The Global Anaesthetist Series: Dr Sonia Akrimi

Written By Dr Sonia Akrimi, Consultant Anaesthetist and ZADP Co Director | Read Time 7 mins

Welcome to the first of our series of articles by individuals working within Global Anaesthesia with links to the Global Anaesthesia Development Partnerships (GADP). Global Anaesthesia is still a relatively small entity and roles within organisations vary greatly. The aim of this series is to provide more insight into this field of medicine. We kick off with Dr Sonia Akrimi, a Consultant Anaesthetist in the UK who works with ZADP, the WFSA and the RCoA’s Global Partnerships team.

What Is Global Anaesthesia?

In my view, global anaesthesia is just anaesthesia.  I think we get a little caught up in thinking that it applies only to overseas work or challenges commonly encountered in countries of low or middle income.  There are global anaesthesia development needs in the hospitals in which we work, wherever we live (for example, dealing with patients who are migrants, practising in situations of low or changing resource access, practising in an over-stretched health system, and dealing with different workforce models providing anaesthesia care).


I think what makes anaesthesia “global” is the way we think in dealing with these development needs.  Each healthcare worker and health system has specific skills and experiences that, by working collaboratively, can aid development, and for me, the global aspect of global anaesthesia is about appropriate ways to share and build together rather than being overseas or thinking only of low and middle-income countries.

Tell Us About How You Got Into Global Anaesthesia And What Your Career In It Looks Like?

My first experience was as a medical student when I undertook an elective in anaesthesia at Korle-Bu Teaching Hospital in Ghana.  I really enjoyed it.  Despite being junior, I felt like I was part of the team and that I was able to contribute to caring for patients alongside anaesthetists.  I learnt a lot, including about practice limitations in a low-resource setting, and my enjoyment of this experience led me to explore anaesthesia further as a career.

During my early anaesthesia training in the UK, I volunteered through short placements teaching medical officers in Myanmar in a long-standing partnership.  I knew I wanted to spend more time volunteering in anaesthesia partnerships overseas, however, for several reasons, I felt like this was better for me to do later in my training.

I joined the Zambia Anaesthesia Development Program as a senior fellow in 2016 and later academic lead of the Master of Medicine in Anaesthesia and Critical Care programme at the University of Zambia.  At this point, I spent a year in Zambia, which was after I had my FRCA.  I returned to the UK to start ST5 and was appointed Director of ZADP and a Trustee of GADP.

My time spent in global health in the years that have followed has been incredible.  I continue as a co-Director of ZADP, enabling me to work very closely with Zambian colleagues in anaesthesia development.  I have travelled to Zambia for many short trips since my first trip, spending time supporting training in the operating theatre, on courses and supporting partnership work. 

My experiences with ZADP have enabled me to build links and collaborate with other organisations supporting global anaesthesia.  I sit on the education committee of the World Federation of Societies of Anaesthesiologists.  I am also the clinical lead for a partnership between the Royal College of Anaesthetists (UK) and the anaesthesia department at the Ghana College of Physicians and Surgeons, meaning that I now work again with the same anaesthesia department I did my elective with back in 2008 and who sparked my career in anaesthesia! 

I also co-lead some international courses developed specifically thinking about some of the non-clinical skills needed for anaesthesia development.  These include Inspire through Clinical Teaching and the Overseas Healthcare Leadership Programme.


Has Your Role In Global Anaesthesia Changed Over Time And If So How?

Even though I have had the privilege of many overseas anaesthesia trips to different countries, most of my time spent in global anaesthesia roles in the last six years has been remote.  Although partnerships incorporated remote ways of working before recent years, we have definitely improved our skills and learnt new ways to do this recently. 


I think this is really important because we each can learn from global anaesthesia experiences, however the opportunity to travel overseas isn’t right or a possibility for everyone.  We know now that you can access remote opportunities in global health from your home country, enabling this learning to be shared even wider and respective health systems to benefit even more.


How Do You Balance Your Clinical Work As An Anaesthetist With Your Roles In Global Health?

This is really difficult, and I think we are all still learning here.  I find that everyone volunteering in global anaesthesia does so differently.  The key is knowing what strategies work for you and respecting and understanding that everyone will use the different strategies that work for them.  Additionally, we need to understand that everyone is balancing competing demands, and we may need to re-shape plans and timelines based on what can be achieved when and where, and be honest about this with each other.


With my roles, I find using WhatsApp, phone calls, and meetings to organise and run global health work works well for me.  I’m moving away from using weekends unless we have some deadlines or big pieces of work going on.  Other people I work with though find it better balanced to do global health volunteering at the weekend.  Gaining the support of your employer to use study leave where possible is helpful if you can, and going forward collectively, I hope we find more opportunities to incorporate time for global health into UK health roles. 

Are There Any Particular Times In Your Global Anaesthesia Journey That Have Been Particularly Memorable Or Defining? Tell Us About Them.

To choose one experience, it’s hard to talk about global anaesthesia in recent years without discussing the COVID-19 pandemic.  This was an incredibly hard time for international partnerships. 


As international travel ceased in March 2020, we brought our in-country ZADP volunteers home- an incredibly difficult decision at the time and something I still think about often.  After doing that and needing to work out how to move forward, it felt like we were a very small partnership in a very big, complex, and uncertain problem.  We were worried about protecting the health of anaesthetists, other healthcare workers and the community in Zambia, but how does a small partnership like ours do something meaningful towards that, especially in the absence of international travel?    


Despite feeling very out-of-depth, we managed a lot.  We identified the main concerns of our Zambian partners at multiple points in the pandemic and ran projects to address each in turn, achieving PPE resources for every anaesthesia provider in Zambia and other healthcare workers, significantly contributing to oxygen delivery capacity at COVID centres, supporting the wellbeing of anaesthesia partners and critical care staff, and we contributed to global campaigning for improved access to COVID-19 vaccines in low and middle-income countries and continued support for global health work.  I will always be proud of the achievements our partnership had at such a difficult time. 

What Advice Would You Give To Someone Wanting To Get Into Global Anaesthesia?

  • Speak to everyone you can with experience in the area to find out what is best for you, what work is ongoing and how each organisation operates. Attending conferences and seminars of key global anaesthesia groups is a good starting point for this.  Each time you encounter someone with experience in global anaesthesia, ask them if there is anyone they could put you in touch with who has experience in the areas that interest you.
  • In addition to looking for opportunities that meet your needs, look for long-standing partnerships and ask them how they operate to ethical values in partnership working. Long-standing partnerships have stood the test of time in relationship building between its members, and therefore, it is more likely they are operating in a way that is mindful and respectful of local needs.  Ask how they remain aligned with the needs of their partners, the role partners have in the organisation and its leadership, and how they recognise and mitigate the negative impacts of international work.
  • Check that the organisation or partnership you want to work with is currently active. With so many clinical and other pressures, it is easy for organisations to become inactive despite the best of intentions.  An active partnership has regular communication between partners and, despite challenges, is slowly progressing towards its goals.
  • Know that whatever your circumstances, there will be an opportunity somewhere that suits you, for example, whether you are junior or senior and looking for in-country, remote, full-time or less-than-full-time roles.

Head To Our Advocacy Page For More Information About Global Anaesthesia.