GASOC VRiMS Advanced Airway and Regional Anaesthesia workshops: Experience from four African nations The teaching of anaesthesia where it matters
A week in the life of an anaesthesiologist and researcher in Tanzania
Association of Anaesthetists Year in Review 2024
Hello everyone,
I hope you enjoyed a break over the festive period. We welcome you back to a special issue to kick off 2025 on global anaesthesia. Many thanks to our lovely colleagues at GASOC, SAFE, the History of Anaesthesia Society (HAS), the College of Anaesthesiologists of Ireland (CAI) and the Canadian Anesthesiologists’ Society, as well as our many contributors for this special issue representing or visiting over 50 different countries to create their articles for this issue.
As well as learning more from our friends around the world and the challenges and opportunities they encounter, we take a look back at 2024, and what a year the Association had! You can find all the details on page 28, including the very exciting news that this magazine won an award in November for Best Magazine Launch or Relaunch at the Association Excellence Awards. Many thanks to my team Chris Steer and Erin Taylor for all their hard work to make this happen.
As always, please reach out to us with any articles, letters, comments, or ideas, after all, they will now be published in an award-winning magazine!
Francesca Cockshull Director, Publishing, Policy and Heritage
ISSN 0959-2962
Association of Anaesthetists
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Editor: Francesca Cockshull
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Design: Chris Steer, Digital Designer Telephone: 020 7631 8803 Email: chris@anaesthetists.org
Copyright 2025
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GASOC (Global Anaesthesia, Surgery and Obstetric Collaboration) is a resident doctor-led organisation whose aims are advocacy for global health issues, partnerships with colleagues in resource poor settings with bi-directional training, research and education and collaboration with like-minded global surgical organisations
GASOC has partnered with VRiMS (Virtual Reality in Medicine and Surgery) since an initial hybrid pilot course was run between Brighton, UK and Kampala, Uganda in 2022. VRiMS specialises in creating resources for medical training through extended reality technologies [1].
This hybrid course had a surgical focus with the aim to use virtual reality (VR) as an innovative training platform in Uganda. The content was recorded in Brighton using 360-degree VR technology, and live-streamed to Kampala, where there were 79 individuals over the four-day course. This is freely available to view live, either on a low-cost VR headset (a smartphone and a cardboard headset), or in 2D via a normal computer screen. Recorded videos are available in the free VRiMS library, which contains over 300 multi-surgical specialty, anaesthetic procedures and simulations. Remote registrations included over 500 individuals, some over multiple days, showing appetite for ongoing work.
GASOC has since organised and run four anaesthetic workshops with VRiMS, the first in Uganda (in April 2023), Cameroon and Zambia (in January 2024) and most recently in Tanzania (October 2024). These focused on advanced airway skills and regional anaesthesia. They have all been organised alongside the local departments to address their specific learning needs. Content has been taught by expert all-African faculty, including ambassadors from AFSRA (African Society for Regional Anaesthesia) to ensure context-specific teaching. Surgical workshops, in conjunction with VRiMS, have also run simultaneously at all these locations.
This workshop was run with Kabale hospital in Western Uganda. Forty-seven anaesthetic officers from the Kigezi region, serving a population of 1.2 million, attended the teaching session. Plan A blocks, advanced airway skills (including video laryngoscopy and front-of-neck access) were demonstrated, recorded, and live-streamed using 360° VR technology. These videos were recorded in both French and English and are freely available on the global VRiMS library. Simulation sessions were also trialled on eFONA (emergency front of neck access) and LAST (Local Anaesthetic Systemic Toxicity).
Qualitative and quantitative data were collected from both candidates and faculty to allow feedback, analysis and improvement for future courses. Feedback has been very positive, and learners have reported positive changes in knowledge, procedural skills and behaviours.
Following this course, we were invited by the faculty to run workshops in their home countries (Zambia and Cameroon), which happened in January 2024.
This was a partnership with two of the previous workshop faculty from Cameroon and their local initiative ASCOVIME (Association des competences pour une vie meilleure) [2]. ASCOVIME is an NGO (Non-Governmental Organisation) based in Yaounde, Cameroon, founded in 2008 by Georges Bwelle. They aim to provide free healthcare and surgery to patients in rural areas, alongside capacity building for healthcare workers throughout Cameroon with workshops and courses. They built a simulation centre in Yaounde, where the GASOC VRiMS workshop was run.
Over three days in January 2024, 12 essential airway and regional anaesthesia skills were taught to 59 physician and nonphysician anaesthetists with medical students volunteering at scanning stations. The content was delivered as requested and added specific topics of ultrasound guided vascular access, E-FAST (Extended Focused Assessment with Sonography in Trauma) and thoracic ultrasound.
Immediate feedback showed that there was retention of knowledge, skills and behavioural changes. The most mentioned ‘take home’ points included comments on airway management with video laryngoscopy, cricothyroidotomy and the difficult airway algorithm which participants said would allow them to manage airways more safely. Faculty feedback emphasised the benefit of the simulation sessions alongside suggested changes, including addition of further topics (obstetrics, ALS and safety in anaesthesia), casebased discussions and further multi-disciplinary theatre team simulation sessions.
Further feedback following the course was also gathered, which highlighted retained knowledge and skills with airway management and regional anaesthesia. Some procedures had been attempted more frequently and with more distant supervision. However, there were ongoing difficulties with lack of equipment in some hospitals. Cameroonian surgeons also started writing a surgical VR curriculum.
The anaesthetic workshop in Lusaka was run with the University of Zambia, also over three days, and 46 participants attended (some on multiple days). Candidates were mainly from Zambia and the Democratic Republic of Congo (DRC). The focus of these three days was advanced airway skills and regional anaesthesia. Feedback from candidates showed increased confidence in performing procedures, and comments for future courses were to have more time for practice, as well as holding the courses more regularly over time.
A Butterfly Ultrasound™ was donated to Zambia and local faculty have reported using the ultrasound daily for vascular access and ultrasound guided regional blocks. Ultrasounds were also donated to Uganda and Cameroon and the process is ongoing for one to go to Tanzania.
Virtual reality headsets were also given to Cameroon and Zambia following the courses and are being used by surgeons
to help them learn new surgical techniques. The future vision is to have 10 VR hubs across the African content to aid with medical training and skills.
Following on from these workshops, both the Cameroonian and Zambian local faculty (also AFSRA ambassadors) held further ultrasound guided regional anaesthesia workshops for local participants at the end of January.
The most recent workshop was run at the end of October in Mbeya, Tanzania following opportune conversations at the 18th World Congress of Anaesthesiologists in Singapore. Thirty candidates over three days attended, and the 12-core advanced airway and regional skills were taught. This time three local faculty were embedded alongside the international faculty members. They also funded the local faculty to stay and teach on clinical cases in theatre after the workshop.
We also tested two videos utilising VR technology on the Virti [3]. Virti is an immersive training platform which leverages VR and artificial intelligence (AI) to allow an interactive interface. These include ‘stop’ moments within the videos to allow teaching on anatomy, questions for the user to answer and specific safety points. The two videos used were regional anaesthesia videos (ultrasound guided axillary nerve and fascia iliaca nerve blocks), with original content filmed from the Uganda course.
In Tanzania there was also collaboration with SWIFTSS (Surgical teams Working in aFrica Together for Safer Surgery) [4]. SWIFTSS is a UK based charitable trust, established in 2019, with the goal to help improve surgical care in Africa through collaboration, education and training. The first main workstream was the Tanzania National Mesh Hernia Project (TNMHP). Following the anaesthetic workshop in Tanzania SWIFTSS ran a surgical camp with ongoing mentorship and teaching.
Over the last 18 months of organising these courses we have learnt huge amounts. There have been changes to learning points and focus, both between courses but also as the planning process developed and the programmes took shape. We have often had last-minute changes and needed to be flexible. Internet connectivity issues have been significant at times, not allowing live streaming of the content to more global VR hubs and rural healthcare professionals. This has been resolved by utilising a local modem (this occurred in Zambia).
Language barriers have been present in countries where we had French-speaking audiences (Cameroon, Zambia with candidates coming from the Democratic Republic of Congo) and we have been able to use the language expertise of our Cameroonian colleagues to facilitate this teaching.
Looking ahead: the key aims are sustainability, collaboration, expertise and innovation. We want to ensure we act on local demand and context as well as using local expertise and maximising the use of virtual reality within our teaching programme.
Virtual reality is being increasingly used in anaesthetic and surgical education [5, 6, 7] and offers opportunities for skill acquisition with complex interventions being practised prior to direct patient care. We would like to see more integration of interactive VR videos within our workshops and an analysis of how best to use this exciting, evolving and innovative technology is underway.
This has been a bidirectional learning partnership across all the courses, and we have really enjoyed learning from local partners and their expertise. We would like to highlight their work and continue to maximise their impact both locally and internationally.
Another key aim is sustainability. The past four courses have all been in new countries, but as our feedback has indicated the previous candidates see value in these courses being repeated regularly in the host country to continue to build knowledge, skills and aid in staff development and ultimately patient safety. We hope to be able to return to countries and sites to enhance teaching, continue building relationships with local health care professionals and ultimately develop teaching so it becomes self-sustaining in the future.
Fiona Linton
GASOC UK Anaesthetic representative, ST5 Anaesthetics, Wessex
Jan Man Wong
GASOC UK Anaesthetic representative, ST7 Anaesthetics, London X: @wongjanman
Pei Jean Ong
GASOC President, ST5 Anaesthetics, Yorkshire X: @twjeanny
References
1. Virtual Reality In Medicine and Surgery. www.vrims.net/
2. Association des competences pour une vie meilleure. https://ascovimecameroun.org/
3. Virti. https://www.virti.com/
4. Surgical teams Working in aFrica Together for Safer Surgery. https://swiftss.org/
5. Duffy CC, Bass GA, Yi W, Rouhi A, Kaplan LJ, O'Sullivan E. Teaching airway management using virtual reality: A scoping review. Anesthesia and Analgesia 2024; 138(4): 782-793. doi: 10.1213/ANE.0000000000006611. Epub 2023 Jul 19. PMID: 37467164.
6. Ashokka Bet al. Educational outcomes of simulation-based training in regional anaesthesia: A scoping review. British Journal of Anaesthesia 2024; doi: 10.1016/j.bja.2024.07.037. Epub ahead of print. PMID: 39358185.
7. Mao RQ, et al. Immersive virtual reality for surgical training: A systematic review. Journal of Surgical Research 2021; 268, 40-58.
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The GASOC Annual Conference was held at Park Inn by Radisson, 18-19 October 2024 in Manchester, UK. This two-day event brought together leading experts and advocates for safer global surgery and humanitarian healthcare. We welcomed over 70 in-person delegates and a global audience viewing from 35 countries
The theme of the conference, ‘Creating Solutions in a Changing World,’ was born out of a need to address the healthcare challenges associated with various ongoing humanitarian crises, political conflicts, and climate change. Through our conference, we focused on working collaboratively to develop solutions to deliver safe and effective medical and surgical care in these difficult situations.
The conference kicked off with a keynote address by Tony Redmond OBE, founder of UK-Med, who delivered a fantastic talk on ‘Establishing and Maintaining Standards in Emergency Medical Humanitarian Assistance.’ He emphasised the importance of maintaining clinical standards and how decision-making can change in a low-resource emergency setting. Above all, he called for healthcare professionals to remain accountable in all situations, including during conflict, war, and disaster.
This was followed by our in-depth, specialist workshops which were tailored to promote more thorough discussions and interaction in small groups. The workshops were led by UK-Med, Global Emergency Care Collaborative (GECCo), GynaeFellow and Lesley Hunt (Consultant General Surgeon with vast experience in global surgery). Throughout the day, our facilitators tackled topics such as the practicalities of deploying an emergency medical team, innovation, and capacity building in a crisis, addressing disparities in medical education in LMICs, and adopting lean, agile and design thinking methodologies in healthcare research.
It was wet and gloomy outside in Manchester, but nothing could quell our excitement for the second day of the conference!
We started with a keynote address from Mukesh Kapila CBE (United Kingdom), outlining the current state of conflict and war across the world. He encouraged delegates to take a nuanced analytical approach as healthcare professionals to ongoing humanitarian challenges, and to apply our skills as healthcare professionals in a neutral humanitarian approach. This was followed by a spirited talk from Kemi Ayoade (Nigeria) on her motivations for changing the narrative for trauma patients in Lagos by taking up further training in Microsurgery in Manchester. She provided some fascinating insights into not only the challenges of plastic surgery in Lagos, but also some realistic solutions to address them.
Reginald Moreels (Belgium) gave an impassioned speech about the universal essential rights to healthcare, food, clean water, education and offered some ideas on how access to quality healthcare can be increased. As a former minister and humanitarian surgeon, he called on delegates to consider how we use our knowledge and skills as clinicians to influence national policies. We were next joined by Chris Lavy OBE (United Kingdom), who gave his insight into the lessons learnt around capacity building (staff, ‘stuff’ or equipment, space, supplies and support) in setting up an orthopaedic hospital and training programme in Malawi.
After lunch, we heard from Katy Kuhrt (United Kingdom) on novel treatments in pre-eclampsia and showcased the potential for innovative point-of-care testing in aiding early detection and management of pre-eclampsia and its complications within resource-constrained settings.
