Cross to ensure that anaesthesia care in their facilities meets International standards. Congratulations to all involved, we are looking forward to seeing where you are going next!

We have interesting articles touching on two current World disasters; Syria and Ebola. Rola Hallam gave us half-an-hour out of her busy schedule earlier this year and we are sure that you will find the resulting Q&A fascinating, enlightening, candid, and sobering. It is also encouraging that a single agency like Hand in Hand for Syria can make a difference, and we know that Rola welcomes contact from anyone interested in further information. Matthew Jackson wrote an interesting article on how he transferred his skills as an anaesthetist and intensivist field-testing a series of potential treatments for Ebola in Liberia and Sierra Leone, which he also recently discussed at GAT.

For those of you thinking about working abroad but who still have questions about how, why not dip in to Ben Gupta’s review on the Developing World Anaesthesia course he runs in Bristol. Signing up for one of these courses is an excellent way to get further information and skills, and you will find various adverts throughout this issue to point you in the right direction. Amaia Arana and Douglas Wilkinson reflect on how the Primary Trauma Care Foundation has shown early growth in China and are now looking towards sustaining this interest, and Michael Carter and Roger Eltringham have provided us with some equipment questions, answers, and solutions.

We are always keen to include your correspondence, so please do write to us as John Brock-Utne did, especially if it puts a smile on all our faces!

Watch out for further news from the World Anaesthesia Society - seminars and workshops are in the pipeline.

Sarah O’Neill and Gordon YuillEditors

Welcome to World Anaesthesia News

15.2 WORLD ANAESTHESIA NEWS | 3

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The World Health Assembly (WHA) is the supreme decision-making body of WHO. Its main functions are to determine the policies of the Organization, supervise financial policies, and review and approve the proposed programme budget. Held annually in Geneva, Switzerland, it is attended by delegations from all WHO member states.

As an organisation in official liaison with the World Health Organisation (WHO) the WFSA is well placed to influence and inform decision makers about the role of anaesthesia and anaesthesiologists, and to ensure that surgical care does not remain the “neglected stepchild” of global health.

WFSA Update

WHA Resolution – a historic day for anaesthesia

4 | WORLD ANAESTHESIA NEWS 15.2

Friday the 22nd of May 2015 marks an important day in history for global surgery and anaesthesia; it is the day on which the World Health Assembly (WHA) passed a historic resolution, “Strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage”.

Approved unanimously at the WHA meeting held in Geneva from 18 – 26 May, this highly anticipated resolution was welcomed by members of the global surgery community around the world.

The World Federation of Societies of Anaesthesiologist (WFSA) is extremely proud to have been a

Julian Gore-Booth

Chief Executive OfficerWFSA

Dr J.P Abenstein (ASA President), Dr Jannicke Mellin-Olsen (WFSA Deputy Secretary), Dr David J Wilkinson (WFSA President), Dr Kelly McQueen (ASA Committee Chair on Global Humanitarian Outreach) and Julian Gore-Booth (WFSA CEO) at the WHA 2015


part of this momentous occasion and among the delegations invited to speak at the WHA. WFSA President, David Wilkinson said, “For the first time anaesthesia is beginning to receive the focus that we all know it deserves.”

This resolution recognises the huge and growing number of surgeries taking place each year, with over 234 million surgical procedures performed globally for a wide range of common conditions requiring surgical care. Low and middle income countries are identified as being the most affected by the world’s burden of disease stemming from surgically treatable conditions.

Now more than ever, this resolution offers a rallying call that safe surgery and anaesthesia should be universally available.

In a statement addressing delegates at the WHA made on behalf of the WFSA, Dr Abenstein, President of the American Society of Anesthesiologists (ASA), urged delegates to approve this resolution, and explained that,

“WFSA remains ready to work with the WHO and Ministers of Health around the world, together with our colleagues in international surgical organizations, to improve the quality of patient care and access to safe anaesthesia and surgery.”

This long awaited resolution is not only a significant step towards addressing the growing global need for safe anaesthesia and surgery it is also symbolic of a rapidly changing global surgery landscape, and a call for action that demands our attention.

WFSA and ICRC Partnership for Safe AnaesthesiaThe World Federation of Societies of Anaesthesiologists (WFSA) has joined forces with the International Committee of the Red Cross (ICRC) on a project to improve surgical care outcomes by ensuring that the anaesthesia care provided in ICRC facilities meets international standards.

This exciting project aims to create an anaesthesia forum for clinical questions from the field, update ICRC’s clinical protocols and establish mechanisms for the deployment of qualified anaesthesiologists to the field.

Both the WFSA and the ICRC are committed to providing safe anaesthesia for patients admitted to ICRC facilities. The initial stage of the project will focus on the establishment of a working group/liaison committee made up of WFSA and ICRC experts who will provide leadership to ensure delivery of the project aims.

WFSA President, David Wilkinson said, “This collaboration is an example of the WFSA’s mission to improve patient care, and access to safe anaesthesia, by uniting anaesthesiologists across the global. Our partnership with the ICRC is a great step forward in our continuing determination to develop strong links with other international groups who wish to improve the provision of surgical and anaesthesia care to all people in the world.”

Julian Gore-Booth (WFSA CEO), Dr Jannicke Mellin-Olsen (WFSA Deputy Secretary), Dr David J Wilkinson (WFSA President) with ICRC representatives


Rola is a very busy woman but we managed to catch up with her earlier this year to find out more about her work and her motivation.

WAN = World Anaesthesia News

RH = Rola Hallam

WAN: Tell us a bit about yourself and your background.

RH: I’ve just completed my training in anaesthesia and intensive care. I feel I have two specialities in medicine. Anaesthesia is very much one of those passions; the other I would refer to either as global health or international health development. They have both become very much part of my life and of my professional life. It’s an unusual, but I think growing combination, and I certainly love it.

WAN: Probably we know you best for your work in Syria. We have seen you on TV and in newspapers with your work with Hand in Hand for Syria. How did you get involved in that?

RH: I’m originally from Syria, so at the beginning of the uprising as it all turned bloody we were very personally affected with family members unfortunately being killed. We worked on a family or local level to try and help with the aid effort to what was then just small pockets of Syria. As the problem grew and war went on to engulf the whole nation it soon became apparent that local or family-based efforts were insufficient and we needed to be more organised. So a group of Syrian expats in Britain set up Hand in Hand for Syria as a formalised charity to help with medical and humanitarian aid. I became involved with them very early on, and have been working

An Interview with Dr Rola [email protected]

Secretary of the World Anaesthesia Society

Consultant Anaesthetist Royal Free Hospital, London

Medical Director of Hand in Hand for Syria

www.handinhandforsyria.org.uk


with them now for three years as a volunteer, delivering medical and humanitarian aid. We are now in something of a grey area: it’s still an emergency, so there’s still the need for aid; but it’s now in its fourth year and infrastructure has been totally devastated, so there’s also a need for development. We have grown massively as an organisation, learning as we’re going along. I am now the medical director of Hand in Hand for Syria, and will be working with them full-time for a short consultancy before taking up my consultant post.

