Lira report Ben Cambers 2022

Dr Benjamin Cambers
LIRA October 2022

My Report:

I was keen to write this report without first looking at my original objectives.

Where to start? I guess the first thing to do is to offer my thanks to the Poole Africa link team for giving me the opportunity to work in a developing country to help teach the students and junior doctors of Lira University Hospital. The fact that many people had travelled this road before my visit meant that we were greeted with a warm welcome. It was very clear that the benefit of ongoing work in a particular region is that it results in a collaborative relationship that I was fortunate enough to benefit from.

It is fair to say that the whole visit was a massive culture shock for me. It takes time to get used to a new environment. Given long enough in a country you inevitably become acclimatised to your new surroundings but in Uganda my senses were at times overwhelmed by how different everything was. Thankfully people are the same all over the world and although the environment was a change it was easy to relate to the people. We take for granted all the amenities and resources we have available to many of us in the United Kingdom.

The vast majority of the people I met in Lira lived off very little. The state provides some healthcare, however the expectation is still that the patient must pay for much of their care. The NHS, although not perfect, is a wonderful provider of care, and sometimes going to a country in which healthcare is dictated by how much money you have, is a perfect reminder of this. I struggled with the challenges that the people of Lira would have to make if they could not afford to visit the hospital. This was evident immediately on our first day when we visited the University Hospital and the referral hospital. The referral hospital was packed to the rafters, patients were crammed next to one another, many were queuing outside and there was a general sense of being overwhelmed (patients and healthcare staff alike). Comparatively, the University Hospital was a multi storey building imbued with a sense of calm and a clear lack of patients. The University was more expensive than the referral hospital (although the complexities of the costs were not clear) and as a result there were far fewer patients here as many patients considered that they were unable to afford to be treated there.

Teaching:

I planned to spend time teaching a mixture of paediatrics and anaesthetics and be guided largely by the needs of the students. I think this was perhaps a little naïve on my part, but I was keen to prepare a few things prior to going to Uganda. With hindsight it was best not to prepare too much beforehand because you really need to appreciate what their needs are and what specifically they want to be taught.
We were given a planned teaching timetable from the university coordinators and this was what we used to guide our teaching. We covered a lot of acute emergency scenarios (ABC management) including basic airway manoeuvres. The students were very receptive of any teaching that involved practical involvement – whether this was clinical skills or simulation work. We performed a whole day of the PROMPT course which was very well received and various other teaching including trauma, paediatrics and anaesthesia.

Other Opportunities:

The visit also gave me the chance to visit the neonatal unit, theatres and intensive care. I was able to see some of the challenges that the staff in the referral hospital were experiencing on a daily basis. There was a lack of basic equipment, that which we would consider to be a mandatory requirement of basic care. The staff were clearly resourceful and made use of alternatives but there was no mistaking the lack of resources. Conditions were cramped in the referral hospital. The neonatal unit had 16 babies in a room that would have normally had up to 4 babies in the UK. Indeed, there were two cots that had 3 babies in each (from different parents). The natural inclination is to help and get hands on with patients and provide patient care but the nature of the role we had was to help with education and teaching. It was some comfort to know that by teaching the Lira university students we may have some long-lasting impact on the care given to patients, but it was hard not to focus on the immediate issues in front of you when visiting the wards.

Alongside Frankie, I was involved in helping to develop a series of guidelines for the new high dependency unit in the university hospital. This involved lots of discussions with the nursing staff, coordinators and management hierarchy and ultimately the production of the protocols. By the end of the trip, we had produced several finalised protocols including admission, discharge, monitoring and infection control policies. This was a wonderful achievement and is hopefully the basis for a successful high dependency unit. We plan to continue to be involved in this process and hope to have a completed protocol list as soon as possible.

Summary:

I would thoroughly recommend the Poole-Africa work to everyone keen to work in a resource limited country. I am passionate about teaching, and there is no greater feeling to those who love teaching, than to think that the skills taught can be used to help care for those who need it the most. It was very much a privilege, a very tiring one, but a privilege nevertheless, to be allowed to come and help teach the students of Lira university hospital. I hope that I can continue to build relationships there and would welcome the chance to go again in the future.

Dr Benjamin Cambers
Anaesthetic/Paediatric Registrar
20/10/22