Robyna Khan (Pakistan) gave an important talk on ethical approaches to resource allocation in LMICs and introduced a framework for priority setting in resource allocation, using the COVID-19 pandemic in Pakistan to illustrate applicability of the framework. Our last talk was delivered by Helene Bassama (Senegal), who offered her honest introspection on anaesthetic leadership in West Africa and obstacles to women’s access to senior positions in healthcare. She highlighted the strengths of female leaders in sensitive communication and the ability to integrate different points of view in leading a team. She called for delegates to champion greater representation of women in leadership positions and societal change through education.
Our conference would not be complete without celebrating the hard work and achievements of our conference delegates! Our final segment focused on work submitted by our conference delegates. This included prize winners for best abstract, best poster presentation and oral presentations, which can be found in our 2024 Abstracts Booklet (published on the GASOC website).
We were grateful to be joined by Nicola Heard, Director of Education and Membership Services, who presented the prize for the Association of Anaesthetists’ Essay Competition, titled ‘Reimagining the future of anaesthesia and critical care provision in resource-constrained settings.’
We are proud to have presented a diverse and exciting line-up of conference speakers and workshop facilitators, who have demonstrated commitment and leadership in addressing challenges posed by conflict and disaster to healthcare. Through thought-provoking keynotes, interactive workshops, and inspiring presentations, the conference provided valuable insights and creative solutions to address the challenges of delivering healthcare in crises.
As we look ahead to 2025, GASOC remains dedicated to fostering collaboration, innovation, and leadership in the global health community. GASOC will celebrate its 10-year anniversary, and we hope to feature the progress made in Global Surgery since the 2015 Lancet Commission in our next conference in Autumn 2025!
If you feel you have missed out, don’t worry! You can still register for an account on MedAll (https://medall.org) to access catch-up content from this conference. Additionally, if you would like to hear more about GASOC or get involved in any of our activities, please visit our website to join our mailing list or contact us via email, Instagram, or X.
Email: gasocuk@gmail.com
X: @GASOC_2015 Instagram: @gasocuk
Pei Jean Ong
GASOC President 2025
Joseph Watson
GASOC Conference Lead 2024
On behalf of GASOC
(Global Anaesthesia, Surgery and Obstetric Collaboration) www.gasocuk.co.uk
This paper is about the importance of teaching anaesthetic principles to the people who administer anaesthetics in remote hospitals in low-income countries. The author’s career oversees developments in Africa, South America, and Asia during the past half century
Like many, I started off ignorant. As a surgical and obstetric resident, I took anaesthesia for granted and it received very little attention during my training. The shock realisation that anaesthetic knowledge was important hit me in a rural East African single doctor hospital when the anaesthetic nurse was nowhere to be found and an obstetric emergency presented. Later in my career, then in the possession of specialist knowledge and abilities, I visited hospitals in low income countries with small reconstructive surgery teams. My last position was as Médecins Sans Frontières’ (MSF) anaesthesia adviser, which took me to the most remote hospitals. It is not encouraging to observe that over the years patients seem to be receiving worse anaesthetic care.
During the 1960’s and 70’s in East Africa, most patients were administered anaesthesia by nurses with just two years of training given at the national or provincial hospitals by specialist anaesthetists. Basic technique consisted of ether by mask or endotracheal tube as well as spinal anaesthesia. The lack of teaching material was resolved by the publication of Primary Anaesthesia edited by the vigorously enthusiastic Maurice King. He had pioneered anaesthetic knowledge engineering and helped to meet educational needs in 1966 with Medical Care in Developing Countries [1], an edited compilation of the conference at Makerere. His initiative to add anaesthesia to the ‘Primary …’ series of textbooks targeted at health workers at all levels in the developing world was vehemently opposed by the WFSA chairman at the time. Anaesthesia was meant to be doctor administered. Despite the resistance of the officials of the profession, and with the help of those who understood the local situations, the low-priced book was published in 1986. [2] Although ether is no longer used, the book’s content remains relevant today and I have found it almost everywhere I have visited. Other important books were Michael Dobson’s Anaesthesia at the District Hospital [2], the Illustrated Handbook in Local Anaesthesia [3] from the ASTRA company and Drugs used in Anaesthesia, WHO model prescribing information. [4]
When setting up teaching in the low income country hospital, it becomes obvious that the material offered needs to fit recipients’ basic knowledge. That knowledge may vary from primary school to university level. There is tension between those who ask just to be shown how to do something and teachers who think that understanding what one does helps
find alternatives when needed. What it amounts to varies, depending on the possibilities. Airway management is technical and easily taught to manually practical people. Fluid management on the other hand requires basic biological and chemistry knowledge.
Hospitals have been classified by the nature of surgical procedures performed in three levels [5]:
1. Rural hospital: Minor surgery; anaesthesia by non-trained staff
2. District hospital: Major surgery; anaesthesia by trained nurse
3. Referral hospital: Professional specialists
Ideally, caesarean sections are performed in the district hospitals. However, due to geographical limitations it is often done in the rural hospitals. Some observations I have made in the past 20 years illustrate the problems patients face in those conditions:
“Doctor, there is a problem in recovery, please come!”
The patients, small children with freshly repaired schisis, are sleeping peacefully with an oximeter on their finger or toe. Seeing no problem, I ask what the matter is.
“They are so quiet!”
When I ask what the situation is I am told, “They always yell and scream!”
Safely dosing analgesics would be troublesome lacking oximeters. Patients would benefit from the provision of oximeters and some appropriate staff instruction. [6] The intelligence and dedication of the staff were not the defining issue here.
“How do you treat the pneumonia after caesarian section?”
It turns out that the excellent anaesthesia nurses had only two months training in the capital many years ago. Their technique was halothane in 100% oxygen by mask. Working for a few months under supervision would enable these nurses to obtain the skills necessary for endotracheal intubation.
In several level 1 hospitals in Sub Saharan Africa, the only anaesthetic was ketamine. There was oxygen 5 l/m from an onoxygen concentrator, if it worked, and if the generator was on. All anaesthetic equipment was lacking. One hospital had heavy bupivicaine and spinal needles, but no ephedrine. The ward nurses took turns providing ketamine anaesthesia in theatre. In another very remote hospital, staff carried out procedures meticulously and with good results. It turned out that the staff performing operations and giving spinal anaesthesia lacked any formal training; they had been instructed by expat physicians in past times. These wonderful people did not understand the background of what they were doing, they copied exactly what they had been taught. In the very poorest parts of our planet, medicine is sometimes practiced by ‘unqualified’ people doing their best. They don’t do it for the money. Their environment is often dangerous; three of the hospitals I have visited have been deserted or torched since.
At district level 2, some administrators invest in MRI apparatus, while their hospital is understaffed, equipment is derelict or not functioning and drugs are bought by the family. The few specialists are mostly in their private practices, leaving day-to-day work to juniors. Patients are looked after by nurses who care.
With these experiences comes the observation that ketamine has made anaesthesia provision so simple that anybody can give it. We’ve gone back half a century. The knowledge and techniques of a person whose job it is to guarantee a safe airway, to maintain fluid balance, to adjust the provision of analgesia, to protect the patient from the negative effects of surgery, are all absent in the level 1 rural hospital, where most patients are. Patients in the poorest hospital settings get substandard care. Management and ministry level administrators either don’t know or don’t care that surgical care is substandard. We, western specialist anaesthetists, can contribute to safe anaesthesia for patients dependent on such hospitals in poor settings by teaching, whoever needs it, locally appropriate techniques. Our obsession with degrees isn’t helpful in the field.
Marten van Wijhe MD, PhD
Member of History of Anaesthesia Society
Former District Medical Officer, Kenya
Former MSF Advisor and Consultant, Groningen University Medical Centre, Netherlands
References
1. King M ed. Primary Anaesthesia. Oxford University Press. 1986. French edition: Anesthesie en practique, Arnette Paris. OOP.; King M ed. Medical care in developing countries. Oxford University Press 1966.
2. Dobson MB. Anaesthesia at the district hospital. World Health Organisation 1988.
3. Eriksson E ed. Illustrated Handbook in Local Anaesthesia. 1969.
4. WHO Model Prescribing Information. Drugs used in Anaesthesia 1989. Published for the same reasons in 1986, is “Safe Anaesthesia” by Lucille Bartholomeusz. The 3rd edition is available from https://healthbooksinternational.org/; also in a French version.
5. Merry AF e a. International standards for a safe practice of anaesthesia. Canadian Journal of Anaesthesia 2010; 57: 1027-34.
6. Lifebox® promotes oximeter presence in all operating theatres and recovery areas.
7. An argument for the importance of teaching appeared in the Lancet 1981; 317: 1151-2.
I encourage anaesthetists, both in early and late careers to volunteer for short missions and for longer terms with humanitarian organisations, especially to understand more about passing on appropriate knowledge and capabilities to whoever is serving their patients day to day.
I first met Mr. Rodwell Banda when I worked as a volunteer doctor at St. Francis’ Mission Hospital in 2018. I was instantly drawn to his warmth, hospitality and willingness to share his wealth of experience of practicing anaesthesia with me. Nothing appeared to faze him – not an anaesthetic induction for a baby with burns injury, nor an impending airway obstruction from acute epiglottitis. I was moved by how much Mr. Banda and his team could achieve, with what little they had to work with. Through his story, I hope to shed some light into the many successes but also challenges faced by anaesthesia providers in remote and resourceconstrained settings.
St. Francis’ Mission Hospital is in the Eastern Province of Zambia in Katete district. It was founded in 1947 and lies on the Great East Road, 500km east of the capital Lusaka and 125km from the Malawi border. It is a busy 490-bed hospital providing medical and surgical care to the people of Katete District, Eastern Province of Zambia and sometimes as far as Malawi and Mozambique [1]
Hi Mr. Banda, please can you introduce yourself?
My name is Rodwell A.C Banda and I was born in 1954. I am the fourth child in a family of nine! I am married with four children and unfortunately lost one child to congenital heart disease.
I completed my secondary education way back in 1977 at Chassa Secondary School. Just when I finished writing the examinations, I was enlisted for compulsory military training, referred to as the Zambia National Service. After six months of military training, I went on to work in a production unit and learnt basic agricultural skills.
It was around this time when I thought of applying to study clinical medical sciences at a college in Lusaka. In 1978, I was invited for the interviews which I sat and passed, and in 1979, I embarked on the three-year course. On completion, I started working as a clinical officer general at a clinic in a remote area and worked there for almost five years.
What was your journey to becoming an anaesthetist?
One of my friends told me that the University Teaching Hospital (UTH) in Lusaka was conducting interviews for clinical officer generals to be trained as anaesthetists. After much consideration, I applied and was successful with my interviews in 1986. I successfully completed the training course and was posted to St. Francis’ Mission Hospital.
I reported for work at St. Francis’ Hospital on 1 May 1988 and I have worked here ever since. I have worked with many incredible surgeons from the UK (including James Cairns), the Netherlands and Zambia.
Anaesthesia has become part of my life now and it gives me immeasurable pleasure when I look back and reflect on all the patients that I have helped - it brings me great satisfaction!
One of the reasons I joined the anaesthesia training course was to upgrade myself. I was not satisfied with the initial clinical officer training and found it difficult to work in such a remote area. This training would also act as an incentive to earn an extra income. But above all else, I wanted to serve the people that needed surgery. At that time, there were very few anaesthetists in Zambia.
did you enjoy most about your job?
Anaesthesia is challenging! In our area, we manage patients who present very late to the health facility but still need to be operated upon. There are limited options to optimise these patients prior to their emergency operation. Nonetheless, it is most gratifying to anaesthetise a patient who is in a critical state one day, to discover the following day that the patient is recovering and doing well after their operation. To do this, empathy plays a part and that is what I enjoy most.
What were the main challenges you faced as an anaesthesia provider?
Soon after reporting for work, I was fearful due to my lack of experience, especially in paediatric anaesthesia. Though I had senior colleagues, most of them were not approachable. They had less experience in the new draw-over apparatus (of which I received training for at UTH) and so were reluctant to assist me when I got into difficulties. I had to learn to be independent and self-sufficient very quickly.
The hospital had only two anaesthetists, including me, and theatre lists were long. We did not cancel cases, and it was not unusual to leave theatre around 23:00 or later in the night. Nonetheless, we did not complain. Some anaesthetists would join the department but left quickly due to the heavy workload. We had some volunteer doctor anaesthetists from abroad who came to work, but even then, they could only stay for a short period of time, the longest of which was a six-month stint.
I read a lot to stay abreast with my work and that helped me manage both my routine theatre lists and calls for emergencies. It was a hectic period and for a three-month period I was the only anaesthetist for the entire hospital!
We did not have the appropriate monitors for our patients under anaesthesia. Our monitors were our hands feeling the pulse, our eyes to see how the patient is doing, our ears to appreciate abnormal sounds and our mouths to shout if there was a problem!
Over the years, the hospital managed to recruit more anaesthetists and services within the hospital expanded, including the number of operations. However, another challenge surfaced - we lacked the stocks and supplies to carry out these procedures. Finances continue to be a problem which the hospital administration are working extremely hard to improve, but this continues to have an adverse impact on the smooth running of our services daily.