WAN: You’ve said the infrastructure has largely been destroyed. What does that mean for health delivery, hospitals, doctors, drug supplies etc?

RH: One thing that people don’t know, and that isn’t really talked about, is that the healthcare system has been utterly devastated, completely destroyed in most of the country except for very small pockets in Damascus, the capital, and Aleppo, the second largest city. What most people don’t know is that this has happened because it has been specifically targeted and systematically destroyed. So for example, Physicians for Human Rights, an American NGO, have documented over 200 attacks on medical facilities across Syria in the last three years. They have the names of over 600 doctors and nurses who have been killed in that time. They have been specifically targeted for their medical aid activities. So if you like, this destruction of the healthcare system has been used as a weapon of war. These are actually crimes against humanity, and war crimes. Medical neutrality by international humanitarian law should be respected: there should be no attacks on healthcare workers or facilities. Physicians for Human Rights say that 90% of these attacks have been by the Syrian government itself, with 10% by other armed actors. And so now there are literally a fraction of hospitals working for a population of about 20 million people. We think approximately 20% of healthcare facilities are functional. This lack of security has led to a massive brain

drain as you can imagine, either because people have paid the ultimate price, or because they are rightly worried for their own or their family’s security, and have left. So now there are almost no healthcare facilities and no healthcare workers. In one hospital I visited last year, in the biggest A&E in one of the biggest cities, there was a dentist and a vet in the emergency department to treat your blast injury! Plus an army of medical students who are insufficiently-trained for the workload and the severity of injuries, but who are increasingly becoming the mainstay of healthcare workers. It’s an utterly devastated system unfortunately.

WAN: So how are you trying to support that? Other aid agencies have had to completely withdraw from Syria. Is it safe for you to send personnel in? Or can you provide supplies or training?

RH: The problem is that nothing operates in isolation and everything is interlinked. So it’s not just health infrastructure that’s been devastated, it’s everything. There is no clean water; there is overcrowding; 10 million people are homeless, most of those inside the country. When you have overcrowding, poor nutrition, and poor sanitation, then this is ripe for infectious diseases. So there is a huge primary healthcare problem. Recently we have had a resurgence of polio, and of measles. It is a huge, huge problem, and it’s so pervasive in all of the country, and

very very difficult to tackle. As a single agency you cannot work alone, and you’re not going to make a huge difference on your own to that massive scale. So it puts a lot of emphasis on co-ordination, on collaboration and on working with other agencies: Syrian agencies, international NGOs, UN entities, all of us trying to work together to try and tackle the problems. As you can imagine that’s much easier said than done, and I would say done nowhere near as well as it could be and should be, bearing in mind the devastation. But, as a small organisation you just have to make sure that you do your bit, and you do it well to the highest standards that you can in that environment. And so at Hand in Hand for Syria the main things that we’ve focused on are maternal and child healthcare. We’ve set up the only women’s and children’s hospital in north Syria and have the only Special Care Baby Unit in the north of Syria to look after pre-term babies. We see 3500 deliveries a year, about 330 admissions for both women and children a month, and about 3200 outpatients a month.

We have already opened our children hospital in the north-west and are awaiting funding before we open the maternal side.

That’s really our mainstay, and from that we have other smaller programmes such as immunisation programmes or nutrition programmes. We are hoping this year to implement a gender-based


violence programme attaching it to our women’s hospital. So those are the main things we’re doing. There are lots of “field hospitals” now in Syria. Because of the attacks on hospitals, these underground hospitals have sprung up. We support about 80 of these around the country in terms of drug supplies, consumables, surgical equipment, and sometimes in the set-up of the facilities. They’re not managed by us but they are facilitated by us, if you like. What we’re also trying to do now is tackle the brain drain and the lack of trained healthcare professionals. We started by doing a nurse training programme last year which was very successful, and we helped the graduates gain employment at our facilities, so we’re hoping to scale that up as well. I’d love to also help train junior doctors as well, and provide employment opportunities: a multi-pronged approach to a big problem. But it’s an uphill struggle!

WAN: Have any of your projects been attacked? Your hospital is almost crying out to be a target isn’t it?

RH: Yes, unfortunately being a doctor or an aid worker is one of the most dangerous things to do in Syria. We had a twin car bomb that went off outside our mother and child hospital. It sadly killed the father and brother of our main paediatrician and hospital manager. There were ten civilian deaths and about 60 people injured. It’s very difficult to know who did it and why. Also the hospital that was three miles away from us was targeted and destroyed. Another one about ten miles away from us was hit by a warplane. It’s an everyday reality unfortunately; one that we work to raise awareness of, and advocate with policymakers and governments to try and uphold international humanitarian laws. But unfortunately from where we are, on the ground in the field, we see very little impact of those advocacy activities, and it remains

incredibly dangerous. The problem really is that access to healthcare for me is a basic fundamental human right. Because not having healthcare is not just that you can’t get your antenatal care or your newborn care, but it’s no antibiotics if you have an infection, it’s no vaccinations, it’s no treatment for your blast injury. But it’s even bigger than that. The European Commission estimates that 200,000 Syrians have died because of lack of access to healthcare so it has an actual mortality impact. And health is so inextricably linked to everything else. If you have poor health you cannot study, you cannot work, so poor health is a sure ticket to poverty and deprivation. And if you go beyond that, one of the things that the Ebola crisis has taught us is that if you have total devastation of a healthcare system in a war-ravaged country, it will become an exporter of infectious diseases, and infectious diseases know no borders. I really feel that Syria is going to be the next Sierra Leone or Liberia in terms of being an exporter of diseases, so I would hope that we learn those lessons and act on them quickly, not in 10 or 15 years when we realise that Syria has become a major hub of disease which affects the world and becomes all our responsibility. So yes, access to healthcare is a human right and I think we should be talking more about that and advocating more strongly for it around the world.

WAN: What can readers of WAN do? Many of us would want to “go and help” but clearly that’s very difficult in this setting. What sort of things could we be doing?

RH: I think there are different levels of involvement as with anything. Mainly I would urge people to find something they feel passionate about and support that, whatever it is, wherever it is. The work that you do will be that much more meaningful to you, and of a much bigger magnitude if you’re following

something you want. Secondly, it depends how much you want to be involved. The first thing is fundraising for organisations that are working in Syria, like Hand in Hand for Syria, but there are many others also doing good work. Then there are different levels of involvement on a professional level. We run training courses in refugee countries for doctors. That could be something people want to get involved in. We would also like to set up a distance mentoring programme for anaesthetists. There are so many different avenues that I think the best thing would be for people to find something of interest to them: advocacy, fundraising etc. and follow that. People are very welcome to drop me an email if they have any specific queries or thoughts or ideas, and I’d happily discuss that with them. But whatever you do, don’t do nothing!

