An Inside View From The Anaesthesia Speciality Training Program In Zambia

Why Did You Apply To The Anaesthesia Specialist Training Program?

After I finished medical school, I became a house officer in Kafue Hospital. Initially, I really wanted to do obstetrics and gynaecology, it was my passion. Then, during one of the hospital briefings, our medical superintendent made an announcement saying that the whole of Zambia needs more Anaesthetists and that they were looking for more people to join the profession; clinical officers, nurses or doctors. I had never thought of anaesthesia before, I knew almost nothing about it at that point. I knew that it was about making a patient sleep during an operation and that spinal injections could be given, but that was it. To find out more I asked Google. Another way I found out more was by talking to one of my friends who had done medical school with me in China as her husband is on the anaesthesia program in Lusaka. At the time she didn’t tell me but she put my name down as someone interested in the program. Not long after I got a call from the Academic lead for anaesthesia, Dr Hazel Mumpansha. I had no idea that she was going to call me that day! I was just seeing my patients and then I get the call, ‘Hi Farai, I hear you’re interested in Anaesthesia!’ I was honest and said that I had another passion but that I was also interested to explore what a career in anaesthesia would entail. In truth, I think that conversation changed my life.

It did take me a few weeks to make the decision but two things pushed me to take the leap towards anaesthesia. Firstly, I felt that so many people are in the more common specialties such as paediatrics, surgery and obstetrics, so it would be interesting to try something different. Secondly, due to the need for anaesthetists, hospitals were encouraged to let you go without any difficulties. I was being given the opportunity to be released without being held back. At that time, this was an incentive for me.

What Is The Process For The Application?

The first thing to know is that there are two programs to apply to; the Specialist Training Program (STP) run by the Ministry of Health or the MMed program run by the University of Zambia (UNZA). I am on the Specialist Training Program and for this program there is an online application on the STP website which was fairly simple complete. When you click on the link everything comes up, you fill in the form, attach some required documents, press submit and you’re done. There is no interview. The thing that you need that is really important is a recommendation letter. In terms of the criteria for application, you needed to have a medical degree, and also to have done your internship.

I chose the STP program based on the timing of the intakes as they are slightly different. The MMed program starts in August through to October whereas the STP program starts at the end of the year, around December. There are some fees for the STP program such as your registration fee and an application fee. After that there are examinations fees for the first and last training years, the other two years are free.

Tell Us About The Program

For both STP and the MMed programs the training takes four years. The focus in first year is basic sciences such as physics, physiology, anatomy and pharmacology. As you then proceed training is all about applying what you have learnt during your basic sciences year to clinical practice.

The exciting thing about anaesthesia training is that you learn on the job. This also means that it is also quite tiring as I spend most of my time at the hospital. It’s a very practical specialty but there is also a lot of theory to learn. My average day starts at 0700hrs or 0730hrs, this depends on whether I have class before theatre starts which is typically once or twice a week. There are sometimes more of these teaching sessions if there are visiting consultants or registrars. The theatre list starts at 0800hrs and then I finish after my last case is done, that can be very variable. Typically, it’s 1600-1700hrs but can be as late as 1900hrs. Twice a week I also have classes in the afternoon.

Tell Us About Some Highlights Of The First Year Of The Anaesthesia Program

My highlights mostly relate to learning so many new skills. Everything that I’ve done this year is like nothing I’ve ever done in medicine before. That has been really exciting particularly if you’re an individual like me who loves to learn. I’ve learnt a different side to medicine. It’s been interesting to care for a patient in a different kind of way. As a senior house officer or intern I would be on the surgical side. Now I am on the other side and it’s not just about cutting the patient. I’ve learned that anaesthetists are the key people who protect the patient, the people who keep the patient alive throughout the operation. This does also mean that it can be a little scary at times but it is also very fulfilling to know that I am the protector of the patient whilst they are under anaesthesia.

What Are The Challenges Of The Anaesthesia Training Program?