In my long career, I also had the chance to use ether! The patients took a long time to reach surgical state and likewise took a long time to emerge from anaesthesia. It was also highly flammable. I really had to pay more attention than usual until the end of the operation and was exhausted by the end of the day!
Do you have any stories or encounters at work you would like to share?
I remember anaesthetising conjoined twins who were born with one abdomen, they were only five days old! I brought two anaesthetic apparatus into the theatre room and started induction one after the other. The operation went well but unfortunately, we lost one child after a week while the other survived.
Some other major procedures that we have accomplished here at St. Francis’ Mission Hospital include perineal resections, mandibulectomy, laminectomies and total abdominal hysterectomies. We have done numerous total hip replacements and successfully managed countless septic patients. I even remember a child who had a six-inch nail in her carina! Nobody could explain how it got there!
We had a tough time when war broke out in Mozambique. Many severely wounded patients were brought to our facility by the helicopter in the afternoon and we would operate the entire night until the following day, it was exhausting!
That is an incredible story! Tell us more about how you anaesthetised the child with the nail in the airway!
She presented with a cough, excessive drooling and was tachypnoeic. When we got the diagnosis through X-rays, I did an inhalational induction and then helped the surgeon to intubate the trachea with the rigid bronchoscope. I could then connect the Ayre’s T-piece to the ventilating arm to maintain anaesthesia. It took several attempts for the surgeon to fish this nail out and was quite the ordeal for the poor child and the entire theatre team! Thankfully, this was a success story and the child was eventually discharged from hospital in a good condition.
You have dedicated a large part of your youth to working hard as an anaesthetist in the hospital, how did you balance your family life?
I have a lovely wife, Ruth Banda, who managed the household and looked after the children when I was hard at work. I do not know how she felt through some of these difficult times as we have never openly discussed it. I am grateful for her support.
Despite all my hard work, I was not promoted to a senior position until much later in my career. I feel sad that sometimes in life, people who are hardworking and honest are not always duly recognised or renumerated for their efforts.
I have worked at this institution for 36 years and retired in 2009 because of a meagre retirement package. I could not sustain myself and my family financially, so I opted to apply and work on a contract basis and have been doing so for the last 12 years. I renew my contract every three years, and when my current contract finishes, I will not renew again as it is time to retire from anaesthesia.
My typical day now involves…
Gardening and farming, as I enjoy this most! Though I do not have much land, I make the best of the small one acre that I have been blessed with. In my garden, I grow kale, spinach and tomatoes but on the small piece of land I grow maize – maize is ground into cornmeal that makes nshima, our Zambian staple food.
Aside from that, I also like preaching the word of our Heavenly Father Jehovah and sharing with other people about the word of God and the ‘Good News about our Lord Jesus Christ’.
Sometimes, I just sit down under a tree with my lovely wife and we chat and laugh about the things we did a long time ago!
What are your hopes for the future of anaesthesia provision in Zambia?
I would like to tell the young generation of anaesthesia providers coming through that anaesthesia is interesting but at the same time very challenging, one needs to keep practicing it wholeheartedly knowing that the life of your patient is in your hands. Any act of simple delay can cost somebody’s life, so punctuality, timeliness and empathy are crucial.
In Shakespeare’s words, “better 3 hours too soon than a minute late”. Anaesthesia training should not be done haphazardly, it needs to be given considerable time, thought and effort to refine one’s skills.
I hope to see more governmental efforts in improving the working conditions of anaesthetists and training more anaesthetists to safely staff surgical departments throughout the country. If working conditions improve, I believe the uptake of training for more anaesthetists will improve.
Pei Jean Ong ST5 Anaesthesia Registrar, Sheffield Teaching Hospitals
Rodwell AC Banda
Senior Clinical Officer Anaesthetist, St. Francis’ Mission Hospital Zambia
According to the latest Global Anaesthesia Workforce Survey (2024), the number and provider density of both physician (PAP) and non-physician anaesthesia providers (NPAPs) have increased since the last WFSA survey in 2016 [2]. This can be attributed to increased training efforts and better accounting of the nonphysician anaesthesia provider workforce. With respect to physician anaesthetists, a minimum density of 4 per 100,000 population has been suggested [3].
From the table [4], despite increase in absolute numbers of anaesthesia providers in Zambia, the total density of both PAP and NPAP in Zambia is less than the suggested 4 per 100 000, though this may be in part due to concomitant population growth. The anaesthesia workforce within the United Kingdom has been included for reference.
References
1. St. Francis’ Mission Hospital. https://www.saintfrancishospital.net/ (Accessed 12/11/2024).
2. Law, TJ. et al. ‘The Global Anesthesia Workforce Survey: Updates and trends in the anesthesia workforce’, Anesthesia & Analgesia [Preprint] (2024) doi:10.1213/ane.0000000000006836.
3. Davies, JI. et al. ‘What is the minimum number of specialist anaesthetists needed in low-income and middle-income countries?’, BMJ Global Health(2018) 3(6). doi:10.1136/bmjgh-2018-001005.
4. Global Anaesthesia Workforce. https://www.globalanesthesiamaps. com/gaws (Accessed 12/11/2024).
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RCoA report reminds us that medicine is still paying lip service to human factors
Farnborough, UK - July 16, 2014: United States Navy Boeing F/A-18F multirole fighter aircraft departing Farnborough Airport.
© iStock Editorial / Getty Images Plus / Ryan Fletcher
Whatever your field of medicine, the RCoA’s recent deep dive into cardiac arrests in cardiology patients receiving anaesthetic care makes unsurprising reading. The major cath lab emergency is a famous nemesis - a smoky labyrinth of difficult communication, unfamiliar equipment and misaligned priorities. Sure enough, the findings, which formed part of the wider NAP7 report, shone a harsh light on human factors issues and the need for our teams to do better for this high-risk patient group.
The report coincided with my invitation from Draken to join their aviation crew resource management course, where I’d reflected with pilots on the thorny issue of transferring CRM principles to medical care. The F18 fighter pilot describing cognitive processes adopted in managing a ‘falling leaf’ spin is far removed from the NHS crash call; clumsy generalisations between aviation and healthcare have certainly become tired. But their openness in discussing error and their scrutiny of near-miss case studies felt aspirational. Not once did any individual speak over another. Periodic CRM training is mandatory for aircrew, aiming to manage risk through awareness of cognitive and interpersonal factors. In contrast, CRM and human factors training has long had its disciples in medical practice, but the chasm with real life application doesn’t seem to narrow.
Let’s be clear – CRM training within medicine is not a new idea. Anaesthetist David Gaba’s reframing to ‘Crisis Resource Management’ in the 1990s, for example, highlighted key facets we could emulate within aviation’s safety gold standard. Much water has passed under the bridge since his early work. Lazy over-generalisation with airline safety may have devalued the message. Simulation of emergencies has been both overused by NHS training bodies to tick all the human factors boxes while being grossly underexploited overall, and limited resources have relegated non-technical skills to an icing-on-the-cake instead of a concrete core of safety.
Rapid deployment of drugs and equipment in the cardiac lab was shackled by the unfamiliarity of the environment for critical care and anaesthetic staff; surely a ripe target for in-situ simulation sessions and a renewed call for standardised storage? Sim is only tentatively stepping out from expensive, purpose-built labs and embedding itself in the spaces we actually work in, a casualty of pressure to churn through real cases.
Communication and teamworking between cardiology and anaesthetic teams was lambasted – that feeling of two teams doing two different operations will resonate with many of my colleagues. Introductions are lacking and lost under pressure or behind facemasks. In the unfamiliarity, the hierarchy of need can feel uncertain. Again, a problem so amenable to practicing together, and to the simplicity of a 30 second ‘time out’ –how often do we feel we need Herculean confidence to propose such a thing during the emergency?
The F18 fighter pilot describing cognitive processes adopted in managing a ‘falling leaf’ spin is far removed from the NHS crash call; clumsy generalisations between aviation and healthcare have certainly become tired.
Passion from human factors advocates maintains optimism - the Association of Anaesthetists’ recommendations on implementing human factors, for instance, create an aspirational vision on how our teams should work and how our workspaces should look and feel, but the drive must ripple out from the silos of the hyper-acute specialties.
NAP 7’s recent chapter reminds us of everything we hoped medical CRM and human factors training should address, but maybe also how we’ve fallen short. Several themes rear their heads again and again.
And debrief? Only undertaken in fewer than half of the cath lab cases which resulted in cardiac arrest – opportunities to reflect operationally on how the team performed lost to fighting fires elsewhere. Debriefing continues to have an on-off relationship with medical emergencies, with time and expertise in facilitation found wanting. For my room of pilots, this was met with incredulity. “How did you guys get better if you don’t debrief everything you do?”, an exRAF officer asked.
These urgent findings should shake us from lip service to human factors and crisis resource management. Ironically, even this report is an optional read and only if you happen to be aware of its existence - arguably a failure of human factors itself. Case studies like these could fuel mandatory discussion during dedicated sessions, a relevant update on the grainy oil rig and air disaster case studies we show our teams.
How we then apply the lessons learnt, and permeate our human factors training through the complex, mixed specialty environments that healthcare workers operate in, warrants careful thought. NAP 7’s findings tell us what we already know - non-technical skills profoundly influence outcomes, and their continual development is a basic requirement, not a luxury, for a forward-looking service.
Sam Goodhand ST7 Anaesthetics and Intensive Care Medicine
I organised my elective in the anaesthetic department at a small semi-rural hospital in the Taranaki region of New Zealand’s north island. Within the department, I gained exposure to and experience in different aspects of anaesthetics, including perioperative care, intensive care, and pain medicine
The learning opportunities were excellent, and my supervisors were keen to teach, with one having prepared learning materials about the basics of anaesthesia which we would discuss during a gap in the theatre lists. Owing to the handson learning and supportive mentorship, I feel much more confident about my basic airway skills going into my first year of practice in a few months’ time. I was also able to learn how to utilise ultrasound for gaining IV access, and my supervisors took the time to talk through the principles and technique with me before closely supervising me and offering guidance and support. The supportive and encouraging environment has reinforced my commitment to anaesthesia as a career.
From a career perspective, being able to speak to consultants and registrars about a career in anaesthetics was something I found valuable. Hearing about some of the benefits and drawbacks will hopefully enable me to make an informed choice about career direction going forward. Moreover, an elective in anaesthesia may help with applications for specialty training in the future. I also had the opportunity to lead my own quality improvement project with the department’s support. The audit focused on epidural blood patch as a treatment for post-dural puncture headache (PDPH). With guidance from my supervisor, I presented my findings to the department (Figure 2) and am currently in the process of
drafting a PDPH pathway for the hospital based on evidence for current best practice. This would give clinicians a quick tool to ensure that management of post-dural puncture headaches is optimised conservatively and that any potential side effects of the procedure are discussed with the patient, allowing them to make an informed choice about treatment.
The elective was an opportunity for me to experience medicine in a different context which I feel has broadened my skills and knowledge and made me feel more confident in their transferability to other settings. It was interesting to compare the health systems between the UK and New Zealand, and I was shocked that despite having universal healthcare there were still significant inequalities in access to healthcare, some patients displayed features of quite advanced disease that one would not expect to see in such a developed country. Indeed, for some of these health inequalities the indigenous peoples of New Zealand were among the worst affected. Working in a country with an indigenous population was a completely novel experience for me but I believe in the short time I was in New Zealand I was able to develop the skills required to navigate communication with dignity and respect.
Finally, having been raised in a low-income household with few opportunities to travel abroad, this elective was a fantastic opportunity to broaden my horizons by experiencing life overseas. Being able to explore a geographically isolated, beautiful country as well as take part in a range of outdoor activities was an unforgettable experience.
From a practical perspective, organising my placement, arranging travel and documents such as visas, as well as dealing with complications and disruptions which inevitably arise, has equipped me with skills and confidence for the future. Nevertheless, none of this would have been possible without the generous support of the Association of Anaesthetists, and I am truly grateful for your assistance. Please allow me to pass on my sincerest thanks to all the trustees at the Association for investing in me. I hope that I may one day count myself among your ranks and contribute positively to the profession.
Luke Solomi University of Plymouth
Jan Man Wong is an ST7 anaesthetic resident from North East and Central London deanery, currently on Out of Programme Training (OOPT) in Australia. She joined the Association’s International Relations Committee (IRC) as a resident anaesthetist international fellow in March 2022 and has served two years
What does the International Fellow do?
The International Fellow is a co-opted member of the IRC and SAFE (Safer Anaesthesia From Education) Steering Group. Specific duties of the Fellow include assisting in reviewing IRC and SAFE grants, aiding the development of educational materials and presenting on the activities and international work of the Association. A few flagship projects during my time include the IRC providing a grant for Anaesthesia to appoint Editor Fellows from resource-constrained settings with honorariums. SAFE also developed an online learning platform on SAFE Paediatrics.
Why did you apply?