WAN: Finally, coming back to you, when you start your consultant job are you hoping to stay involved with the work in Syria? How will you make that happen? It sounds very all-consuming.

RH: I think it’s a question we all face; whatever the non-anaesthesia element of our life is almost doesn’t matter really. I think it boils down to how much you want it to be part of your life. For me it’s global health and Hand in Hand for Syria, for some it’s research, for some it’s something completely outside of medicine. So it depends on your passion and drive for it, how much you want it to be part of your life and how much you are willing to sacrifice or compromise for it, or fight for it if necessary. So I absolutely plan to stay involved in it. As I said earlier, I see global health as very much part of my career and speciality. I’m sure it won’t be straightforward but I think it’s doable, so I will attempt to have two hats: part anaesthetist, part global health, and carry on regardless!



The current Ebola outbreak is unprecedented both in number of patients affected and geographic spread. In early 2015, I was offered an opportunity to work as a trial doctor in West Africa to field-test a series of potential treatments for Ebola. During this time, I spent seven weeks working across several sites in Liberia and Sierra Leone. It was a real privilege to be involved in this project. To successfully conduct our studies we had to rapidly learn about Ebola and its management within the treatment centres. Our team was then responsible for conducting the study within the centre alongside managing the administrative tasks required for the smooth running of the study. This experience has given me an insight into how

Working with Ebola

my skills as an Anaesthetist and Intensivist might be transferred to a novel situation.Ebola is recognised as a public health concern for equatorial Africa.1 Ebola outbreaks have become increasingly frequent. Previous outbreaks have been small and self-contained in rural communities; Ebola has never before affected Liberia, Guinea and Sierra Leone. While an expertise in managing this disease has slowly developed over the last 30 years, this is the first time there have been sufficient patient numbers to systematically test treatments, which might offer a better chance of survival. This outbreak was characterised by rapid transmission across a large geographical area,

Matthew J Jackson

ICU © VSO / Ben Langdon

Outside an embola treatment centre

ST 7 Anaesthesia & Intensive Care Medicine, HEE NW


including crowded urban centres. Mortality has approached 70%.2,3 It has affected some of the poorest countries in the world where pre-existing healthcare infrastructure was poor.4 The international response was slow and underwhelming; mid-crisis, predictions were dire.3 Thankfully since the start of 2015, patient numbers have started to decrease rapidly. Though our team arrived as patient numbers were falling, the human cost of the crisis was painfully evident across the country. At the time of writing, Liberia has been declared disease free and transmission rates have fallen in Guinea and Sierra Leone - but vigilance remains high. As a disease, Ebola is incompletely understood. It is characterised by non-specific symptoms.2,5 Presentation to treatment centres

is often late.4 While classified as a haemorrhagic fever, uncontrolled bleeding has been rarely seen in this outbreak.2 In the West African setting, the differential is wide and includes bacterial sepsis, malaria, typhoid fever, yellow fever, Lassa fever and Dengue fever.6 While the ability to perform Ebola PCR and malarial antigen testing has become universally available, tests for other differentials are limited in the field. The disease progresses from a Systemic Inflammatory Response Syndrome to multi-organ failure and refractory acidosis.7 Though Ebola was a new disease to me, in the later stages it felt familiar - behaving similar to severe sepsis, which I frequently manage back in the UK.

Treatment for Ebola is largely supportive, with the occasional use of compassionate experimental therapies. Patients are often treated

presumptively with empirical broad spectrum antibiotics, antimalarial and de-worming medication. Within the treatment centres patients receive supportive and symptomatic treatment with fluid replacement, electrolyte replacement, nutritional support, anti-pyretics, anti-emetics and anti-motility drugs. Currently there are several programs to investigate various treatment and preventative strategies.8,9 To be part of one such program, working to develop a specific treatment for the disease, on the background of unprecedented human suffering was truly humbling.

Within the treatment centres there is a strong focus on infection control. Chlorinated water (0.05-0.5%) is used for cleaning and decontamination. Great emphasis is placed upon the correct donning and doffing of Personal Protective Equipment to prevent healthcare workers acquiring the disease. Patient and healthcare worker flow is optimised to prevent spread of the virus. In many ways these protocols were a natural extension of infection controls procedures and patient pathways used within UK ICUs and theatre complexes.

The nature of our research meant that we also had responsibilities outside of the treatment centre. At the time it was important that the local community understood the nature of our research - to this end I was interviewed by the local and international media, alongside running several community information sessions. In spite of the context, we wanted to ensure our research was performed to the highest standards. I was therefore involved in multiple conversations with various ethics boards and pharmacy boards to ensure we had the correct approval to conduct our trials.

ConclusionAs an Anaesthesia and Intensive Care Medicine trainee, I am conscious that traveling to work as a researcher in a viral outbreak is unusual. Nonetheless there is precedent for a greater involvement of our specialties: during the avian and swine flu outbreaks in the UK, critical care and anaesthesia played

Personal protective equipment

key roles in patient management. As a specialty, I believe we should look to play a larger role, both nationally and internationally. For me, this experience drove home the centrality of research to practice, even in a humanitarian crisis: patients in this outbreak benefited from knowledge gleamed from previous outbreaks - hopefully the knowledge generated by my team will improve the care offered in future outbreaks. Finally, traveling as a researcher gave me the opportunity to observe several treatment units in action and reflect how my current clinical skill set might have been deployed, had I travelled in a clinical capacity.

References:1. Feldmann, H. and Geisbert, T. | (2011). Ebola haemorrhagic fever. The Lancet, 377(9768), pp.849-862.

2. Schieffelin, J et al (2014). Clinical Illness and Outcomes in Patients with Ebola in Sierra Leone. New England Journal of Medicine, 371(22), pp.2092- 2100.

3. Ebola Virus Disease in West Africa — The First 9 Months of the Epidemic and Forward Projections. (2014). New England Journal of Medicine, 371(16), pp.1481-1495.

4. Fowler, R. et al (2014). Caring for Critically Ill Patients with Ebola Virus Disease. Perspectives from West Africa. Am J Respir Crit Care Med, 190(7), pp.733-737.

5. WHO, (2014). Case definition recommendations for Ebola or Marburg Virus Diseases. [online] Available at: http://www.who. int/csr/resources/publications/ ebola/ebola-case-definition- contact-en.pdf [Accessed 8 Jun. 2015].

