My Global Anaesthesia Fellowship And How It Shaped My UK Clinical Work
Why Did You Decide To Do An Anaesthesia Fellowship?
What Anaesthesia Fellowship Did You Do?
I first saw the ZADP fellowship advertised before I started anaesthetic training, and immediately knew I wanted to be involved. The ethos of ZADP as a sustainable partnership – the focus on capacity building, supporting Zambian anaesthetists as they became leads for the program, and a longer-term relationship with the hosting institution – really appealed to me. I was keen to avoid turning up, doing some teaching, and then leaving without a plan for how to sustain or build on the training delivered, and ZADP had been doing this for years with their support of the Zambian anaesthesia training programs.
I also had fond memories of Zambia as a medical student – I’d done a community health project outside Lusaka and the people had been so welcoming, and the country was so beautiful – so I jumped at the chance to spend some more time there!
The structure of my fellowship ended up evolving slightly with time due to changes in personal circumstances and the Covid-19 pandemic. When I applied in January 2020, ZADP had a well-established program of visiting fellows and I interviewed for a 6-month fellowship. The pandemic arrived shortly afterwards and, in common with the rest of the world, everything changed. I saw how ZADP had to bring a temporary halt to in-country volunteering, but admired how the partnership had continued and evolved to deliver online training support, buddying, and advocacy campaigns.
What did your ZADP Fellow role involve?
Myself and another Fellow based ourselves in Lusaka, predominantly at University Teaching Hospital (UTH) which is Zambia’s large tertiary hospital and provides anaesthesia services for adult and paediatric elective and emergency cases in all specialties except cardiothoracics and major vascular.
Pre-Covid there were usually 4-6 in-country volunteers in the department at a time, with a longstanding routine for junior and senior teaching (similar to primary and final FRCA level in the UK). During the pandemic the regular teaching moved online, and the aim when we arrived was to strike the balance with this new hybrid model of teaching – the remote fellows continuing with theory-based teaching and the in- country fellows focusing on clinical activities.
It was exciting to have a blank canvas, but also overwhelming at times – where did we even start? We were guided by the Zambian faculty and the trainees themselves in terms of priorities – they requested a focus on simulation, in-theatre teaching and OSCE practice. It was a challenge balancing our teaching activity with the online teaching and the heavy clinical workload of the Zambian trainees, and we were mindful to avoid overburdening them. We tried to bring a focus on trainee wellbeing, organising a coffee and breakfast meeting once a week where trainees could informally debrief difficult cases, and some social time outside work too.
We were able to co-ordinate activity with other short-term training visits from institutions in the USA – for example, a group from the University of Wisconsin did two weeks with a regional anaesthesia focus, and we co-ordinated with local MMed graduate and regional anaesthesia wizard Dr Polela to ensure this momentum continued with in-theatre teaching and support.
How did you find returning to clinical work in the UK?
Everybody warned me about the culture shock of practicing in a lower-resourced setting such as Zambia, but I wasn’t prepared for the reverse culture shock of returning home again.
Routine tasks that could have been done on autopilot before going away took a lot of cognitive effort (“Is this how I set up for TIVA?” “Can I just double check the normal doses for this drug?” “How do these monitors work again?”), and I would sometimes forget about the existence of things we didn’t routinely have in Zambia (transporting a patient without end-tidal CO 2 monitoring!). Colleagues very kindly let me preface every sentence with “Well, in Zambia we did…” and didn’t roll their eyes too much as I rambled on about my experiences.
There were times when I got exasperated at colleagues’ approach to minor inconveniences such as shortages of specific drugs. The rationing of remifentanil caused widespread dismay, and I found it very hard to empathise having seen colleagues in Zambia trying to deliver safe anaesthesia without absolute fundamentals such as propofol or long-acting muscle relaxant; I felt Zambia had given me a very different sense of perspective.
I also missed little things such as picking avocados off the tree in my garden in Lusaka, sitting out in the sunshine for my morning coffee, the colours of the flame trees on my walk to hospital, and chats with friends in the department at UTH.
On the positive side though, I found that once I had readjusted to the differences in setting, I was much more confident than before in my decision-making and ability to lead a team, particularly in an emergency. In bigger departmental issues, I have felt able to take a step back and use the newfound perspective from the clinical and ethical situations we encountered in Zambia.
I also found myself taking a more proactive role with education and training. This worked both in the way I supported junior trainees in the clinical setting, but also in the way I sought out training opportunities and feedback for myself; being on the other side had made me more aware of my own training needs and how to meet them.
There were a few things I found helpful in my first few weeks readjusting to being back in the UK. The first was contact with people who been in a similar setting – I checked in with the ZADP program leads and my fellowship buddy regularly, but also found a lot of shared experience and feelings with a friend who had recently come back from maternity leave, which reassured me I wasn’t alone in feeling a bit wobbly at the start!
I was also lucky in that my deanery offers a Supported Return to Training program. I had a chat over Zoom with one of my local consultants while I was still away (sitting in a hotel in Ndola in the midst of a power outage!), and we caught up again once I was back in post to check I was settling back in.
I found being open with colleagues about the fact that I’d just returned from 6 months away made it easier to ask for help, and I actively invited them to challenge me if they saw me doing something unusual or thought I might have forgotten something important!
Would you recommend a global anaesthesia fellowship?
Absolutely, without hesitation. I feel I have grown as a clinician, an educator and a leader as a result of my experiences in Zambia, and I have come back with a renewed enthusiasm for both training and clinical practice.
I had so many great experiences living overseas, from the day-to-day experiences such as watching the tropical birds in our garden, to once-in-a-lifetime opportunities like waking to the sounds of hippos outside our tent on a weekend safari, and swimming at the top of Victoria Falls.
It has opened up some amazing opportunities for ongoing personal development through the charity – more teaching, organisation and understanding of bigger issues such as business planning, funding & governance, which will be essential for consultant posts.