After completing the Improving Global Health Fellowship supported by (formerly) Health Education England and serving as the UK Anaesthetic Representative of GASOC (Global Anaesthesia Surgery Obstetric Collaboration), I have always had a strong passion for advocating for global anaesthesia. During a long case, I was discussing my ventures with one of my consultants, who was an elected member of the Association at the time, and she encouraged me to look out for the International Fellow role. I am also a medical education enthusiast, so I thought I could fit some of the essential criteria. I was fortunate enough that my Training Programme Director (TPD) was fully supportive of the application.
What did you learn during your term?
Plenty! I joined with a huge amount of imposter syndrome. The IRC and SAFE Steering Group both have six-monthly virtual/inperson meetings. These are formal meetings where paperwork is sent a few weeks beforehand, including grant rating and the meetings go through each item in detail. Being the youngest (by age) in the room may feel intimidating. However, the chairs have always been interested in hearing the voice I represent, and I quickly learnt how to respond as eloquently as possible in ‘high-brow’ meetings. I still find myself muddled at times. Slowly though, I realised my growth later, upon reflection, when invited to join the representative team of the Association at the General Assembly of the WFSA in Singapore this year.
What is the most memorable achievement during your term?
When I was first appointed, one of the action plans was to increase awareness of the Association’s global work in a creative way. I have always enjoyed the stories of amazing heroes around me. With the great help of Andrew Fyles at the Association, and my guests, we recorded three episodes of Coffee and a Gas
podcasts covering SAFE, research, and equity within the realm of global anaesthesia. I was also invited to co-edit the Global Anaesthesia edition of Anaesthesia News in November 2023. The people behind the stories always inspire me!
Listen to Coffee and a Gas here
The IRC co-badged, along with the World Anaesthesia Society, a morning session on Global Anaesthesia at the most recent Association Annual Congress in Harrogate. I was grateful to be able to help organise the speaker and attend the conference. It’s sobering to see how humanitarian work is more relevant than ever. It was also a privilege to be in the room where poignant discussions were held. The topics of conversation included the utility of IRC funding, marrying of short- and long-term projects, and the wellbeing of workers in war-torn countries, to name but a few.
I do drop the ball sometimes! There are many more little projects that I want to do such as further work with SAFE. I have been quite lucky that I was in a 1:12 rota during a good chunk of this fellowship. Educational Development Time (EDT) was becoming more acceptable. Tei Sheraton also helped a lot in mentoring me and guiding me. I do have a few rules about work-life balance since COVID-19 and I still adhere to them –24 hours per week without doing work-related tasks and only partaking in activities that bring positive energy, not giving up on socials and exercising (I did the London marathon in 2022 –never again though!)
Do you have any final remarks?
It goes without saying that the people make the experience better! I am always indebted to colleagues I meet along the way in resource-constricted settings. You inspire me with your resilience and innovation. I especially thank Nicky de Beer, CEO of the Association, Jolene Moore, Chair of SAFE Steering Group and Tei Sheraton, immediate-past IRC Chair. They welcomed me with open arms from the interview onwards. I would also like to extend my thanks to Andrew Fyles and Olivia O’Mahoney, who worked tirelessly behind the scenes to show me the ropes of the Association and aided smooth-running of (near enough) everything.
A
unique digital educational project to supplement FCPS training in anaesthesiology
Using a grant from the International Relations Committee, we delivered virtual interactive teaching sessions to anaesthesiology residents in Bangladesh, on core topics based on the Fellowship of the Bangladesh College of Physicians and Surgeons (FCPS) Anaesthesiology syllabus. We worked with local partners who organised the administrative aspects and promotion of the sessions. These sessions were interactive with continual Q&A and quizzes, and were delivered by a range of anaesthetic consultants, staff grades, and registrars from UK hospitals. The sessions were recorded, and we hope in future to deliver these recordings on a USB to benefit those in areas with reduced access to IT and connectivity.
The project had its advantages and limitations. In terms of advantages, it improved international cooperation between Bangladesh and the UK as we now have close contact with our local partners in Bangladesh. It was beneficial to doctors in both Bangladesh and UK, as there was mutual learning and sharing of knowledge between the two. The local practice of anaesthesia in both countries based on the local resources and infrastructure was often discussed. There were some limitations owing to time, cultural, and education style differences.
of organising a single session was challenging, the advantage of this project is that the sessions only need to be delivered once as they are recorded and can be distributed later.
In conclusion, we found organising the sessions practically more challenging than initially expected owing to the physical limitations mentioned above. We are reconsidering the format of our project, so that pre-recorded sessions incorporating elements of interactivity are distributed to the participants (e.g. MCQ quiz), and there will be a dedicated email where we can answer any questions participants may have.
We recommend that in the future, the physical limitations of organising virtual sessions across two countries with different time zones and cultures be considered more strongly.
We recommend that in the future, the physical limitations of organising virtual sessions across two countries with different time zones and cultures be considered more strongly. We remain positive that it is a good thing that there exists a close relationship between the two countries, as international cooperation can have enormous benefits to increase the range and variety of practice of anaesthesia for both countries.
Joanna
Wong Kae Ling Anaesthetic Registrar, North East Central London Programme
Local participants and organisers were satisfied with the programme – they found the teaching useful as it was based on their exam syllabus. The sessions acted as a supplement to their local initiatives and not a replacement, which was our aim. Feedback was received about the logistics of the sessions, and the time difference of 6 hours was an issue. It was challenging to find UK tutors who were available to teach during their lunch breaks; and Bangladesh doctors had to remain at work late to join the sessions or do it from home where the environment may be less conducive. There were also issues owing to IT due to poor internet connectivity or unfamiliarity with Zoom.
This project required a significant time commitment from both the UK and local organisers, including time needed to prepare and deliver the teaching material, finding appropriate tutors, ensuring the timings and dates were suitable for tutors, and troubleshooting IT issues that often cropped up. Although the process
For my elective, I had the privilege of joining a team of rural generalists working in the remote location of Forbes, New South Wales. Rural generalism was not a speciality I was familiar with before arriving in Australia
The idea of a doctor who worked as a GP, anaesthetist, surgeon, and medical doctor all at the same time felt fantastical. However, during my time at Forbes I learnt the teamwork, excellent organisation and surprisingly the strong community spirit present there meant that this speciality could be practised not only safely but in a way that genuinely improved patient care. The doctors in Forbes would see their patients right through their journey – from their initial presentation at the GP with an abdominal mass to the pre-operative assessment in theatre for the hernia repair and finally to the post-operative checks as part of the ward round. I had never seen continuity of care like it and was truly impressed by how intimately the doctors there knew their patients’ lives.
Obviously, my main experiences of anaesthetics came from my time spent in theatre. Generally, the anaesthetics were performed by one of the local clinicians and the surgery would be performed by someone who had flown in from a larger centre like Syndey or Melbourne. As a result, I was able to form quite strong relationships with the anaesthetic team because they were the same clinicians that I knew from the medical ward rounds or the GP consultations. My primary responsibilities were cannulation, preoxygenation, and basic airway management –including manoeuvres like jaw thrusts and inserting Guedel airways. None of these skills were new to me. I had either practised them on real patients or mannequins. However, the dedicated mentorship I received at Forbes made me recognise how nuanced such techniques can be. For instance, I had always practised jaw thrusts with the patient supine, but I didn’t really consider how the movement slightly changes if the patient needs a colonoscopy and is therefore on their side.
so many different skills when the opportunities to practice them weren’t always readily available. Perhaps the time I was most able to witness the depth and breadth of rural generalism came during an overnight emergency caesarean section. The GP I had been in clinic with that very same day was called in to perform the spinal anaesthetic. However, initially, the spinal didn’t work so the other GP, who had been called in to perform the surgery, scrubbed up and assisted, carefully guiding the needle into the right anatomical location, before then proceeding to perform the surgery, assisted by me. Thankfully, the caesarean section was mostly unremarkable, but the truly remarkable event was that the next morning it was the same GP who on the obstetrics ward round diagnosed the neonate with meconium aspiration syndrome; initiated the management plan and arranged the transfer to the local regional paediatric centre. Rural generalists wear several hats and must be well-versed in switching between them.
I would like to thank the Association of Anaesthetists for all of their support and for awarding me 500 pounds to make such an elective a genuine possibility.
I was also afforded several opportunities to practice my anaesthetic skills outside of the theatre. Forbes being a rural location unfortunately had a lot of agricultural and mining injuries. Several of our patients attended A&E with amputated fingers or toes and so I became fairly competent at performing ring blocks and using local anaesthetic. Similarly, as skin cancer is so prevalent in Australia, I was fortunate enough to attend several skin clinics where I was charged with preparing and administering the local anaesthetic before a wide local excision was performed.
During my time in theatre, I also assisted in regional nerve blocks, primarily for ophthalmic surgery. It was incredible to witness infra-orbital blocks being competently performed by rural generalists who might have to do these specific lists once every three or four months. I recognised how the speciality embraced the idea that medicine and anaesthetics involved a lifetime of constant learning and revision and the challenges of having to be competent in
Ultimately, during my time at Forbes, I gained an insight into the depth and breadth of rural generalism and was fortunate to begin developing a number of my anaesthetic and airway management skills. I would like to thank the Association of Anaesthetists for all of their support and for awarding me 500 pounds to make such an elective a genuine possibility.
Matthew D’Costa University College London
As we look forward to 2025 and the Association’s 93rd birthday, we also take this opportunity to reflect on 2024.
Dr Tim Meek President president@anaesthetists.org
Nicky de Beer
Chief Executive Officer nickydebeer@anaesthetists.org
The year was dominated by our advocacy work on behalf of members and the specialty.
As core participants in Module 3 of the UK COVID Inquiry alongside RCoA and FICM we submitted oral and inperson evidence to raise awareness of just how much our members had contributed and sacrificed during that unprecedented time and crucially to turn this into the lessons we must learn for any future pandemic.
In the run up to the General Election, we sent our manifesto to all candidates setting out clearly on behalf of anaesthetists our asks for the next parliament. After the election, we held our second fringe event at the Labour Party Conference with RCOG and RSM focusing on women’s health and became a founding member of the charity, Wellbeing of Women. We have met and continue to meet and lobby policymakers in all four UK nations.
We continued to respond to key government consultations about the workforce crisis, repeating and reinforcing priorities set out in our election manifesto: recruitment, retention, and making the NHS an attractive place to work. We worked alongside RCoA to develop a workable Scope of Practice for Anaesthesia Associates and will be a key contributor to the Leng review of PAs and AAs
We moved our position on assisted dying to one of neutrality which means that we do not argue for or against but can actively engage with the legislation as it develops. We acknowledged that individual opinions about assisted
dying are an intensely personal matter, but we will continue to influence policymakers, recognising the wide range of views held by members.
Our publications saw continued success in 2024 with Anaesthesia maintaining its position as one of the most cited anaesthesia journals worldwide, and Anaesthesia Reports maintaining its impact factor. After a considerable project to refresh Anaesthesia News, it won the award for Best Magazine Launch or Relaunch at the Association Excellence Awards in November.
We welcomed hundreds of members to WSM and Annual Congress in 2024. In an exciting new development, our 2025 Resident Doctors Conference will be pitched to attract European residents for the first time, widening our horizons and ensuring the Association remains relevant on a global stage. We’ll also be creating a bespoke Leadership Development Programme designed to meet the needs of those aspiring leaders in turbulent times.
What we deliver will continue to be shaped by your voice, backed up by the Association’s vision, core values, and its four strategic priorities of Patient Care & Safety, Education & Research, Advocacy & Support, and Innovation & Growth. With developments in our membership and education offers, 2025 is set to be another busy and exciting year. Every one of you has a stake in the work we do and there are plenty of opportunities to get involved. We’d love to hear from you.
