Anaesthesia in Namibia: a phoenix from the ashes
Judith Hall, project lead for Cardiff University’s Phoenix Project, explains why it is vital to have anaesthesia in the right place at the right time in Namibia
As part of Cardiff University’s Phoenix Project, and in support of the Welsh Government’s Wales Africa programme, I travelled with a small team from Cardiff University and the NHS in Wales – Dr Chris Terblanche (Moriston Hospital) and Dr Najia Hasan (Welsh senior trainee) – to kickstart Namibia’s anaesthesia education. Together we delivered the first of three anaesthesia courses for Namibia. Feedback scores were excellent, and we believe that the course has benefited the very junior doctors who attended.
So what is the problem?
Even if you are a man, imagine you are having a baby. As clinicians, we know that having that baby is a big event. Fortunately, there are many people looking after you: your GP, your midwife in the community, your hospital midwife, your obstetrician and possibly your anaesthetist, all of whom are available to assist, guide and encourage you in the delivery in a safe, clean environment.
Now imagine that you are having a baby in Namibia: there is greatly increased risk for both you and your baby. If you are a mother in Namibia, you are 17 times more likely to die in childbirth than in the UK. There is certainly no anaesthetist to look after you, to help recognise emergencies, treat you or resuscitate either you or your baby. And, of course, anaesthetists are essential to deliver your baby safely for anything other than natural childbirth.
Namibia is a huge desert country with enormous distances between homes, clinics and hospitals. It’s 40 times bigger than Wales with nearly the same population. It can take many hours to get to hospital and, tragically, mothers and babies die before or during transfer. I’ve seen a woman travelling eight hours to get to a hospital for help only for her and the baby to die on arrival.
The big killers during childbirth are infections and sepsis, bleeding and hypertensive disease. Add to that the problem of obstructed labour and you begin to understand the risks of childbirth in sub-Saharan Africa. Surgeons and obstetricians need their anaesthetists to function in emergencies. In Namibia there are only two part-time qualified anaesthetists. A similar population in Wales would be served by 1100.
The Phoenix Project
How do you get the right care in the right place in the community?
Cardiff University’s Phoenix Project and anaesthetists from the NHS in Wales are trying to improve the situation by training anaesthetists so that they can become an integral part of the health structure in Namibia.
During 2015 we are running three intensive courses concentrating on recognition and immediate management of sick mothers and safe anaesthesia for caesarean section. The courses are funded by a Tropical Health and Education Trust as well as by Cardiff University. We have just returned from the first of these three courses and the interns and medical officers were very enthusiastic and fully committed. and we have shown improvement in test scores and in simulated emergencies. Could we have a success on our hands by the end of 2015? I hope so.
In parallel we are developing an MMedAnaesthesia with the University of Namibia. This will be the first ever home-grown and delivered postgraduate qualification for Namibian doctors.
The Phoenix Project is one of Cardiff University’s five flagship engagement projects to transform communities using University and Welsh expertise. It represents a very major investment by Cardiff University in the people of Wales, including our staff and students, and is certainly designed to benefit Wales as well as Namibia. We are working in tandem with the Welsh Government’s Wales for Africa programme.
The Phoenix Project is not just about anaesthesia, it is a very broad university-to-university collaboration and there are many very successful projects within it. These are all formed in response to the United Nations Development Goals and centre on poverty reduction and health improvement. Among our many projects we have: health journalism; maths (essential for good water engineers); open-source software writing; public health and family medicine support and academic and research skills development.
The Phoenix Projectis a five-year project and is open to volunteers. To find out more, please contact us on firstname.lastname@example.org.
Professor Judith Hall OBE is head of the Anaesthetics, Intensive Care and Pain Medicine department in the School of Medicine at Cardiff University.