6. Kreuels, B., Wichmann, D., Emmerich, P., Schmidt-Chanasit, J., de Heer, G., Kluge, S., Sow, A., Renné, T., Günther, S., Lohse, A., Addo, M. and

Schmiedel, S. (2014). A Case of Severe Ebola Virus Infection Complicated by Gram-Negative Septicemia. New England Journal of Medicine, 371(25), pp.2394-2401.

7. Fletcher, T., Fowler, R. and Beeching, N. (2014). Understanding organ dysfunction in Ebola virus disease. Intensive Care Med, 40(12), pp.1936-1939.

8. Marzi, A. and Feldmann, H. (2014). Ebola virus vaccines: an overview of current approaches. Expert Review of Vaccines, 13(4), pp.521-531.

9. Bishop, B. (2014). Potential and Emerging Treatment Options for Ebola Virus Disease. Annals of Pharmacotherapy, 49(2), pp.196-206.


Cleaning and decontamination


History and BackgroundThe Developing World Anaesthesia course was set up in Bristol 4 years ago to meet the need of a growing numbers of trainees and consultants who wish to broaden their experience with a period of time working in the developing world. Over the duration of a day the course provides a broad introduction to this kind of work and provides a good starting point and, hopefully, some inspiration to delegates. The course continues to run annually in April in Bristol and due to demand is now running in October at the RCoA in London. Developing World Anaesthesia continues to be generously supported by Diamedica, world leaders in specialised anaesthetic equipment for the developing world.

Developing World Anaesthesia Course - Bristol 2015

Bristol 2015The course took place at the University Hospitals Bristol Education Centre and 27 delegates attended from all over the UK with 2 attending from overseas. The majority of delegates were trainees with a small number of consultants. The faculty was drawn from throughout the consultant body in the UK and contained a large amount of collective experience in working in the developing world. The only omission on the faculty was Dr Rachael Craven who lived up to her billing as an experienced trauma anaesthetist and was called up to work in Nepal the day before the course!

Anaesthetic Equipment The fundamentals of anaesthetic equipment for the developing

Dr Ben Gupta

ST6 Bristol School of AnaesthesiaDeveloping World Anaesthesia CourseMSF

[email protected]

www.dwasouthwest.org

Group discussion


world and specifically draw-over anaesthesia were covered in a number of sessions. In the morning Dr Michael Dobson from Oxford gave a clear and concise lecture on the fundamentals of draw-over and also touched upon the use of anaesthetic agents that might be novel to those from the UK e.g. halothane and ether. After this, delegates split into small groups and took part in two extended practical sessions where they had the opportunity to handle draw-over vaporizers and put together drawover circuits as well see oxygen concentrators and integrated drawover machines (Glostavent) action. The practical sessions were run by Drs Michael Dobson, Elma Wong (Birmingham), Jeanne Frossard (London) and Mr Robert Neighbour (CEO of Diamedica Ltd.) and received excellent feedback.

KetamineThis drug is vital to much work in the developing world and Dr James Rogers (Bristol) gave an excellent introductory lecture to it’s use, illustrated by several examples and some very user friendly ‘recipes’ for use in the field.

Organising your time away and making it countAs well learning something about the technical side of working overseas delegates were encouraged to think about the practicalities of working overseas for example what sort of project to become involved in and how to fit it in to your normal working life.

Dr Jo James, who is the Bernard Johnson advisor for international programmes at the Royal College of Anaesthetists UK was ideally placed to deliver this lecture and provided a unique insight about how to fit working overseas into your training.

Small Group Seminar SessionsFor a significant part of the course delegates were split into small groups of 5-6 and took part in a series of short seminar style

sessions. Topics covered were Obstetric Anaesthesia (Dr Hilary Edgcombe - Oxford), Paediatric Anaesthesia (Dr Philippa Seal - Bristol) and Decision making/Ethics in the field (Drs James Rogers and Keya Quader - Bristol). These sessions allowed some time to questions consultants experienced in their field and examine some case examples in more detail.

TraumaNo matter where you go to work in the developing world trauma of some kind will be a feature and Rachael Craven, having working in Haiti, Syria, Nepal and Libya to name just a few was ideally placed to deliver this lecture. However, as detailed above Rachael was called up at the last minute to work for MSF in Nepal. In the event, Dr Ben Gupta (Bristol) drew on his experience working with MSF to deliver this lecture instead.

Being a good visitorThis short session was new to the course this year and was well received. Dr Naomi Shamambo (Zambia) and Nurse Anaesthetist Barbie Podi (Papua New Guinea) both pre-recorded short lectures on how to be a good visitor from the point of view of a local anaesthetist.

Their respective positions enabled them to give the group some very insightful views.

Experience from the fieldIn the final session of the day, delegates heard three short presentations from anaesthetists who had all recently been working overseas on very different types of projects. Dr Elma Wong spoke very evocatively about her work with MSF in Papua New Guinea and Jordan, Dr Tom Barrett (Bristol) spoke about his interesting experiences working on ‘ear camps’ in Nepal and finally Dr Ben Greatorex (Bristol) gave an impressive account of his time endeavoring to build capacity in Intensive Care Medicine in Ethiopia.

ConclusionFollowing a successful day delegates and faculty retired to a nearby pub for further informal advice and networking. Formal feedback from delegates indicated that all had found the day useful and informative. Some delegates fed back very constructive pointers for improving the course, which the organising team will be taking on board for the upcoming course in London in October 2016.

Programme

Glostavent training


The PTCF is a non-profit organisation set up by clinicians to train doctors and other health care professionals in the management of the severely injured patient, introducing them to a set of trauma care procedures and teaching methodology in order to develop an appropriate Primary Trauma Care training model suitable for their context, especially in the rural areas, being sensitive to the sociocultural and religious background.

Since 1996 the PTCF concept has been continually growing and today the course is taught in more that 60 countries worldwide. The PTC manual has been translated to several languages and can be found freely on the internet. The World Health Organisation has incorporated the PTC manual into the publication of the WHO “Surgical Care at the District Hospital”1

Why China needs PTC?China is the third largest country in the world, with a total estimated area of 9.758.801 km2 embracing a varied topography of highlands in the west and plains in the east, including vast areas of inhospitable terrain. With just over 1.35 billion people it is the world’s most populous country, representing 20% of the world’s population.

With the rapid development of the Chinese economy there are an increasing number of casualties due to traffic accidents, adding to other natural disasters such as earthquakes and floods. Particularly, in recent years the automobile numbers have increased dramatically and as a result the amount of people killed in car accidents every year has augmented considerably. In China, the number of registered motor vehicles increased from 1.59 million in 1978 to over 186.58 million

The Primary Trauma Care Foundation Chinese Project: 2010 - 2013

1. Consultant Paediatric Anaesthetist, Leeds Teaching Hospitals NHS Trust. Chinese PTC Programme Medical Coordinator.

2. Consultant Anaesthetist in Intensive Care, John Radcliffe Hospital, Oxford. Founder of PTCF and co-author of the PTC course manual

Primary Trauma Care Foundation (PTCF)

www.primarytraumacare.org

Dr Amaia Arana1 and Dr Douglas Wilkinson2

in 2009. There are now about 200 million drivers in China. It’s estimated that about 55 thousand new motor vehicles are registered in China every day. Every year on Chinese roads between half a million to a million people are killed or permanently disabled with millions more hospitalised, leaving behind shattered families and communities. In China pedestrians, motorcyclists and bicyclists are disproportionally affected.2 Some of these casualties should not die or suffer disabilities if sufficient rescue and treatment endeavors could be made in time.

