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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 April 14; 334(7597): 800.
PMCID: PMC1852027
Personal Views

The refresher course

Isabeau Walker, consultant paediatric anaesthetist

The setting is the Mengo hospital for plastic and reconstructive surgery in Kampala, the meeting the Ugandan Society of Anaesthesia's annual refresher course. I am working with Andrew Hodges, who has established the charity Interface Uganda and moved to Kampala with his wife and family to set up a plastic surgical training programme. Sarah Hodges is an anaesthetist and is coordinating the refresher meeting. There are a handful of speakers from Britain for the two courses, held back to back, which are attended by nearly all of the anaesthetists and anaesthetic officers in the country. That's a total of 280 of the 330 anaesthetic officers, 11 consultant anaesthetists, and three trainee anaesthetists currently in Uganda. The population of Uganda is 24 million. The Royal College of Anaesthetists has 13 000 anaesthetists on its books in the United Kingdom.

We give a series of lectures and workshops with the local anaesthetists and debate common problems: anaesthesia for caesarean sections, paediatric emergencies, acute abdominal pain. We encourage discussion from an audience that is polite, listens intently, and objects if we flick to the next slide too quickly. After all, if you have no textbook to refer to, how else will you retain this information? We explain how spinal anaesthesia has contributed to the reduction in maternal mortality after caesarean section. It is difficult to know how to respond to the questioner who says that they have no spinal needles. In Uganda ether is deemed to be the anaesthetic agent of choice for the general surgical patient. It hasn't been used in routine anaesthetic practice in the UK for more than 40 years.

We discuss the importance of careful postoperative monitoring in a high dependency area. There is no question here of intensive care to ventilate sick patients, because when the electricity goes off—which it does every other night—so does the ventilator, even in the main teaching hospital. We hear a story of a girl's quest to find out why her favourite aunt died after a hernia repair. She trained as a nurse, wanted to find out more, moved into anaesthesia, and realised that high quality postoperative care is crucial to success. Maybe a future intensivist? Maybe. We clearly speak the same language, are driven by the same desire for knowledge, and wish to care for our patients. Yet our opportunities to practise our speciality are so different.

We discuss working conditions—anaesthetists always complain about being stuck in theatre, unappreciated. But it is difficult to take a holiday when there are only two of you in the hospital. Maybe there will be an opportunity overseas? Maybe they should leave anaesthesia; there seems to be so much more money going into HIV and AIDS.

The highlight is the quiz at the end of the meeting. The questions are tricky, and the answers emphasise important learning points: no 5% dextrose for resuscitation, don't delay surgery for a patient who is bleeding, magnesium is the treatment of choice for eclamptic fits. The prizes are handed out. It is humbling; the most coveted prize is an anaesthetic T piece, a basic piece of disposable equipment. These T pieces will not be disposed of: how else can you administer anaesthesia safely to the children in your hospital?

At the end of the meeting we realise that we have imparted some knowledge, but we have also learnt much about a specialty in crisis. Anaesthesia is taken for granted in the developed world. In Uganda the personnel are coping with a huge burden of work; drugs (including oxygen) are inconsistently available; equipment is barely adequate to provide a safe service. The delegates all leave with a copy of the Oxford Handbook of Anaesthesia, donated by the Association of Anaesthetists of Great Britain and Ireland under the “books for anaesthetists in Africa” scheme.

And we know that the situation in Uganda is the same as in many other parts of sub-Saharan Africa and that the remedies are not expensive. We have been moved by the dedication of this group of professionals, and by the efforts of individuals such as Andrew and Sarah Hodges and their colleagues, in the face of such difficulties.

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