Guidelines
Peri-operative care of transgender and gender-diverse individuals: guidance for clinicians and departments
Guidelines
with
• We produced the following guidelines: Return to work, Peri-operative care of transgender and gender diverse individuals: guidance for clinicians and departments, Peri-operative pain management in adults: a multidisciplinary consensus statement from the Association of Anaesthetists and the British Pain Society, Guidance on solo working: tips for anaesthetists in training and SAS doctors, Association style guide for describing types of anaesthetist and staff groups
• The International Relations Committee (IRC) awarded funding to 11 individuals and organisations to deliver projects in Bosnia, Kenya, Nairobi, South Africa Uganda and Zambia
• Four SAFE projects were funded by the SAFE Steering Group in Cambodia, Ghana, Nepal and Tanzania
• Since 2011, the SAFE programme has trained over 8,000 clinicians in 50 countries. These are mostly anaesthesia professionals but also midwives, obstetricians, surgeons, and other physicians
• Over 1,350 clinicians have been trained as SAFE trainers
• Delivered our first-ever Heritage Open Day, welcoming over 100 visitors to 21 Portland Place, where they found out more about anaesthesia, its history, and the Association’s role in representing the specialty
• Hosted a fully booked Open House Festival event exploring the fascinating architectural history and features of 21 Portland Place
• Connected with over 1,000 curious visitors at New Scientists Live who left with a deeper understanding of what anaesthetists do
• Launched the Heritage Centre’s Instagram page and revamped the Heritage newsletter, to include features like Collections close-up and team recommendations for books, TV and film
• Welcomed 815 visitors to the museum and held 16 Heritage Centre group visits, six off-site outreach events and workshops and three travelling exhibitions
• Awarded six research grants and four John Snow iBSc Intercalated Awards through our continued partnership with the NIAA
• Funded 28 medical student electives travelling to 16 separate counties
• Awarded the Wylie Undergraduate Essay prize to Gabriella Mazzoni medical student, King’s College London, for her essay How does a 'well' workforce benefit patient safety? which featured in the September issue Anaesthesia News
• Earned a 2023 Impact Factor of 7.5 for Anaesthesia and also achieved over four million full text views of journal content
• Welcomed Yavor Metodiev as the new Executive Editor of Anaesthesia Reports, accumulated over 71,000 full-text views of journal content, and expanded the scope to include new article types
• Received 50,318 views of the 1,352 videos on Learn@, our free to members online learning portal, which now has 3,644 users (39% of the membership)
• Ran 15 webinars with 5,661 bookings, covering a range of topics including regional anaesthesia, women in anaesthesia, pride in perioperative practice and targeted webinars for resident doctors and SAS doctors
• Sold 95 online courses
• Held a fTOE practical assessment day at 21 Portland Place, run for the second time on 4 July 2024 with 14 delegates, 12 of whom were successful
• Worked to increase the visibility of our Quality Assurance activities, by revamping our Quality Assurance webpage, publishing an article in Anaesthesia News and delivering a talk at Annual Congress
• Organised 21 seminars and courses, of which two were hybrid, and welcomed over 560 delegates in total
• Ran 11 one-day core topics events across the UK from Glasgow to Exeter with over 482 delegates
• Delivered three annual conferences: Winter Scientific Meeting, Trainee Conference and Annual Congress, with over 1600 attendees in total
• Worked with 100 exhibitors and 19 sponsor organisations representing leading med-tech manufacturers and suppliers, pharma, medicolegal and other services
• Attended 23 meetings with politicians (10 Members of the Scottish Parliament, seven MPs, three members of the House of Lords, one Member of the Northern Ireland Legislative Assembly, two Members of the Welsh Parliament)
• Attended 27 meetings with policy makers, professional and national bodies
• Had five parliamentary questions tabled on behalf of the Association
• Received four mentions of the Association in legislatures
• Responded to 13 policy consultations
• Delivered three oral evidence statements to the Covid Inquiry
• Reviewed 16,860 documents linked to the Covid Inquiry and, where appropriate, actioned them
• Written 10 Covid update emails for members
• Produced seven policy position statements
• Sent the Association’s general election manifesto to 4,500 prospective parliamentary candidates
• Relaunched our magazine Anaesthesia News in May with a new look, a refreshed table of contents including five different sections, new article types and expanded to 64 pages
• Earned a 57% increase in views within three months of relaunching Anaesthesia News
• Won a ‘Best Magazine Launch or Relaunch’ award at the Association Excellence Awards in November
• Welcomed over 765 new members to the Association
• Launched our first ‘Lunch and Learn’ event at James Cook University
• Attended and represented the Association at the World Congress of Anaesthesiologists, Euroanaesthesia, The Wounded Healer, Anaesthesia and Critical Care, and GASOC
• Forged connections with Anaesthesia Student Societies at universities to support students interested in studying anaesthesia
Over 10,000 Members
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The Association of Anaesthetists’ securitas (safe in sleep). Our vision patient under our care is kept safe.
We are a respected and independent organisation, committed to speaking up and speaking out on behalf of our members and the anaesthesia community.
For over 90 years, we have helped to set standards, share knowledge, and support thousands of people in a vital profession. Our expertise matters to our members and globally.
We look forward, not back. We care about the future of anaesthesia and actively help shape its future on behalf of our members by listening, responding, and innovating.
We are a dynamic, diverse, and inclusive community. We exist because of, and on behalf of, our members.
Our mission is to safeguard patients by educating, supporting, and inspiring every anaesthetist throughout their career, enabling them to provide the best care in every healthcare setting.
• Advance and improve patient care and safety in the field of anaesthesia.
• Inspire and support our members always to practice with safety in mind.
• Be the leading publisher of anaesthesia safety guidelines and expert advice.
• Preserve, develop, and share the heritage of the specialty.
• Develop and provide world class education in anaesthesia.
• Promote global access to anaesthesia education.
• Work in partnership with others to build capacity through national and international research initiatives.
• Be the leadership voice for the anaesthesia specialty.
• Represent and advance the interests and wellbeing of our members.
• Protect and support our members throughout their careers.
• Promote anaesthesia as a specialty led by and delivered by doctors.
• Research and promote innovations in sustainable working practices for the specialty.
• Use the latest technology to enable us to deliver the best services for our members.
• Promote the diversity, wellbeing, and continuous development of our people.
• Invest wisely, protect, and optimise our assets, and always act with sustainability in mind to ensure the future of the Association.
Safer Anaesthesia from Education (SAFE) is a project initially developed in 2010 through a collaboration between the Association of Anaesthetists and the World Federation of Societies of Anaesthesiologists (WFSA) which provides short courses in subspecialty areas of anaesthesia practice
The training initiative aims to equip anaesthesia providers with essential knowledge and skills so they can deliver safe care to their patients, and to create a sustainable training model which can be embedded in the national health system. More than 300 SAFE courses have been run in more than 50 countries, training over 9,000 providers.
Aimed at physician and non-physician anaesthesia providers, the 2–3-day courses use a modular approach and a variety of educational methods including lectures, small group discussions, low-fidelity simulation, and manikin-based skills practice. Flagship courses include:
• SAFE Obstetrics: The first SAFE course, developed in 2011, addresses the role of the anaesthesia provider in managing obstetric cases and emergencies, including clinical scenarios based on the conditions causing 80% of global maternal deaths (haemorrhage, sepsis and eclampsia), and maternal and newborn resuscitation
• SAFE Paediatrics: Developed in 2014, this course emphasises the principles of safe care for children, including anaesthesia for common elective and emergency conditions in children, pain management, fluid resuscitation, trauma, and newborn and paediatric life
In 2017, the SAFE Operating Room course was developed in recognition of the need for multidisciplinary training to support safe surgery. Developed in partnership with the Royal College of Surgeons of England, the Association for Perioperative Practice, the Royal College of Obstetricians and Gynaecologists, and the Lifebox Foundation, course content is based on the WHO Standards for Safe Surgery and includes sessions on leadership, teamwork, communication, decision making and conflict resolution, as well as surgical site infection prevention, the WHO Surgical Safety Checklist, procurement, and quality improvement.
SAFE courses can be run as standalone training, although are often run as part of broader capacity building projects and in collaboration with national anaesthesia societies, educational institutions, health authorities and partner organisations including Mercy Ships, Smile Train, Operation Smile, International Committee of the Red Cross and other international organisations and teams. This approach, along with training of local trainers, and provision of equipment and materials, contributes to building sustainability.
The initial approach combines visiting anaesthetists with local instructors, who are provided with a one-day SAFE ‘Train-the-Trainers’ course to become the in-country faculty of the future. Ongoing support is provided thereafter to establish local expertise in course delivery.
Over 1,350 trainers have taken part in the ‘Train the Trainers’ course and many courses are now being run independently by local and regional trainers.
The SAFE initiative is managed by the Association of Anaesthetists' SAFE Steering Group who oversee the management of SAFE including course materials and updates, language translations, funding, monitoring and evaluation, impact, and strategy.
As the SAFE initiative expands, further models of training have been developed and piloted to strengthen the impact and sustainability of SAFE including:
• Adaptations to create context specific courses for delivery in specific regions or countries; the modular nature of SAFE courses lends itself to this
• SAFE course refresher and commitment to change workshops
• SAFE on-site training and mentorship programs to accompany classroom learning
• Incorporation of courses into national anaesthesia curricula or other training programmes
• Combining SAFE modules or courses with other short courses
• Online and hybrid options (see below)
In addition, new versions of SAFE Paediatrics courses have been developed in response to feedback and requests from SAFE partners. These include:
• SAFE Paediatrics GBI: A version of the original course adapted for UK anaesthetists in 2019. To date, 15 courses have been delivered in 10 UK locations, with funds over and above running costs directed back into supporting courses in low-resource settings
• SAFE Paediatrics Cleft: Launched in 2022, this course focuses on the principles of providing safe anaesthesia to children undergoing cleft lip and palate repair surgery including sessions on intercurrent illness and associated conditions and syndromes
Whilst originally designed for low resource settings, there has been increasing interest in SAFE from higher-income settings. The Japanese Society of Pediatric Anesthesiology have been running a locally adapted version of SAFE Paediatrics GBI since 2021, and there is growing interest from other countries, potentially expanding SAFE further as a global education program.
Scan QR code for more information, to apply for SAFE funding, or to register an interest in becoming a trainer
SAFE Online (https://safe-anaesthesia.org) provides online SAFE courses (currently Obstetrics and Paediatrics) via interactive e-learning. Following development in 2021, and a two-year period offering online courses to registered groups, the platform launched open access in March 2024. The learning platform is mobile compatible, minimises data usage and allows users to access materials and work offline, providing flexibility to continue learning when there is no connection, and the potential to reach more providers and enable shared learning across broader geographical locations. Enabling both online and hybrid options, where e-learning is accompanied by interactive online discussions +/- in-person skills days, courses can be completed by individuals, or by groups who complete the courses over a given timescale. Materials can also be used as pre-course preparation and/or post-course refreshers. Since its open access launch in March 2024, the platform has over 800 registered users across 145 countries.
Standardised monitoring and evaluation have been used to evaluate learning and impact across multiple countries in East, Central, and Southern Africa, and in South Asia. These evaluations have demonstrated retention of knowledge and skills and, utilising qualitative methodology, reported improved confidence and positive behaviour changes. In addition, workplace observations following the SAFE Obstetrics Course have shown positive behavioural change, suggesting translation of knowledge into clinical practice (for reference list see ‘Impact and Sustainability’ page at https://safe-anaesthesia.org).
In addition to a continuous medical education opportunity, the courses have provided a platform for the development of support networks and collaboration among anaesthesia providers locally, regionally, and globally.
Jolene Moore
SAFE Program Lead
Consultant Anaesthetist, Aberdeen
Over 50 countries Over 300 courses delivered Over 1350 trainers Over 9000 participants trained
Our courses: Obstetrics (since 2011, with Obstetric Fistula module added in 2021) , Training of Trainers (since 2012), Paediatric (since 2014), Operating Room (since 2017) and Paediatric-Cleft (since 2021).
"The course was amazing. Previously, I saw these topics as minor issues, but this training has helped me understand their broader impacts on our work. We gained valuable knowledge and shared insights from colleagues in different hospitals. The sessions were brief and clear, so I’ll be making some changes in my work based on what I learned. Very productive and educative -it’s already helping me improve OR practices with my colleagues”.
Jennifer Landry is an anesthesiologist at Saint John Regional and St. Joseph’s Hospitals in Saint John, NB, and an assistant professor at Dalhousie University. Born and raised in Saint John, she completed her undergraduate studies at McGill University, medical school at the University of Ottawa, and Anesthesiology residency at Western University. Landry serves a diverse patient population in both official languages and has been active with the NB Section of Anesthesiology since 2018. A former competitive judo athlete who represented Canada internationally until 2019, she enjoys diving, kayaking, gardening, and exploring Saint John’s natural beauty
It’s just after midnight, and this night isn’t going as expected. I’m on call and have done two cases since the beginning of my shift: a fractured hip, and a fractured ankle. I was feeling a bit unwell earlier today, but I thought I could make it through this shift and get some rest later. In actuality, the symptoms have worsened as the night progressed, and I’m feeling miserable. I have two cases left before I can even think about sleep. As I’m informed my next patient is ready, I consider whether I should call for relief. Thankfully, I have a group of very supportive colleagues who would help in an instant if I needed them. I’m careful however, to use this lifeline sparingly, as these colleagues are scheduled to work later today, and the pressure to keep rooms running and avoid exhausted anaesthetists working is real. I decide to press on and stay focused.
Miraculously, I make it through a hip washout and an appendectomy, and drop my patient off in the PACU. It is now 4:00, and this is the worst I’ve felt all night. Like a runner physically spent after a race, I sit on the recovery room floor. I pray to the Anaesthesia Gods that no more cases materialise, and that the labour and delivery ward remains quiet! The general surgeon is dressed in street clothes and appears to be heading out: a moment of relief and joy. The lingering threat of a laparotomy seems to be dissipating. The nurses are clearly concerned about me and offer an IV. I take them up on their offer. A stretcher is pulled around, I hop on, and the kind nurses resuscitate my sickly body with IV fluids, ketorolac, acetaminophen, and ondansetron. I settle in the call room bed and get some much-needed sleep until the daytime crew arrives a few hours later.
I spend the rest of the day sleeping and resting. A potential new member of the department is coming for a site visit today, and I was looking forward to meeting him at our
departmental dinner later tonight. I’m disappointed I will have to miss this. I was also looking forward to a social evening with my colleagues. They are a quirky and funny group of people, and I have fun hanging out with them. I decide to rest up and hopefully I can make it into work tomorrow.