China is also one of the countries most affected by natural disasters such as floods, droughts and earthquakes. China has suffered 5 of the 10 deadliest natural disasters on records, the top 3 occurred in China. The number of natural disasters was significantly high during 2013, with earthquakes occurring much more frequently than anticipated. The biggest Sichuan earthquake during the period, occurring on April 20, 2013, was M7.0 and killed more than 196 people, injured 13,484, and affected 2.31 million. Affecting more than 200 million people every year, disasters in China are an important restricting factor for economic and social development.

One of the main problems is the low primary trauma care level in China. There is no systematic training for trauma care procedures or methods. In particular many medical staff working at the front line lack the knowledge of correct rescue/treatment strategies of stabilising the wounded, wining treatment time and subsequently saving lives.

The PTCF project in ChinaPlanning, coordination and implementation of the programThe PTCF, in cooperation with the National Institute of Hospital Administration (NIHA) under the leadership of the Ministry of Health China (MOH-NIHA) and funded by the Kadoorie Charitable Foundation, explored and built an appropriate Primary Trauma Care training model suitable for the Chinese context

to establish PTC as the National Chinese Trauma Program.

Project Objective The project aimed to introduce Chinese doctors to a set of trauma care procedures and teaching methodology in order to develop an appropriate Primary Trauma Care training model suitable for the Chinese context, especially in the rural areas.

The project was planned for implementation over 3 years.

Year 1The main objective was to begin the foundation of the Primary Trauma Care training network: the initiation of the courses, introduction of new teaching techniques, observation and adaptation of the program to China, implementation of the exam process, and the gradual devolution of responsibilities to the new Chinese instructors.The courses were to be held in 4 provinces acting as NTC (National Teaching Centres): Hubei, Henan, Guangxi and Liaoning, and to be implemented in three phases.

Phase one lasted from the beginning of September 2010 till the beginning of October 2010, with the courses taking place at Wuhan Union Hospital in Hu Bei province over a four weeks period. The courses were attended by doctors from the others NTCs who subsequently were going to lead the courses in their own provinces during phase two. During phase one, two groups of experienced foreign PTC instructors travelled to Wuhan to teach in the courses, each group taught during two weeks. There were between five and six foreign instructors in any of the groups at any one time.Initially the courses were exclusively delivered by the foreign instructors. As they had to work entirely with translators this required doubling the time. The basic PTC course was followed to the letter keeping to the slides, whilst the foreign instructors observed any adaptations that were needed immediately for ChinaLater, as the Chinese new instructors mastered the PTC

concept, the required knowledge and skills, the courses were handed over gradually to the Chinese instructors, initially under the supervision of the overseas instructors. The teaching was becoming more effective as the time needed for translation was diminishing. When the Chinese were starting to act as instructors they were encouraged to take a very active role and recommended to make explanatory comments of the slides, that they were more suited to do. The new Chinese instructors also took part in the assessment process from very early on as was judged necessary to familiarise them with the procedure. At the end of the working day, the foreign instructors together with the new Chinese instructors had a meeting to provide feedback, evaluate how the day went, what was needed to be changed, and to allocate the teaching sessions and workshops for the following day. The input from the Chinese instructors during these sessions was extremely valuable; most of them were highly motivated and participated very actively.

There were 20 to 22 students in each course and a total of 167 medics were trained in phase one. Several specialties were represented including anaesthesia, emergency medicine and surgical specialties.

In phase two, between 11th October and the 13th November 2010, the courses were moved to the other NTCs. The newly created Chinese instructors during phase one were now teaching back at home in their own provinces. The four NTC’s were located in: Wuhan in Hu Bei province, Zhengzhou in He Nan province, Nanning in Guang Xi province, and Shenyang in Liao Ning province. Students from different parts of the province were coming to these centers. Two foreign instructors, working together with the local instructors, were helping in any one NTC during the implementation of the courses in phase two.

In phase three the Chinese instructors were now in charge


of cascading the courses to other localities within the provinces of the NTCs. Foreign Instructors did occasionally supervise the courses to ensure project progression, standard course validation at all sites and quality assurance of the program.

By the end of the first year 107 courses were taught in the four NTCs provinces and 2185 Chinese medics were trained. The foreign instructors were involved in 27 of the courses, mainly during phases one and two. The cascade model of teaching was then established to enable the course to move rapidly to district and rural areas in years 2 and 3.

Year 2Another 11 new provinces started the PTC program in year two, whilst the existing four provinces were continuing to hold more PTC courses. There were courses in 15 provinces.

The courses in year two were taught by Chinese instructors. Occasionally, some overseas instructors joined the courses in the new provinces to help at the earlier stages of implementation of the courses with supervision, coaching and feedback.

During year 2 there were 346 courses taught, 7013 students were trained, and 16 foreign instructors attended 28 of the courses

Year 3The courses expanded to 25 Chinese provinces. During this year there were 795 courses and further 15900 medical staff were trained.During the 3rd year nurses joined the PTC courses as students as well as becoming instructorsThe foreign instructors attended 13 courses during this year and their role was limited to help, listen

to the Chinese instructors and students regarding their feelings about the course, give feedback, observe how the course was adapted and molded to the Chinese requirements, and to make sure that the “core” message of the course was maintained through the generations .

By the end of the project 1248 courses were taught and more than 25000 Chinese medical staff trained.

A total of 25 foreign instructors helped with the implementation of the project, attending a total of 68 courses over the three years in 21 out of the 25 provinces where the courses took place, which represents about 5% of the total amount of courses, the other 95% were entirely delivered by the newly trained Chinese instructors.

Although all trained candidates did the instructor’s course not all of them were involved in teaching later on.

CME (Continuous Medical Education) points and ExamsThe Chinese MOH decided to award 3 CME points for this course, and requested for the course to be pass/fail and not just a certificate of attendance. This was something new to the PTC program, and in order to set an objective marking system an Examination Committee was created. Six members constituted the committee, all of whom were instructors in the courses during the phase one of the project and therefore were able to appraise the practicalities of the exam process in practice.

The exam of the two days PTC basic course consisted of a MCQ paper and a practical scenario on the primary survey. A “Student Evaluation Form” was designed,

with a student’s photograph attached to it and where the results of his/her performance were recorded.

