Although it has only been a few months, I already feel that I have learned an incredible amount about the challenges faced daily in the medical field here in Uganda and hope that, similarly, I have been able to share what I know about anesthesiology and patient care.
Recently, a young man was rushed into the operating room for emergency brain surgery following an accident on a boda boda (a motorcycle). Road traffic injuries are a serious problem in Uganda with the country having the fifth highest rate of road deaths in Africa (WHO, 2013). The health outcomes from road traffic injuries are exacerbated by the scarcity of anesthesiologists and other health professionals able to treat patients who experience such traumas.
When this patient presented for surgery, I was working with a resident anesthesiologist and we were able to administer anesthesia without complication. But it was during his post-operative care that the real lesson began.
After the procedure, the patient should have remained intubated (with the breathing tube) and been admitted to the intensive care unit (ICU). It turns out that the ICU was not open that day due to some newly initiated repairs, which meant no ventilators were available. We were able to remove the breathing tube, but the patient still required oxygen, a nasopharyngeal airway, oropharyngeal suctioning, and close monitoring. It took an incredible amount of effort and time to coordinate the safest possible postoperative bed for him. I was able to find a bed and monitor in the emergency ward, but the monitor only had pulse oximetry. I also had to locate a functioning suction machine to have at the patient’s bedside. With not enough nursing care available, patients here in Uganda often have a family member that stays with them and helps with care, referred to as an “attendant.” I, therefore, taught the patient’s brother about pulse oximetry, suctioning, when to change the IV fluid bags, how to monitor urine output, and when to call for help. The patient’s brother did an excellent job monitoring these things and after about a week and a half, the patient was discharged in good condition.
The next week I asked my resident to share his thoughts on the meaning of patient ownership and he wrote the following:
“Patient ownership is not just to be a medication prescriber but to be actively involved in all aspect of patient care such as disposition plan, follow up, talk with outpatient provider and family members. In most health conditions, the patient ownership is a shared ownership involving a large multidisciplinary team to ensure patient safety and quality of care. Knowing everything about the patient is not the patient ownership, it is more than just a good patient care. It’s to learn how to be most responsible person for your patients.”
It was incredibly rewarding for me to see how one of my students has come to understand this critical aspect of delivering quality anesthetic care, which is especially important in this low resource setting.
I believe that these efforts, in addition to the many small teaching moments every day, will enhance my residents’ education and result in long-term changes in anesthetic and surgical delivery practices at the hospital.
In addition to postoperative care and patient ownership, I have also tried to teach the importance of the preoperative patient assessment to my students. Providing safe anesthesia depends on learning about the patient’s medical history, doing a physical exam, and communicating with the surgical team about the planned procedure. Frequently here, however, I have seen what happens when these preparatory steps are missed, such as aspiration from not checking the patient’s preoperative fasting status. At the door to the operating room I teach by example and examine my patients before they enter. I am also working with one of my residents to rewrite the form for the preoperative anesthetic evaluation and anesthetic record. The hope is that this new form will help ensure that preoperative exams are performed and that critical intraoperative checkpoints, like antibiotic administration, will be completed. I believe that these efforts, in addition to the many small teaching moments every day, will enhance my residents’ education and result in long-term changes in anesthetic and surgical delivery practices at the hospital.
It is truly this sharing of knowledge between caregivers that improves patient care.
While working in and out of the operating rooms, I have both learned from and taught many parts of the perioperative team: the cleaning and support staff, patients, patients’ families, nurses, medical students, surgeons, surgery assistants, anesthesia residents, and anesthetists. It is truly this sharing of knowledge between caregivers that improves patient care. Being a part of these collaborations as a GHSP Volunteer has been a great experience so far and one that I know will strengthen the anesthetic care I can provide for my patients here in Uganda and after I return, for my patients in the United States.
Being a part of these collaborations as a GHSP Volunteer has been a great experience so far and one that I know will strengthen the anesthetic care I can provide for my patients here in Uganda and after I return, for my patients in the United States.
Lauren Welsh, MD, a pediatric anesthesiologist who recently finished her training at Boston Children’s Hospital is serving as a volunteer educator in Uganda this year as part of the Global Health Service Partnership (GHSP) – a joint initiative between the non-profit Seed Global Health, the Peace Corps, and the US President’s Emergency Plan for AIDS Relief (PEPFAR). Lauren’s work in Uganda is also supported by Gradian Health Systems. Dr. Welsh works alongside local faculty teaching best practice standards in the classroom and in the operating room.