I wake up at 6:00 and assess my situation: better than yesterday, but not quite back to normal. I’ve asked for an easier day at work, and I think I can manage. I’ve been assigned a gynaecology list with only two cases, to be done at a smaller hospital in the city – St. Joseph’s Hospital. When I first started working here, we only did day surgery cases. When most of the arthroplasty programme was moved to this hospital a few years ago, some healthier inpatient surgeries were added to the roster. I very much enjoy working at this hospital occasionally, and as every member of our department rotates through, I end up there about once a week. The added bonus is I can walk there from my house!
Once I’m ready, I set out on foot. The first order of priority is coffee. I walk to the coffee shop and then to the hospital. It’s an extra 15 minutes of walking, but well worth the effort! I arrive and am pleased to see the mood is lighthearted, and the playful banter has already begun. I enjoy teasing the respiratory therapists and nurses, and they like to tease me back. The atmosphere at this hospital is more relaxed, and many patients have commented on how much they appreciate it. My first patient for a laparoscopic hysterectomy is young and healthy – a rare treat these days. The case proceeds uneventfully. I’m feeling relatively well, apart from a lack of interest in food. My second case is a laparoscopic salpingectomy and endometrial ablation in a second, young and healthy patient. The Anaesthesia Gods are being kind to me today! We finish early, and I’m happy to head home after
checking in with my patients. I’ve finally worked up a small appetite, so I stop by the City Market for a soup and continue walking home.
After a short rest, I head to the Aquatic Centre for a swim. I’m hoping a little water immersion will do me some good! Tuesday nights are my tap-dancing nights, so I head to the dance studio for a fun class. So far, I’ve walked everywhere today, a benefit of living in the centre of a small city. And as is common in small cities, you can’t go anywhere without running into someone you know. Almost half of the tap class also works at the hospital. Two of my tapdancing buddies work with me in the OR, my teacher is a dialysis pharmacist, and there’s also a dialysis nurse!
I’m feeling back to normal today. The morning starts with our weekly departmental rounds. The topic today is Morbidity and Mortality. Two of my colleagues present a case they feel warrants discussion. One is a thoracic patient with a very difficult airway that ran into respiratory difficulties a few days post-op, the other is an obstetrics case. A good discussion ensues between department members on flagging difficult airways for the postoperative period.
Today’s list has two cases: one is a re-resection of a recurrent rectal cancer which will involve my general surgery and urology colleagues, and the other is a sigmoid colectomy. The general surgeon gave me a courtesy call on my way to the hospital to mention this case would be more complex and may involve more blood loss than usual. I had already anticipated this; however, I appreciate the heads up, and the ability to discuss the day’s plan. The patient had an earlier abdominoperineal resection, and a long course of neoadjuvant chemoradiation therapy. I start the case uneventfully, and ensure I have excellent IV access. The surgeons struggle as the case is complex, but they never seem frustrated. There is no significant rapid bleeding, but a prolonged slow ooze throughout, which requires the transfusion of six units of blood and a dose of platelets and keeps me busy all day. We finish the first case at 16:15, so the second case is cancelled.
Starving, I head home for a bite to eat. I’ve not had anything to eat all day and had my first bathroom break at 15:00! Tonight is jazz night, and I don’t want to miss it. Joel Miller is playing. I’m conflicted though, as I have a lot of reading material before my upcoming Board meeting this weekend and my Section meeting tomorrow. I compromise and get some work done at home first. I then head to jazz night to enjoy the music and read about governance (a riveting topic for an anaesthetist)!
Today is a big day. On the roster are two scoliosis cases. I arrive at the hospital earlier than usual. My set up is a little lengthier with the planned neurophysiological monitoring. I’m already familiar with the second patient as I met them previously in the preadmission clinic, but I’ve not met the first patient who is 12 and has idiopathic scoliosis.
The first patient is very anxious, but the team successfully reassure and distract her, and she is surprised at how painless the IV insertion turns out to be. The induction of anesthesia, line insertion, and intravenous maintenance proceed uneventfully. Baseline signals are good, then surgery begins. We are fortunate to have a person at our centre who performs intraoperative spinal cord monitoring. One used to occasionally travel from a centre four hours away, and it would make scheduling scoliosis cases much more difficult. Where I trained previously, the anaesthetists would do the monitoring and the anesthetic. I’m happy that’s not the case here!
The invasion of my personal space begins with the mass of equipment for the image-guided surgery converging on my side of the blood brain barrier. The various stealths and O-arm imaging units take up space but are a necessity. We complete the image acquisition, and the process of inserting screws starts. The surgery takes longer than expected, as the patient's curve is quite pronounced and rotated. There is some blood loss, but it’s only significant enough to generate a small amount of replacement product via the cell saver. We are a cardiac centre and have perfusionists to run the cell salvage. They really are a fun bunch of people, and I'm happy to work with them even though I don’t give cardiac anaesthetics. We finish the first surgery around 13:30. The final images show a very successfully straightened spine! The patient is somewhat slow to wake up but is neurologically intact. On to the next!
The second patient is 18, and much more relaxed than the first. We’re running late, but everyone on the team agrees to stay. I’m hoping we will be done by 18:00, as I have a Zoom meeting to run tonight, but what will be, will be! The second case proceeds in a similar fashion to the first, but the curve is not as challenging. As the final sets of images are acquired and examined, a curve ball is thrown: one screw is not in the right place. We need to redo that part. There is no way I can host a meeting now, as we will not be done on time. I quickly write an e-mail to my provincial colleagues to notify them of the last-minute cancellation of the provincial section meeting. The screw is reinserted, and we finish the case at 19:45. The patient wakes up and does very well. This may seem like a late finish, but compared to my last assigned scoliosis list, this is early! Several months ago, we did the first neuromuscular scoliosis cases at our hospital – two siblings with spinal muscular atrophy who had travelled from another city – and the whole team stayed until 2:00 to finish the cases. That is the longest elective list I have ever done!
I head home for some much-needed decompression, and an early bedtime!
I’m leaving later today for the Canadian Anesthesiologists’ Society (CAS) Board meeting in Montreal. I’m looking forward to seeing my colleagues from across the country again. But before that, I have lots to do! I pack my bags, clean up around the house, and review the last few Board meeting documents. I’m also behind on getting my business taxes to my accountant; I absolutely need to tackle that today. I force myself to focus, and though it's a painful process, I’m relieved to finally have it done. Time to drop off the documents on the way to the airport!
I arrive to find my colleague and his wife already there. It’s rare, I think, to have two people from a small hospital simultaneously on the Board of Directors of a national organisation. This speaks to our hospital staff’s desire to get involved and try to influence positive change. Our little department of less than 20 has had a past CAS president, an executive member, multiple board members, and a few different committee members.
The one-hour flight to Montreal seems to take no time at all. I take the bus into the city and initially think I might make it in time for the social event. But alas, the road is suddenly blocked off by police, and we are forced on a lengthy detour. I doubt the social event is on the cards for me tonight. After a long delay, the bus drops me off in the middle of the road, and I walk the rest of the way to the hotel. I used to live in this city, so I know my way around. It does seem quite a bit more chaotic tonight than I remember though. As I walk, I encounter riot police, who suddenly start tapping their shields and marching military-style down the road. I follow the military-style unit as they turn onto the hotel street, and march along with them until I find my hotel. I later discover the news of a large protest happening in this area before I arrived. I will get some rest tonight, so I am ready for a day of meetings tomorrow. What a start to the meeting weekend! And what an end to an interesting week.
Jennifer Landry MD, FRCPC Anesthesiologist, Saint John Regional Hospital, Canada CAS Board of Directors
The most difficult period of my career began on a sunny Saturday morning. I’d just sat down with a coffee to catch up with the neverending emails. One of them was from my employer. They were instigating formal disciplinary action against me. Having found gaps in my notes, they were alleging that my operating techniques were deficient. I was restricted to non-clinical duties pending investigation.
I just felt numb. I called Medical Protection and was assigned a very supportive medicolegal consultant. That support was a lifelineespecially when, not long afterwards, I was completely suspended.
Medical Protection instructed an independent expert surgeon, whose main criticism was around record-keeping. I did a lot of reflection on this and took an online course as part of my membership.
Eventually, the investigation found no grounds for ongoing suspension, and I returned to clinical practice. Medical Protection got me through those two long years of regulatory and legal process, and constantly kept the pressure on the hospital to move forward. More than that, their insight and understanding helped to make me a better doctor.
A mother's wail needs no translation. It comes not from the lungs but from the heart. Directly from and to the universe.
Shaking she rounds the nurse's station, both wall and daughters keeping her upright. She had been briefed. We had cleaned his face. She hovers by the door before her cries become louder, knees weaker, breath frail and shuddery.
My boy.
My boy.
My boy is a year and a half. Hers, 25.
Her boy.
They stung, those words. Penetrative. Melancholic faces in green, blue, navy, not knowing where to look. There was nowhere to look. Some ask to leave, quite rightly. Adrenaline kept him going for a short while.
He was found 50 yards from his vehicle. Prehospital did everything they could. Pupils no longer moving.
Black holes. Her boy.
Jonny
Dauncey
ST5 Anaesthetist, Welsh School of Anaesthesia
Jonny would welcome direct messages to: jdauncey@nhs.net
I work in anaesthesia because I am fascinated by human physiology and how anaesthetics interact with the body in complex responses. Early in my career, working as a registrar in paediatric orthopaedics, I cared for a child undergoing a procedure who tragically didn’t survive due to anaesthesia complications. This experience deeply affected me and I realised the critical shortage of anaesthesiologists in my country and the life-saving role they play. My passion for physiology and commitment to acute care shaped my decision to be an anaesthesiologist, knowing that I could make a difference in the lives of patients in critical situations.
As co-founder of Essential Emergency and Critical Care (EECC) with Tim Baker and Otto Schell, my role stems from our shared frustration at seeing patients die due to a lack of basic, lifesaving care in hospitals. Together, we conceptualized EECC as a solution and have since built consensus on its content, conducted extensive research, and initiated its implementation.
What I love about my role is the opportunity to make a meaningful impact on people’s lives. With over a decade of experience as an anaesthesiologist, I’ve realised that despite tremendous efforts we make in acute care, patients deteriorate and lose their lives in wards and other parts of hospitals due to gaps in the most basic essential care. These experiences drove me to seek solutions to help healthcare providers deliver efficient, timely lifesaving care to patients. My determination is to ensure no patient dies due to a lack of essential care.
I love the sense of a fresh start that Monday mornings bring. At the POETIC (Provision of Essential Treatment In Critical issues) office at MUHAS (Muhimbili University of Health and Allied Sciences), I start by checking my to-do list before our morning meeting at 9:00. Our team is tightly knit and focused on advancing Essential Emergency and Critical Care (EECC) for critically ill patients. We meet to review last week’s progress, discuss shortcomings, and lessons learned. Today, our team achieved 88% of our weekly which made us proud and keeps us motivated. Our work spans research, advocacy, policy development, and implementation, with two major projects underway: EECC Integration in Primary Health Care in Mainland Tanzania and Zanzibar (EECCiT) and the African Partnership for Perioperative and Critical Care Research (APPRISE).
A highlight of our Mondays is sharing breakfast, alongside an uplifting discussion led by the ‘breakfast host.’ Today’s delicious casserole, made by our coordinator Aneth, and a discussion on ‘gratitude’ added warmth to our meeting before we broke into project-specific discussions to strategise for the week.
Tomorrow, I’ll travel to my home island, Zanzibar, to attend a symposium organised by the Ministry of Health and the Emergency Medicine Services Academy (EMSA). Tim - my EECC co-founder, mentor and supervisor - and I, will lead a session on EECC and a three-day EECC champions workshop.
In the afternoon, I finalise workshop materials, organise tasks for the week, and align my team for the days ahead. The excitement of the symposium and the potential to strengthen critical care in Zanzibar energises me as I wrap up the day.
Today marks the first day of the Building Capacity of Emergency and Critical Care Services to Strengthen Access to Quality Care at the Primary Health Care Level in Zanzibar symposium. Alongside Tim and three EECC facilitators, I delivered a session on EECC and preparing for the threeday EECC Champions Workshop. The workshop is an initiative by the EECC Network empowering individuals to champion and spread EECC locally and globally. Since 2023, the Tanzania hub, based at the POETIC-MUHAS office in Dar es Salaam, has conducted workshops targeting
movers and shakers from different levels of the health care systems from Tanzania and globally. Tim chaired the EECC session, outlining the global and Tanzanian burden of critical illness and the importance of sustainable systems rooted in EECC. Building on this, I presented an overview of EECC, from the unmet need and conceptualisation to global research, content consensus, and its ongoing implementation in Tanzania, with Zanzibar as a key focus under the EECCiT initiative.
The symposium’s venue, set against Zanzibar’s stunning beach, gathered healthcare providers, trainers, policymakers, and dignitaries, including the Health Minister and the Second Vice President of Zanzibar. It provided an ideal platform to raise awareness and advocate for EECC as a solution for improving care for critically ill patients. Government officials shared progress in strengthening primary healthcare systems, while emphasising persistent gaps. EECC stood out as a critical solution, complementing significant investments in oxygen systems, ICUs, and EMDs.
The day ends with networking, where we discuss improving the care of critically ill patients. Back home, my mom and sister surprised me with my favourite seafood meal. We spend time catching up with my brother who had just arrived from abroad two days prior, adding personal fulfilment to an already impactful experience.