Those students who passed the PTC basic course and shown attendance to 100% of the course were invited to the one-day PTC instructor course.

An “Evaluating PTC Instructor Form” was created where the teachers assessed the different skills (knowledge, communication, facilitator, leadership, organiser and attitude) desirable to become a new PTC instructor.

The student’s assessment process has been a new innovation introduced during the PTC courses for the China project. It has been highly educational to see how was evolving in order to become adapted to the Chinese requirements, practical and fair.

Observations and recommendationsIt was fascinating, and certainly challenging, for the foreign instructors to teach the PTC course and apply the PTC concept to China in a setting with many cultural differences, particularly the language and the scripture. It was interesting to observe how the course was evolving in order to get adapted to the Chinese requirements.

Many of the problems secondary to language, translation and cultural differences were fading as the Chinese were taking over the programme.

As an opening session in all courses, a local doctor interacting with the audience covered an introductory “local trauma perspective” talk. This was aimed to arouse the awareness of the need.


1st year 2nd year 3rd year total

No of courses provided 107 346 795 1248

No of Chinese doctors trained 2185 7013 15900 25098

We strongly recommend that explanatory examples and pictures were added when adapting the course to the local environment

The systematic approach and the practical aspects of the course were highly rated by the students.

The cultural differences with teaching styles: interaction during lectures, learning a skill, scenario teaching, discussion group and feedback were unanimously new to most Chinese candidates. Most of them showed a great interest and excitement for these new methods, although somehow they found the course not long enough to get familiarised with them, but surely their curiosity was awakened.

The early hand over of the teaching and organisation of the program to local leaders and instructors, empowering them with a pronto devolution of responsibilities and

ownership, is paramount to obtain long-term sustainability.

The futureThe direction should be growth and sustainability of the PTC, eventually covering all doctors and medical staff in the country. In such as vast country as China this might take years.NIHA has expressed his plan of incorporating the PTC program into Medical Basic Skill Scheme so it will become compulsory for Chinese medics before they become qualified.For the already qualified doctors there have being talks of incorporating the PTC program into the Continuous Education Scheme through CME points system.The establishment of a Primary Trauma database and Trauma register in the country would be also highly desirable.


AcknowledgementsPTCF would like to thanks to all the people who in many ways have contributed to make this project in China a reality: all students and instructors, foreign and local; administrative and clerical staff, secretaries, catering, the Hong Kong Kadoorie Charitable Foundation; the National Institute of Health Administration (NIHA); and the Ministry of Health China (MOH)

References1. World Health Organisation. Surgical Care at the District Hospital. Geneva: WHO, 2003. ISBN 92 4 154575 5.

2. Zhang X, Xiang H et al. Road traffic injuries in the People’s Republic of China. Traffic Inj Preve 2011. 12;6: 614-620

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The Smile Train charity funds teams of specialists to provide operations for cleft lip and palate operations around the world, where these operations would not happen without their support. I joined a small team to a new Mission Hospital in Western Kenya, knowing that it had some excellent reconditioned western anaesthetic equipment. I asked the team leader to bring a Diamedica DPA02 as a back up for the work. I had used this portable equipment in Nepal in 2012.

The patients began to arrive on the Monday and were screened by Mr Tony Giles for their surgical condition, then reviewed by a Norwegian GP, Dr Bjorn Pettersen, so any medical problems were identified. Each patient was weighed and measured, and a BMI calculated. In the under-fives, a mid-upper arm circumference tape was used to assess malnutrition (<125mm). When concerned, these small babies were put on a feeding programme for several days to optimise their response to

surgery. At the end of screening, the patients were reviewed on the admission ward, and an operating schedule was drawn up. We anticipated performing three operations each day.

The MUAC tape (Teaching Aids at Low Cost) and the size and condition of the smallest babies meant that we did the bigger children at the start of surgeries, and the smallest and youngest babies had their operation at the start of the last week.

The list order was written, a fasting time set, and a time and dose for Oral Rehydration Solution and Paracetamol syrup recorded for two hours pre-operatively. This routine was followed at the end of each day.

Every morning I connected all my equipment to the power supplies, checked the back-up oxygen cylinder and the oxygen concentrator (New Life Intensity), and switched on and calibrated the Datascope Spectrum OR with ECG (respitrace), oximeter,

Kimilili, Kenya 2014. A Smile Train visit to a new hospital

Consultant Anaesthetist Luton & Dunstable HospitalLU4 ODZ

[email protected]

Dr Michael Carter

Using a capnograph on a Diamedica DPAO2 to adjust Fresh Gas Flows


Figure 1: Patient Weights

capnograph and NIAP. It was the first opportunity I had to use a capnograph with the DPA02 anaesthetic machine produced by Diamedica UK that weighs 9kg in its carrycase. The halothane level was checked, and the team briefing took place as the surgeon returned from the ward. The T-piece circuit was fixed to the vaporizer of the DPA02 system.

The WHO Surgical Safety Checklist was completed and anaesthesia began with an oxygen/halothane induction given to patients of all ages, and the intubation was done with monitoring on the patients when the depth of anaesthesia was regarded as adequate. The tube

was secured and a throat pack positioned, and the surgical team prepped and draped the patient. The surgical sites were marked up, and local anaesthetic (lidocaine 2% with 1:80,000 adrenaline/epinephrine) was injected from 2.2ml dental cartridges, following confirmation of dosage maxima on the basis of the patients’ weight and condition. The Ayre’s T-piece balloon was passively scavenged to the floor. A chest stethoscope was also fixed and used. Smile Train (East Africa) donated a Lifebox oximeter to the hospital, and funded the surgeries.

At the end of surgery the patient was extubated deep with a Guedel

airway in place, and transferred to recovery when further instructions were given to trained staff. Paracetamol was given regularly to all patients, and if the children were greater than 10kg and had a reasonable urine output (e.g. wet nappies) then ibuprofen was also given in a dose related to their weight. Intra-operative IV fluid was given to the cleft palate patients.

With all the physiological parameters available to me, I adjusted the fresh gas flow oxygen into the diamedica vaporiser sufficient to prevent rebreathing. The halothane setting was decreased as determined by the respiratory rate and cardiovascular observations. All but one of the 34 patients were children. Total duration of anaesthesia was approximately 65 hours. During the course of 11 days of operating four 250ml bottles of halothane were required. The oxygen concentrator was in use for about 70 hours. I used the adult circuit (Figure 3) for the four largest patients.

In the sunshine of Mount Elgon at about 5,000 feet altitude, we found that all the patients healed well and were discharged a day or more earlier than in Banjul at sea-level, operated on by the same expatriate team over four visits of Mercy Ships Teams to the Gambia.