The biggest challenge that I’ve encountered is that it is a very involved specialty, it is very hands-on. This sometimes means that if you haven’t had time to learn about the theory of anaesthesia, you may not be running your anaesthetic correctly. At the start this can be nerve racking as it’s a case of you don’t know what you don’t know. This is why it’s so important to have seniors present who can guide you.

Another challenge is that most of my time is spent at the hospital. On this course you have to have a lot of motivation to study when you return home after a day in theatre. It’s difficult to get a balance between the in-theatre duties and keeping up-to-date with studies. It’s hard if you are motivated and you want your knowledge to be as good as your technical skills as they often don’t increase at the same rate. Currently I feel that my technical skills are good but my knowledge is lagging behind at the moment, so I am trying to correct that balance.

What Do You Want To Do After You Finish Your Training?

At this stage, I haven’t worked out what I want to do after I complete the program. There are many subspecialties now available in Zambia for example paediatrics, obstetrics and regional anaesthesia. The paediatric fellowship that PATA runs does sound very interesting and I do enjoy paediatrics, it has definitely caught my attention. Equally, I am also I’m interested to be on the other side of obstetrics and do the anaesthesia because of the passion I had for obstetrics before I started my anaesthesia training.

Currently, there aren’t many physician anaesthetist in Zambia, so it does mean that we have opportunities to work in many different places when we finish. This also includes the private sector as there is a big demand for us. Also relevant to me being a female, I’ve heard about some surgical teams wanting to have an all-female crew. There are also some opportunities to do observerships outside of Zambia. Prior to Covid the WFSA had an observership in South Africa that Zambians frequently went on.

What Tips Would You Give To A Trainee Who Is About To Start The Anaesthesia Program?

Take the risk and try out anaesthesia. At least think about it, it’s actually not so far off from the other specialities. For example, there is a lot of internal medicine, the only difference is that you have to apply this knowledge to your anaesthetic and that’s why it’s so interesting. I didn’t think that I would be interested in it until I got into it. I took a risk and now I feel like it was a good risk, a risk that I don’t regret. Doing anaesthesia changed my whole world, sometimes you have to let a passion grow from zero to something and for me, my passion has flourished over time.
Be patient with yourself. At the start of training you will learn a whole new skillset, not just practical skills like intubation and spinal injections but also leadership skills like how to communicate with and lead a theatre team. At the start of the program I found intubation very difficult and there were days that all my attempts at spinal anaesthesia were unsuccessful. It’s so important that on these days you are kind to yourself and don’t beat yourself up, you will get better. For me as a shy person, speaking out to the theatre team was also very difficult, but I’ve learnt by doing the anaesthesia program that it is paramount. I have found a voice because it is my job to protect the patient and I am passionate about doing this. The anaesthesia program has taken me outside of my box which means that has been essential for me to be patient with myself.
Find a balance. We currently only train in a tertiary hospital so it does mean that we are doing many cases, some of which are very long. Sometimes this means that your studies lag behind so strive to find a balance. Aim to learn one fact every day, just read one small page. There is so much to learn and limited time to study so use the technique of little and often. I got a shock when I found out what adult learning was all about. It is not like medical school where you are told what to learn. The program is self-directed, and therefore you need to be your own motivation and your own guide.
Speak up! There will be hard days on the program so if you are stressed make sure that you talk to people, share the hard days as well as the good days. Do not be afraid to talk to someone about what you are going through. I wish I had learnt this sooner. I could have spoken to someone about what anaesthesia was instead I waited to talk to Dr Mumpansha when she reached out to me. It would have also been so helpful for me to speak to people during my first year. My difficulties were likely to have been my seniors’ difficulties at some point.

By speaking up I have found that anaesthesia is a big supportive family where people are always there for you, someone always wants to guide you. This is one of the best things about anaesthesia, you don’t have to feel shy or scared to call for help, it does not make you any less of a person. It’s such a healthy environment to work in in this respect. There are so many people around you who can be there for you emotionally and physically.