The day began early with preparations for a three-day EECC workshop. Our mission was to train 23 participants—nurses, doctors, trainers, and hospital administrators—into EECC champions equipped with the knowledge and skills needed to deliver life-saving care, even in resource-limited settings. These champions would not only implement essential care for critically ill patients in their facilities but also advocate for sustainable systems to improve outcomes. This was the
fourth EECC Champions Workshop my team has organised. The group was especially interesting because it included professionals directly from their facilities, offering practical ideas and experiences. Most participants were women, many sharing challenges I have faced in advocating for better care throughout my career. Alongside my team of three skilled trainers, we facilitated interactive sessions that blended foundational principles with feasible strategies for implementation.
During a break, I joined a World Federation of Societies of Anaesthesiologists (WFSA) Critical Care Committee meeting via Zoom. I’m passionate about WFSA’s work, including integrating EECC into global critical care initiatives, leading SAFE and VAST courses and developing new training programs. Today’s discussion focused on creating an EECCthemed ‘Anaesthesia Tutorial of the Week’, organising a webinar, and writing a review article for Update in Anaesthesia.
By day’s end, participants were energised and equipped with EECC’s core principles. A trivia game added a fun, educative touch. I ended the evening with a stroll through Stone Town’s streets, reconnecting with a childhood friend—a perfect close to an impactful day.
We arrived early to set up and refine our approach for day two of the EECC workshop, adapting the content to fit Zanzibar’s healthcare context. Our goal was to emphasise why EECC is essential as a practical solution for critically ill patients. Recognising the importance of clear communication, we used more Kiswahili, which participants understood better. The sessions were interactive, with presentations, group discussions, and icebreakers to keep everyone engaged. In small groups, participants examined differences in their practices and identified challenges to implementing EECC. A highlight was the ‘Defend-EECC' role-play, where participants practiced advocating for EECC across different levels of care. This activity deepened their understanding of EECC and their role as champions.
Midday, I attended a WHO Research Prioritisation Working Group meeting on global optimisation of respiratory support. As oxygen therapy is core to EECC, I’m passionate about contributing to initiatives that ensure essential care reaches low-resource settings, aligning with my commitment to feasible, equitable care.
Later, the symposium organisers and I met with Zanzibar’s Ministry of Health permanent secretary, who was pleased with our work and requested an East African Regional Conference on EECC to be held in Zanzibar next year, with our team collaborating with ministry colleagues to organise it.
To unwind, I joined colleagues running the other sessions alongside our workshop at Zanzibar’s famous Forodhani Gardens. We watched the sunset, enjoyed fresh sugarcane juice, and savoured Zanzibar ‘mix,’ ending a fulfilling day with a taste of home.
We had to plan Friday carefully, as in Zanzibar, the lunch break aligns with Friday prayers, which start promptly. To accommodate this, we asked participants to arrive early and began our session 30 minutes ahead of schedule.
The day focuses on helping participants develop plans to implement EECC in their healthcare settings. By this point, participants understood EECC principles, content, and importance, allowing them to draft feasible, actionable plans. They presented their drafts to peers, refining ideas with feedback, and shared final versions with the EECC Champions Coordinator for ongoing support. A representative from the Ministry of Health visited our workshop and was impressed by participants’ energy and enthusiasm. The ministry recognised EECC’s importance in providing foundational, lifesaving care like identifying critically ill patients, administering oxygen and fluids, positioning patients in recovery, and organising resources to ensure bedside readiness when patients become critically ill.
No EECC workshop is complete without participant feedback and a celebratory ‘EECC Champions’ cake. We wrapped up on a high note, with participants energised and committed to improving critical care in Zanzibar. Our lively closing celebration was the envy of the other trainings!
In the evening, the Ministry hosted a gala dinner to thank all symposium facilitators. I was asked to give a vote of thanks on behalf of all the trainers and facilitators. It was a beautiful
evening of laughter, awards, networking, and discussions about future collaboration, filled with warm conversations that strengthened connections among colleagues.
I spent a peaceful Saturday with my mother and family in Zanzibar. The slower pace of life here is incredibly relaxing, and weekends in Zanzibar help me unwind and recharge for the week ahead. The newly renovated roads with well-lit walkways make evening strolls especially enjoyable. My sister, brother, and I took a walk, ending the night at Zamani cafe where we tried on traditional outfits, ate delicious traditional Zanzibari food and enjoyed an ambience of old times—a perfect way to cap off the evening.
Early on Sunday morning, I took the ferry back to Dar es Salaam. The stunning view of Zanzibar’s Stone Town coastline is one I never get tired of. Back home, I enjoyed a quiet day with my husband and four wonderful kids, wrapping up the evening with some reading. It was a perfect moment to reflect on the past week’s experiences and make plans for the week ahead.
Karima Khalid
Consultant Anaesthesiologist, Lecturer and Researcher Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
Instagram: @barmuasab
Twitter: KJK
LinkedIn: Karima Khalid
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Venue: Peebles Hydro in the Scottish Borders, reduced rates for conference delegates
Great value CPD and a chance to network with colleagues from across Scotland and beyond
Dinner and Ceilidh 24th April 2025
Keynote Speaker: Dr James Robson MBE, A life in sports medicine
Topics will include: Periop Medicine across the British Isles, obstetrics topics, paediatric emergencies, periop care for transgender patients, organ donation, top 10 papers and much much more
Trainee abstract competition will open in January. Email: ssatraineerep@gmail.com www.ssa.scot For full details and booking link visit:
This article describes my personal experience as an anaesthetist in end-of-life care of my partner at home
I’m a cardiothoracic anaesthetist working in a tertiary hospital in Brussels, where my primary focus remains clinical anesthesia—a field I’m truly passionate about. However, I’m also fortunate to be involved in several exciting research projects.
I was born in Iran and, due to the Iran-Iraq war, left my homeland in 1986. From a young age, I knew I wanted to pursue medicine, and although anaesthesia wasn’t initially my first choice, it turned out to be one of the best decisions I’ve ever made. At the time, it was simply the specialty with available spots, but looking back, I’m so grateful for that twist of fate.
I’ve been living in Belgium for the past ten years with my partner, Piergio, an Italian engineer who made the brave decision to leave his family and career in Italy to start a new life with me here. We’ve shared a simple but joyful life, just the two of us, without children. Our bond deepened during the full COVID lockdown in March 2020, and in April 2020, we celebrated his 50th birthday in a quiet, intimate way.
The shock was overwhelming. My instinct was to turn to PubMed to learn everything I could, but the information I found was devastating. The survival rates were disheartening, even with aggressive treatments. It felt like our peaceful life had been ripped apart in an instant.
"The purpose of life is to discover your gift. The work of life is to develop it. The meaning of life is to give your gift away."
Quote by David Viscott, sent by Piergio in an email to M. Momeni
Belgium’s healthcare system is well-organized, and when you turn 50, you’re given a colorectal screening test at home. It was during this routine test that Piergio received the unexpected news that he had tested positive. None of us were overly concerned at first, as his father had lived with Crohn’s disease for years. But soon after, a colonoscopy revealed a large rectal mass. Within days, we learned that Piergio had an aggressive and rare form of cancer.
Piergio’s treatment plan began with chemotherapy, followed by radiation and surgery. I made sure to be there with him through every chemotherapy cycle. Sadly, the response to the treatments wasn’t as promising as we had hoped, but surgery was still scheduled. I was happy that as an anaesthetist working in the hospital, I had the opportunity and the privilege to be actively involved in the organizational aspects of his treatments and more specifically his surgery. Thankfully, the surgery in May 2021 went well, despite a few minor complications. After a slow recovery, Piergio regained enough strength to dream again, particularly about his lifelong passion for astronomy and the telescope he had brought with him by car from Italy, which weighed 34 kg and measured 190 cm (Figure 1). It was a beautiful symbol of his resilience and his enduring spirit.
But just a couple of months later, in July 2021, Piergio began to feel unwell again. He experienced severe abdominal pain and distension, and I knew something was terribly wrong. The replacing oncologist told us that the CT scan showed peritoneal carcinomatosis and that there was nothing to be done. It’s hard to describe the feeling in that moment, all I could do was cry, I felt paralyzed with grief, but Piergio, ever strong, told me he wanted to die at home.
That day, I began the painful process of organising his endof-life care. I sought advice from a palliative care specialist who told me that death cannot be planned, even with the best of care. I’ll never forget those words.
A few days later, Piergio’s personal oncologist confirmed there was nothing more to be done and gave us a grim prognosis: 4 to 6 weeks. We started home-based palliative care, and initially, Piergio seemed determined to fight. But as his symptoms worsened—the pain, the bloating, and eventually the difficulty breathing—it became clear that his body was giving in. He could no longer eat, and the oral pain medications were no longer enough. He needed me for everything, but he didn’t want anyone else to help.
In his final week, we made the decision to switch to morphine for pain relief. To my surprise, it was administered subcutaneously, which led to widespread haematomas. Knowing he had a well-functioning port-a-cath venous access, I couldn’t accept that every medication (saline, morphine, midazolam…) would be injected subcutaneously. I had to send an email to our family physician and ask her to give the permission to the palliative care nurses to use the port-a-cath. However, nobody within the palliative care system was able and willing to perfuse the port-a-cath. I had to do it by myself.
Piergio had become more distrustful of the nurses, especially after a failed attempt to insert a nasogastric tube, so I took over that task too.
In those final days, I took on the role of caregiver, nurse, and partner, often staying awake at night to monitor his condition. The nights were long and sleepless. I was terrified of losing him, and at times, the fear and exhaustion seemed overwhelming. But as his condition worsened on his final day, I knew I couldn’t leave him alone. His body language had changed, and I made sure to repeat over and over that I would stay by his side no matter what.
At one point, he opened his eyes and whispered, "Ti amo"—"I love you." A few hours later, I called our family physician in an emergency. I knew I needed to administer large doses of morphine and midazolam, but I didn’t want to make that decision alone.
Piergio passed away in my arms on August 31, 2021, just one year after his cancer diagnosis. Looking back on that year, I realize how many roles I played in those final months. I was a partner, a caregiver, a ‘triloved’ woman, as Piergio used to call me. But most importantly, I was able to use my skills as an anaesthetist to provide him comfort during his suffering. Whether it’s called palliative care or anaesthesia doesn’t matter. The goal is the same: to relieve pain and bring comfort. And I now see that many of us in the anaesthesia field already incorporate aspects of palliative care into our daily practice without even realizing it.
Every day without Piergio is still a struggle, but I’ve come to understand that I couldn’t have given him that small piece of peace and reassurance if I weren’t an anaesthetist. I’m proud of my work, and I’m grateful for the privilege of having been there for him in his final days.
Piergio: Born in Italy on April 24, 1970 – Deceased in Belgium on August 31, 2021
Acknowledgements:
I would like to thank Louise Bragge, Philippe Baele and Francis Veyckemans for reading the manuscript and their kind suggestions in improving the text.
Mona Momeni M.D., Ph.D.
Deputy Head of Department, Department of Anaesthesia, Cliniques universitaires Saint-Luc; Brussels, Belgium
Immediate Past President BeSARPP (Belgian Society of Anesthesiology, Resuscitation, Perioperative medicine, and Pain management)
ESAIC Council member for Belgium
Figure 1: Piergio’s telescope at home in Belgium. Piergio donated his telescope to ‘Schiaparelli Observatory’ in Italy with the wish to send it to Hakos Farm, 130 km from Windhoek (Namibia), where it is currently used.
It's your
Anaesthesia
News… and we’d love to encourage more of our readers to share their opinions and experiences.
A prize will be awarded to the best letter in each issue. The winner will receive their choice of a brand new book from our collection of previously featured reviews and interviews in the magazine.
To increase your chances of winning:
• Keep it short (no more than 300 words)
• Be clear and accurate
• Use humour where appropriate
• Keep it topical
The award will be made at the discretion of the Editor, and her opinion will be final. No cash alternative is available. We will contact the winner to select their book and arrange free postage.
Send your letters to:
The Editor, Anaesthesia News at anaenews.editor@anaesthetists.org
Dear Editor,
In recent weeks I, along with many others, have struggled greatly trying to insert the fluid giving set spike into the DEMO SA’s metronidazole and paracetamol bottles. Removing the ring pull is only the prelude to the ensuing battle one encounters.
The force required to pierce the bottle is considerable. People have been reported placing their body weight in a downward direction on top of the spiker, twisting ferociously as they try to connect the two items, searching the department for the self-proclaimed strongest human or ultimately questioning the efficacy and evidence-base behind prophylactic antibiotics or indeed paracetamol, the latter a vain effort to bypass the struggle entirely. One could surely cause grave injury to oneself or others if they were to slip at an inopportune moment during these efforts.
However, whilst the issue is reported, a temporary solution has been discovered. Gentle prior piercing of the insertion site on the bottle with a needle – ideally a non-filtered drawing up needle – weakens the insertion point and results in just reasonable human force being needed to connect the medication to the giving set. Multiple piercings in a circular pattern seems to be the optimal approach. This has been found to almost entirely remove antibiotic bottle piercing stress or unsolicited upper body workouts in the anaesthetic room.