I ask a question of those who have used draw-over breathing systems such as the Diamedica DPA02 in small children. Do you use a disposable HME filter on each patient, and does the filter obviously increase the work of breathing? If you don’t use a filter, how are you cleaning your T-piece circuits? Do you have a new circuit for each patient? I have used and demonstrated to a Clinical Officer Anaesthetist the reliability of the DPA02, but I did not have HME filters available. I am unaware of any studies on the extra work of breathing that HME filters add to the babies on a draw-over breathing system in spontaneous breathing mode.


Figure 2: Patient’s mid upper arm circumferences

Figure 3: DPA02 Portable Anaesthetic Machine

Teaching was in several formats


Reports of the successful use of the Glostavent anaesthetic machine in difficult environments have prompted many questions. Here are some of the more common ones posed by anaesthetists who are planning to work with unfamiliar equipment in situations far removed from their comfort zones.

Q1. What is the Glostavent?

A. It is an anaesthetic machine that has been specifically designed to deliver a safe anaesthetic in locations where normal facilities are unreliable or non-existent. For example, it can function in the absence of oxygen or electricity and does not require the attention of highly skilled engineers for servicing and maintenance.

It has three principal components; a draw over breathing system, a gas driven ventilator and an oxygen concentrator.

Q2. What exactly is a draw over system and why is it used?

A. It is a breathing system that can deliver inhalational anaesthesia in the absence of compressed gases. In its simplest form it consists of an open ended reservoir with a side port for supplementary oxygen, a vaporiser with a low resistance to allow spontaneous breathing, a self inflating bag for controlled or assisted respiration and a valve to prevent re-breathing of expired gases.

Q3. Can it be used for both controlled and spontaneous respiration?

A. Yes. Spontaneous respiration requires an airtight fit around the facemask to enable sub atmospheric pressure to be generated. If this cannot be achieved e.g. uncooperative patient or facial trauma, continuous flow is required.

Q4. How is it converted to provide continuous flow?

A. If the flow of oxygen entering the reservoir is increased until it exceeds the patient’s minute volume leaving the reservoir the pressure in the reservoir

rises and flow automatically becomes continuous. If there is no oxygen source available the self-inflating bag is used to create the necessary pressure.

Q5. Can it be used on infants and neonates?

A. Yes – in these instances assisted ventilation is advisable to overcome the resistance of the breathing system. If oxygen is available a Mapleson E system can be used.

Q6. Which volatile agents can be used?

A. A basic vaporiser is calibrated for both halothane and isoflurane. A separate vaporiser is available for sevoflurane.

Q7. Is the Glostavent portable and can it function in any location?

A. The standard Glostavent with oxygen concentrator and ventilator is not portable. However, there is a separate portable version, known as the DPA 01, consisting of a simple draw over breathing system supplied in a rigid case and weighing just 10 Kg.

Q8. How much does the Glostavent cost and where can it be obtained?

A. The standard model costs £13500 and the portable model costs £3000.They can be obtained from Diamedica, a British engineering company in Devon. Details can be obtained from www.diamedica.co.uk.

Q9. Does draw over anaesthesia have any advantage over TIVA with propofol?

A. Yes. No electricity is required. There is no wastage of anaesthetic agent at the end of the operation. No additional equipment is required for oxygen therapy or controlled ventilation.

Q10. Where can I see it demonstrated in the UK?

A. Demonstrations and films can be arranged via the manufacturers, Diamedica Ltd, Grange Hill Industrial estate, Bratton Fleming, Devon, EX31 4UH or [email protected].

Ten frequently asked questions about the glostavent and draw over anaesthesia

Roger Eltringham

Medical Director, Safe Anaesthesia Worldwide



Here are two tips on how to use ether to anaesthetise patients if ether is the only anaesthetic option.

As young registrars in anaesthetics in King Edward 8 Hospital, Durban, South Africa in the early 1970’s some of us took up a challenge by one of our consultants. The task was to give a mask ether anaesthetic via a Mapelson A anaesthetic system as the sole anaesthetic. The Mapelson A system was attached to an anaesthetic machine with oxygen flowing through a Boyle’s bottle full of ether. My first sole ether anaesthetic was not pretty as my patient, a very strong ASA 1 gentlemen, began to cough and leap about on the operating table. People had to hold him down. To minimise this problem, I was told afterwards, you had to place an intravenous line (IV) prior to the mask induction. Through the IV you gave the patient atropine 0.6 mg and meperidine (pethidine) 1 to 1.5 mg/kg intravenously before you induced ether anaesthesia. This led to a much smoother induction. We would start with pre-oxygenation and then slowly, up to a 20 min period, move the leaver on the Boyle bottle upwards until the patient was anaesthetised. In ASA 1 and 2 patients a stable heart rate and blood pressure ensued with the respiration slow and deep. The latter was very useful when you had a difficult airway and no specialised airway equipment. (See next paragraph).

If you have a patient with a difficult airway in a developing world country with only ether and halothane and no specialised airway equipment except endotracheal tubes, laryngoscopy and a gum elastic bougie1 then here is a description of a method we used at that time. This could only be used if the patient tolerated a mask induction. Monitors and an IV were placed. Atropine and meperidine were given IV as above and an inhalational anaesthetic with halothane commenced. Within a few minutes the patient was asleep but breathing fast and shallow (panting like a dog). At that point you introduced ether as described above while reducing your halothane. After about 10 to 15 minutes the patient was breathing slowly and deeply. At that time you could either orally or nasally secure the airway blindly. A whistle was attached at the proximal end of the endotracheal tube (ETT). When the ETT entered the trachea in a spontaneously breathing patient everyone in the room could hear that the whistling sound indicating that the ETT was in the right place and we could breathe a sigh of relief. (…. and so could the patient).

Ether was also used in the following way in those days. After an anaesthetic induction with thiopental and narcotics given IV, ether was introduced in both spontaneously breathing patients and in patients where the airway was secured with an ETT.

I remember fondly my time in a small hospital in Zululand north of Durban not far from Mozambique. The hospital operating room consisted of a barrack sitting in the middle of a green field where goats, pigs, chickens and other members of the animal kingdom traversed freely. The operating room had several doors; each leading to 3 to 4 steps down to the grassy field. In those days ether was the gas of choice – primary because it was the only gas. At the end of a long day with ether anaesthetic, we would regularly find chickens asleep in the corners of the operating room. The arrival of the chickens in the operating room was a daily occurrence and many were return customers, Ether being heavier than air meant highly concentrated ether at floor level. Carefully we would carry them outside and watch them wake up over a 10 to 15 minute period. It was very interesting to observe the chickens as they woke up. They all opened with great bewilderment their right eye first. Why they did that I don’t know. I should have published my ‘ground breaking’ observation on ether anaesthetic emergence in the fowl in an appropriate journal.

