Safer surgery in Ethiopia

At present, Africa has just 3% of global health workers but bears 24% of the global burden of disease. In the last two decades, these shortages have been exacerbated by thousands of health workers leaving to find employment in developed countries, including the UK.

In the first issue of Centre Stage we have interviewed two NHS professionals who are volunteering at Yekatit Hospital in Addis Ababa, Ethiopia.

Tom Bashford, Anaesthetist

Is there a need for more anaesthetists in Ethiopia?

"There's a huge need here for anaesthetists but crucially for anaesthesiology doctors. For a country of 85 million people, there are only around four to five hundred anaesthetic nurses or non-physician anaesthetists and just 17 anaesthesiology doctors."

What have you done as an anaesthetist on your placement?

"I've been trying to improve surgical safety by supporting and training the anaesthetic nurses in my hospital and by helping them with complicated cases, assess patients before they come to theatre and manage them during big operations. A big thing I've been working on is the World Health Organisation Surgical Safety Checklist to improve surgical safety by enhancing communication between surgeons, anaesthetists and scrub nurses and to make sure nothing is missed during the operation that could hurt patient care. It has been shown to reduce surgical mortality, especially in the underresourced world, by as much as 50% - so it's a really valuable tool here in Ethiopia."

Have you seen positive outcomes since the checklist has been put into practice?

"Yes - many cases for example, a patient had a huge tumour occupying their entire mouth which made it challenging for an anaesthetist to put an airway in. The anaesthetist assessed the patient, communicated difficulties to the surgeons and so the operation was postponed until specialist equipment, assistance and a plan could be put in place. A number of plans were formulated and a successful outcome for the patient was achieved purely because there was a better system of preparation, assessment and communication."

Do you think the surgical checklist will continue to be used?

"I'm really confident that it will because one-month after its pilot, it's being used on about 83% of all general anaesthesia cases which is amazing. Plus, there's a programme to expand it nationally with an international NGO based in Addis Ababa and our regional health bureau."

Jacqueline McAuley, Nurse Midwife

Describe your work at Yekatit Hospital

"It varies from bedside clinical teaching of qualified nurses and student nurses, to working clinically as well as preparing materials and equipment to help support and capacity-build within the hospital. I helped to introduce the WHO Surgical Safety Checklist with Tom with the aim of reducing communication problems and errors that occur within the operating theatre."

How have you worked with the nurses here?

"In Ethiopia, nurses are generally disempowered and lack confidence so I've tried to support them by allowing them to make decisions independently. I think I've managed to empower the nurses here by making them feel important, ensuring their opinions are heard and considered at multi-disciplinary team meetings."

Do you think your placement has had an impact?

"My work has been sustainable through the impact I have had on other nurses and midwives, and the work that they will continue to do after I've gone. By improving the clinical skills of nurses and midwives, you help them identify issues sooner. I think long-term volunteering, particularly within a development context, is ideal and crucial, as it makes projects much more sustainable."

Fast Ethiopian Facts

  • It is the 10th largest country and the 3rd most populous country with 87mpeople in Africa, its capital is Addis Ababa
  • The local currency is the Ethiopian Birr. The official language is Amharic but English is widely used in schools and business
  • It is 4620 metres above sea level at its highest point and 100 metres below sea level at its lowest
  • It is the birthplace of coffee
  • There are 13 months in the Ethiopian Calendar
  • Malaria is endemic
  • Its proximity to the Middle East and Europe, together with its easy access to the major ports of the region, enhances its international trade
  • A constitution was adopted in 1994, Ethiopia's first multiparty elections were held in 1995.





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