This is a summary of a brief talk given by Andrew Weatherall at PACSA 2015 as part of a breakfast session on pathways to education in kids’ anaesthesia. The brief was to discuss (in just a few words) what you might get out of involvement in aid trips.
Why not start with a request? You’re coming to the end of your training and one of the orthopaedic surgeons at your hospital asks if you’d like to join a team to do lower limb surgery on kids in a remote spot in India. Your aim is to fix things like this.
The catch is this: you’re going to a clinic that doesn’t usually do this sort of surgery and the requirement is that you have to bring everything. There is no machine to offer volatile anaesthesia. What would you do?
Planning for a trip like this makes you develop a far broader understanding of how you anaesthetise. As well as coming up with an appropriate way to provide anaesthetic care, you need to come up with a plan for how much stuff you should take. How many cases will you do? How much equipment do you need? What are the basic requirements for equipment on every list you do? Who will you ask to help with the stuff you need?
There’s nothing like being forced to plan to make you understand how to plan.
What we did
We actually ended up providing sedation with a mixture of propofol and ketamine. We added regional anaesthesia to block the noxious stimuli. We never would have come up with that plan without being forced to think outside the square. And it worked really well. Then each time we’ve gone back we’ve improved the postoperative analgesia and built on that first plan.
Of course not all trips are low resource. There’s nothing super low resource about a cardiac trip. There are a few simple considerations to keep in mind for all trips though.
1. Make a good plan for everything, not just surgery
You want to be efficient rather than leave mess for local services to deal with. This particularly goes for complications.
2. Don’t let it slide
An aid trip needs your best care, even if it’s modified by what is around you a bit. You still have to provide acceptable care and good outcomes. If you can’t provide that for a particular surgery within the limits set then you need to remember that standards matter.
3. It’s not about those on the aid trip
When you leave and you’re done with your trip, it’s the local health system that has to keep looking after the kids. You can’t just leave them with a patient whose recovery is beyond what is available. The surgical team is about 1% of the story but that 1% has to be geared to helping continuous growth in the system by working with the locals.
4. Choose wisely
You can’t turn up and do every single case that turns up. If you’re on an orthopaedic trip, offering plastic surgery just isn’t appropriate. You’re there for maximum benefit in a way that doesn’t leave huge issues for ongoing care for the local resources to be taken up with.
5. Leave more than sutures
Ask yourself, what happens for the other 350 days of the year when you aren’t there? Part of the aim of these trips is to develop skills locally until you’re no longer needed.
6. The next trip starts yesterday
If you’re not continuously using the experience of this trip to make the next better, you’re failing.
So there’s a really quick tour.
Oh, and the results for that first patient?
And now he comes back to counsel the next generation of patients.