Reference1. Macintosh RR An aid to oral intubation Br Med J 1949;1.28

How to use Ether, should you need to (Let us not forget)John G. Brock-Utne, MD, PhDProfessor of Anaesthesia, Stanford University Medical Center

Letter to the Editors

The International Relations Committee (IRC) of the Association of Anaesthetists of Great Britian and Ireland (AAGBI) The IRC has a major role in co-ordinating and facilitating overseas anaesthetic training programmes, visiting lecturerships for refresher courses and distribution of limited supplies of textbooks and equipment to developing countries. It administers the Overseas Anaesthesia Fund to facilitate donations to assist in this type of work. It runs the Ugandan Anaesthetic fellowship programme and is involved in the global oximetry project, which has informed Lifebox.

www.aagbi.org

World Federation of Societies of Anaesthesiologists (WFSA)The World Federation of Societies of Anaesthesiologists (WFSA) is a unique organization in that it is a society of societies. By virtue of membership in a national society, an anesthesiologist is automatically a member of WFSA. The objectives of the WFSA are to make available the highest standards of anesthesia, pain treatment, trauma management and resuscitation to all peoples of the world.

21 Portland Place,London, W1B 1PY United KingdomTel: (+44) 0207 631 1650Fax: (+44) 0207 631 4352 www.anaesthesiologists.org

LifeboxLifebox is a not-for-profit organization saving lives by improving the safety and quality of surgical care in low-resource countries by ensuring that every operating room in the world has a simple pulse oximeter.

www.lifebox.org

Primary Trauma Care FoundationAn organisation training doctors and nurses in the management of severely injured patients in the district hospital.Box 880Oxford OX1 9PGUnited Kingdomwww.primarytraumacare.org

PTC Chairman: Charles Clayton [email protected]

PTC Administrator: Annette Clarke [email protected]

Technical Assistance at Low Cost (TALC)A unique charity that supplies low cost healthcare training and teaching materials to raise the standard of healthcare and reduce poverty worldwide.PO Box 49St AlbansHerts AL1 5TXUnited KingdomTel: +44 (0) 1727 853869Tel: +44 (0) 1727 846852E-mail: [email protected] plc

Courses in Anaesthesia for the Developing WorldAnaesthesia for Developing countries - 5 day course Kampala Uganda (annually)Contact: Dr Hilary Edgcombe, Nuffield Dept of Anaesthesia, John Radcliffe Hospital Headley Way, Headington, Oxford OX3 9DU, UK Tel: (+44) 01865 221590 E-mail: [email protected]

Developing World Anaesthesia1 day course in Bristol 30th April 2012 Contact: [email protected]

Organisations

Useful Information

This organisation has bought ECHO and now supplies drugs and equipment to developing countries.

Durbin plcDurbin House180 Northolt RdSouth Harrow, Middx. HA2 0LT United KingdomTel: +44 (0) 20 8869 6500Fax: +44 (0) 20 8869 6565www.durbin.co.uk

REMEDY (Recovered Medical Equipment for the Developing World)Collects equipment and distribution to the developing world

3-TMP, 333 Cedar StreetP.O. Box 208051New HavenCT 06520-8051USA

[email protected]: (203) 737 5356 Fax (203) 785 5241

Society for Education in AnesthesiaInternational members are invited to join this Society that promotes techniques and excellence in the teaching of anaesthesia.

520N Northwest HighwayPark Ridge, Illinois 60069-2573USATel: (847) 825 5586Fax: (847) 825 5658E-mail: [email protected]


Douleurs san Frontieres (DSF)A French NGO that aims to create or to encourage any structure involved in the treatment of pain and suffering (cancer pain, AIDS, acute pain, etc.)

Douleurs sans FrontieresHôpital Lariboisière 2, rue Ambroise Paré 75475 Paris, Cedex 10, France E-mail: [email protected]

International Anesthesia Research Society (IARS)A non-political medical society founded in 1922 to advance and support anaesthesia and research and education.

100 Pine StreetSuite 230San FranciscoCA 94111USATel: 415 296 6900Fax: 415 296 6901E-mail: [email protected]

The International Committee of the Red Cross (ICRC)The ICRC acts to help all victims of war and internal violence, attempting to ensure implementation of humanitarian rules restricting armed violence.

ICRC Headquarters19 Ave. de la PaixCH-1202 GenevaSwitzerland Tel: +41 22 734 60 01Fax: +41 22 733 20 57www.icrc.org

Medical Training Initiative (UK)Anaesthetists seeking posts in the UK should contact:International Programme AdministratorRoyal College of Anaesthetists35 Red Lion SquareLondon WC1R 4SG UK(+44) 020 7092 1552Email: [email protected]

REDRRedR is an international charity that improves the effectiveness of disaster relief, helping rebuild the lives of those affected.

They do this by training relief workers and providing skilled professionals to humanitarian programmes worldwide.

www.redr.org.uk

Going Overseas NetworkA multi-disciplinary, multi-professional network, which facilitates and encourages UK healthcare staff to participate in training and service visits to the less developed world.www.goingoverseasnetwork.org

Health Volunteers OverseasPrivate non-profit organization dedicated to improving the availability and quality of health care in developing countrieswww.hvousa.org/

Medecins Sans Frontieres (MSF) offers assistance to populations in distress, to victims of natural and man-made disasters and to victims of armed conflict. They require volunteers for both long and short-term projects. If you are interested in obtaining more information, contact them at:

64-74 Saffron HillLondon ECIN 8QXUnited KingdomTel: (+44) 020 7404 6600E-mail: [email protected]

Mercy Flyers Mercy Flyers is a not-for-profit organisation whose mission is to take specialist medical care to those who are geographically remote and living in poverty in southern African countries. www.mercyflyers.org

VSO VSO is a leading development charity that sends volunteers to work abroad with full financial support. www.vso.org.uk

Mercy ShipsMercy Ships provides free surgery and medical care, and partners with local communities to improve health care, offering training and advice, materials and hands-on assistance. www.mercyships.org.uk

Mothers of Africa Mothers for Africa is a medical educational charity that trains medical staff in Sub-Sahara Africa to care for mothers during pregnancy and childbirth. www.mothersofafrica.org

THET (Tropical health and Education Trust) THET is committed to improving health services in developing countries through building long-term capacity. www.thet.org

HINARI The HINARI Programme, set up by WHO together with major publishers, enables developing countries to gain access to one of the world’s largest collections of biomedical and health literature.More than 7,500 information resources are now available to health institutions in 105 countries www.who.int/hinari

If you wish to advertise your organisation on this page (free-of-charge), please contact:

The Editors: [email protected]


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Address:

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Signed:

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Please return this form to:

Rola AlkurdiHonorary Secretary World Anaesthesia 21 Portland PlaceLondon W1B 1PY UK

Application FormWorld Anaesthesia Society

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July 2015 ISSN 1472-8820


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