By: 4 January 2022
Anaesthetist in Focus – Dr Arop Kual

Dr Arop Kual is currently working as an anaesthesiologist in Francistown Academic Hospital and running day care surgeries at Bots Plus Care Clinic and City Medical Centre in Francistown, Botswana. He is involved in the conduct of anaesthesia to surgical patients and also in the management of critically ill patients admitted to the ICU. Recently, he has also been recruited to work overseas as an international member with Doctors without Borders = Medicines Sans Frontieres (MSF) organisation.


JAP: As a specialist in anaesthesia, could you tell us more about your experience and training background in this field?

AK: In Africa, to become an anaesthetist it requires that you do an undergraduate medical degree first which took me six years, then I completed the internship training which is mandatory, I was lucky to get a scholarship to embark on studying masters of medicine in anaesthesia from Makerere University in Uganda for a period of three years. Upon completing my residency anaesthesia programme, I returned to my home country of South Sudan to practice anaesthesia from the year 2012 to 2017. In 2017 I came to Botswana to continue my practice. In 2018, I was lucky again to get a scholarship to do my fellowship in Paediatric Anaesthesia in Japan.


JAP: What drove you to choose anaesthesia as a career?

AK: In my own experience, important factors in my decision-making were the role models who gave their time to reveal to me the special talents that anaesthetists possess such as Dr Dario Kuron Ladu, a general surgeon by then who encouraged me to specialise in anaesthesia, he later did his sub specialisation in urology surgery in the UK. After becoming a junior medical doctor, I spent most of my first years in the surgical wards of a large teaching hospital where I had direct responsibility for many acutely ill patients and those requiring surgery. It became obvious to me through management of these patients that nurse anaesthetists were often called upon to manage these cases as there was no single physician anaesthetist in the whole South Sudan.


JAP: What’s the best part of your job?

AK: the major factors influencing the best part of my anaesthesia practice as a career include the challenge of managing critically ill patients, the clinical application of physiology and pharmacology, the “hands-on” nature of the specialty, as well as the impact of positive role models.


JAP: … and the worst?

AK: This could be a difficult question to answer; the specialty incorporates specific expertise in the management of critically ill patients and those with intractable acute, chronic, and often cancer-related pain. In my decade of training and practice, I have had the privilege of being involved in the whole spectrum of care that affects the lives of many people at their most difficult times – everything from delivery of new life to provision of comfort at life’s end. I think these were the most difficult and challenging times for me, as taking care of the critically ill patients is not an easy task, it is also difficult to explain to patients that the outcome they will have may not be exactly what they expect.


JAP: What has been the highlight of your career so far?

AK: The true highlight of my career as an anaesthetist has been the opportunity to work with different surgeons and within different subspecialties. I had a privilege to work with Dr RT Ladu, he is a renowned surgeon who has a genuine and immense following for his precise surgical techniques and clinical care outcomes. I feel grateful daily to have joined the incredible team. This will allow me to utilise my talents and training to the greatest extent possible for my patients.


JAP: Are you currently involved in any research?

AK: Yes, I have become more interested and involved in research in the few recent years of my practice. I have published so far a number of case reports with some reputable journals including the Journal of Anaesthesia Practice.


JAP: Please can you tell us more about the research and what it could mean to patient experience and outcomes?

AK: In many countries, research makes priority-setting decisions in order to control healthcare. These decisions take into account relevant criteria, including clinical effectiveness, cost-effectiveness, and need, and are supported by evidence usually drawn from clinical and research studies.

Patient experience is required for a decision-making process that considers all relevant evidence. For fair priority-setting, decision-makers should consider relevant evidence and reasons, so patient experience evidence should not be ignored. Patient experience must be gathered in a way that generates high quality and methodologically rigorous evidence.


JAP: Are you planning to attend any training events in 2022? Either online or in person

AK: Yes, I am planning to do more training on research writing.


JAP: If you weren’t an anaesthetist what would you be?

AK: I think if I weren’t an anaesthetist, I would have become a paediatric surgeon.


JAP: What would you tell your 21-year-old self?

AK: Anaesthesia has aspects to attract and sustain all personality types; however, it is crucial to develop the know-how to work both as a team player and as a team leader, to keep a cool head during a crises, and to remain vigilant at all other times. I think I finally understand what it means to be an anaesthetist.


JAP: If you were Health Minister for the day what changes would you implement?

AK: I would make many changes in regards to access to healthcare resources for the communities. In my country, and in many African countries, access to healthcare resources can be very cost-prohibitive and many individuals are not able to seek the treatment that they need.


JAP: Away from the clinic and operating theatre – what do you do to relax?

AK: I enjoy reading research, books and novels. I listen to music frequently.


JAP: How do you think the future looks in the field of anaesthetics and patient experience and what are your predictions for the decade ahead?

AK: People are understanding medicine in general and anaesthesia in particular in a different way than before because of the news and media.

I am impressed with the knowledge that a lot of my patients now have. I do believe it is my job to provide them with the most scientific information available versus what may be available from the media. Therefore, I think that now, more than ever, physicians have to make it a priority to educate patients and help them understand the whole process that they will be going through.