Yours faithfully,
Joseph Gallaher ST5 Anaesthetics
Preeya Chakraborty Consultant Anaesthetist, Lewisham and Greenwich NHS Trust
Dear Editor,
As head and neck anaesthetists and also dog owners, we were delighted to discover a potential alternative, affordable supply of eFONA training materials in our local pet shop (Figure 1).
These tracheas are available in various sizes, ranging from ostrich (paediatric) to buffalo (large adult), and in various preparations (cured/dried or raw/frozen) to suit institutions’ differing storage requirements and preferred level of training fidelity.
If you are (barking) mad enough to use these for an airway workshop, participants’ religious beliefs, local infection control policies and anatomical limitations must be taken into consideration (dimensions differ from human tracheas, and larynxes with cricothyroid membranes are not included). Sometimes sold as ‘windies’ (wind pipes) in the pet world, it is worth noting that they don’t smell too great either (to humans!).
No competing interests.
Jane Louise Orrock
Advanced Airway Fellow, St John’s Hospital, Livingston
Patrick Alexander Ward
Consultant Anaesthetist, St John’s Hospital, Livingston
Can you introduce yourself and your careers in pain medicine?
Hi, I am Vasu, a consultant in pain medicine in Leicester. I did my medical schooling in India and worked for five years postgraduation before coming to the UK. My senior house officer training in anaesthetics was in Glasgow and registrar training in the Welsh School of Anaesthesia. I had the opportunity to do a one-year fellowship in pain medicine in London. I worked as a consultant in anaesthetics and pain in North Wales for eight years before selecting a full-time pain medicine career in Leicester for the last 10 years.
Hi, I am Shyam, a consultant in pain medicine in a university hospital. I was a medical school colleague of Vasu and had a similar career pathway. In the UK, I started my anaesthetic training in the Yorkshire Deanery before moving to the Midlands. I completed a pain fellowship in Canada before taking up a consultant post in Coventry in 2007.
Why was it important to you to create a treatment guide for back pain?
Back pain is the most common condition encountered by a pain specialist. Management of back pain is complex given the varied presentation and the way it affects a person as a whole. Given the fact that there are multiple differing guidelines, there is limited evidence for all interventions and treatments for back pain. Even though the guidelines base their guidance on clinical efficacy and cost-effectiveness, pain consultants need a range of tools in their armamentarium to help pain sufferers. We felt that it was essential to create a simple, easy-to-read manual that can help clinicians to manage people living with back pain. With clinical experience in the field of pain for nearly three decades, and our academic/teaching credentials, we were confident about preparing a manual to guide clinicians, carers and patients.
What are the main messages you’d like readers to take away from The Back Pain Manual: A Guide to Treatment?
We want our readers to have a simple approach to diagnose and manage people with back pain. After reading the manual, they will have a clearer understanding of the pathology of back pain. They will know how to triage a person presenting with back pain and will be aware of multimodal management strategies encompassing biopsychosocial aspects. The manual should enable clinicians to improve the quality of life of a person with back pain, rather than treating the symptoms alone.
The manual is aimed at helping all clinicians involved in managing back pain. It may also help increase a patient’s knowledge where they are interested in learning more about their condition. Hospital and primary care doctors, nurses, physiotherapists, psychologists, occupational therapists, medical students, and all healthcare professionals will find the book useful to improve their understanding of this common condition. For patients, there are sections on selfmanagement, education, exercise, nutrition, sleep — all of which are relevant to back pain management. The evidence shows that education improves long-term prognosis in back pain.
Back pain is a common theme in most pain qualification exams. Resident anaesthetists and candidates sitting exams will find this manual handy when preparing for their assessments.
Which kind of manuals did you find useful when preparing for examinations?
Examinations are indeed a stressful experience! We did our examinations many years ago. Textbooks, manuals and online resources tailored for exams were limited at that time. We found that Royal College publications with multiple choice questions and the BJA Education (CEACCP in those days!) were very useful for our examinations. The lack of easily readable resources for back pain, even in the present day, motivated us to write this manual. We hope that clinicians will use this manual in their practice even after passing their examinations.
You’ve mentioned that healthcare professionals are able to influence people’s beliefs about their back pain. How can clinicians positively influence people’s approaches towards healing back pain?
“If knowledge is power, communication is the king”. Education is the key to influencing people’s belief about back pain. We clearly know that catastrophising worsens the outcome of back pain. Despite decades of education in back pain, we still see patients telling us that previous clinicians have told them that their “spine is crumbling”, “discs are damaged”, “you will end up in a wheelchair” — our manual will help to change this! Appropriately used metaphors emphasise the importance of maintaining activity when living with back pain. We have written dedicated chapters on communication and metaphors. We firmly believe that clinicians have the power to influence the attitude of a patient and rescue them out of the vicious cycle of ‘pain — disuse — disability’.
You mention the number of people worldwide experiencing low back pain is predicted to rise from 619 million to 843 million by 2050. Why is this?
Thanks for asking! This is not our prediction as authors of the book, but we have quoted from the evidence given by the World Health Organization (WHO, 2020). NHS England (2016) estimated that 11% of the total disability in the population is accounted for by back pain. It is estimated that 15-20% of adults have back pain in any given year, and 50-80% experience at least one instance of back pain during their lifetime.
We believe that the COVID pandemic has worsened the trend. This could be due to changing work patterns as well as the effect of long COVID in the population. The Office for National Statistics (ONS) in the UK has shown that problems with the back and neck rose by 28% between 2019 and 2023. Back pain is an epidemic and is attributed to a multitude of medical and psychosocial factors.
Divine is the task to relieve pain. We are passionate about our job as it allows us to make real changes in people’s lives. Service users are thankful for our interventions and support. A pain medicine career gives a variety of flexible working options — face-to-face clinics, virtual consultations, providing advice and guidance to general practitioners and multidisciplinary
staff, using our knowledge and skills to perform a variety of injections under ultrasound and fluoroscopy guidance, working in a multidisciplinary team; this variety brings challenges, opportunities and satisfaction. We both are privileged to work in teams with supportive colleagues.
Vasu: I organise a variety of cultural activities in Leicester, UK, ranging from singing and dancing programmes to Tamil (an Indian language) literature events; from Diwali celebrations to Christmas festivals. I am a trustee of a local charity, the RISE Foundation Leicestershire, that has contributed to charitable causes locally as well as globally. I also lead and organise a national medical interview course for A-level students in school, and this is fully run by volunteers with proceeds going to charitable causes. I organise a walking group and walking trips for the local community.
Rise Foundation www.risefoundationuk.com
Shyam: I am a keyboard player in the music band, ‘Bollywood Therapy’; this keeps me energised. Band members, mostly doctors, jam regularly — a great opportunity for relaxation and team building. We have performed in many regional and national gigs. I love travelling with family and friends. My daily routine includes doing the range of movement exercises described in our back pain manual.
Bollywood Therapy https://www.facebook.com/share/VLucim8e19hMcBFt/
Thanthullu Vasu MBBS MD DNB FRCA FFPMRCA
Consultant in Pain Medicine, University Hospitals of Leicester NHS Trust
Shyam Balasubramanian MBBS MD MSc FRCA FFPMRCA
Consultant in Pain Medicine, University Hospitals Coventry & Warwickshire NHS Trust
20% discount code available on the advert on next page. Buy the book here:
Paperback:
ISBN: 9781913755492
260pp
Retail price: GBP £25
Ebook editions:
ePub ISBN: 9781913755508
Mobi ISBN: 9781913755515
Web pdf ISBN: 9781913755522
Back pain is the single leading cause of disability worldwide; the World Health Organization regards back pain as a condition f or which the greatest number of people may benefit from rehabilitation. It is estimated that low back pain alone affects 619 million people globally and this is estimated to rise to 843 million people by 2050. Up to 60% of the adult population will have low back pain at some point in their lifetime. Healthcare professionals see people with back pain routinely in their clinical practice and so education and awareness of back pain and the various treatment options are vital for an effective outcome in these situations. This book will discuss back pain in great det ail and is written in an easytounderstand style, while keeping an evidencebased approach. Doctors, nurses, physiotherapists, occupational therapists, medical students, and other healthcare professionals will find this book informative.
This book will be of immense use to candidates preparing for examinations conducted by the Faculty of Pain Medicine of the Roya l College of Anaesthetists, UK (FFPMRCA), American Board of Anesthesiology (ABA), Royal College of General Practitioners, UK (MRCGP), Colleg e of Anaesthesiologists of Ireland (FFPMCAI), American Board of Pain Medicine (ABPM), European Pain Federation (EFIC) (European Dipl oma in Pain Medicine [EDPM]), Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists (FPM), and the World Institute of Pain (FIPP/CIPS).
20% discount on ALL tfm’s medical books www.tfmpublishing.com and enter promotional code SPO24
Supporting healthcare professionals with practical, everyday solutions to raise awareness, change attitudes and improve working environments.
Back our campaign today to promote:
• Enhanced education
• Protected rest breaks, and
• Better access to facilities
The Association of Anaesthetists will award the Wylie Medal to the most meritorious essay on this year’s topic: Inequalities in health this year: how does it affect pre-operative care & recovery? written by a medical student at a university in Great Britain or Ireland.
Prizes of £500, £250 and £150 will be awarded to the best three submissions.
The overall winner will receive the Wylie Medal in memory of the late Dr W Derek Wylie, President of the Association 1980-82.
For further information and to apply please visit our website: anaesthetists.org/Wylie-medal-2022 or email secretariat@anaesthetists.org or telephone 020 7631 1650 (option 3)
Closing date: 12 January 2022
Are you passionate about undergraduate medical education and want to support medical students? We support aspiring anaesthetists by offering a chance to experience a transformative medical elective or to win the prestigious annual Wylie undergraduate essay prize.
Your role as a national assessor
As an assessor, you’ll have the important task of reviewing and scoring applications from medical students in Great Britain and Ireland. By volunteering, you’ll help guide the future of anaesthesia and the wider medical profession.
Shape the next generation: Your feedback helps aspiring doctors access career-defining experiences.
Professional growth: You’ll receive evidence for your portfolio or revalidation after each scoring round.
Stay connected:
Receive updates from students you’ve helped as they travel and learn.
“It’s always very rewarding to read about the students’ experiences on their return and the invaluable perspective they bring to their teams in the NHS. The applications are not very long to read or mark, taking me about 10 mins to score each”.
Dr Stefanos Ioannidis, Lead assessor
Apply now and be part of shaping the next generation of anaesthetists.
Funding is awarded twice a year, with scoring rounds in February and September. All assessments are online, giving you flexibility to review applications at your convenience.
This is an ideal opportunity for early career anaesthetists with an interest in developing a role in medical education. If you’re a resident doctor, SAS doctor or consultant, with a passion for undergraduate medical education, get in touch! Reach out to our Governance team via secretariat@anaesthetists.org to express your interest in joining the panel.
27 - 30 January 20 25
Anaesthesia, Critical Care & Pain
Dermatology • General Practice • Plastic Surgery •Radiology • Trauma & Orthopaedics • Other Specialties
• Hands-on workshops
• Multidisciplinary lectures
• Satellite and joint sessions
• Bedside ultrasound course
• Contribution from allied specialities
• Keynote lectures by invited speakers
Date: Thursday 15 - Friday 16 May 2025
Location: ICC, Belfast
• Two jam-packed days of obstetric anaesthesia educational content, with expert speakers and plenty of time for discussion.
• Take part in our social event programme.
• View the latest abstracts in obstetric anaesthesia by visiting the e-poster boards and listen to your colleagues present in-person.
• Meet up with industry and get your hands on the latest equipment!
For more information and to book visit
In 2024, to reinforce the commitment and significant interest of our College towards this growing and critical area of our specialty, the President, Donal Buggy, put in place a new Global Health Committee. Currently our College is involved in three main projects. Two of the projects are in Malawi, one of Africa’s poorest countries, which our College has been associated with for over 20 years. The first project is a high dependency, obstetrics, and trauma (HOT) course that we run annually. It is aimed at anaesthetic officers who perform the bulk of anaesthesia in Malawi on a day-to-day basis. We then sponsor two resident anaesthetists each for the duration of their four-year programme and we are also immensely proud to be involved in the development of CANECSA (College of Anaestheiologists of East, Central and Southern Africa). Outside of the College’s official programmes, I am also aware of numerous CAI Fellows who voluntarily give their time and expertise to NGOs and other programmes in less wellresourced areas of the globe.
We have run the HOT course in Malawi since 2005. Now in its 20th year, the course was originally conceived by Tom Schnittger, CAI Fellow, in consultation with local clinicians. It is based on local needs with a particular emphasis on the systematic assessment and management of trauma and obstetric emergencies.
To date it has trained over 800 healthcare professionals in Malawi including doctors, nurses and clinical officers and has an ever-growing network of local faculty who are instrumental in organising and teaching the course. Efforts are made to rotate the venues around the country to facilitate the delegates who frequently make huge efforts and travel great distances to attend. In 2023, courses were run in Blantyre and Zamba in the south. This year the capital, Lilongwe, and the northern city of Mzuzu were selected.
Typically, the course takes place over two days and includes a series of lectures interspersed with simulations and small group tutorials. It is a demanding two days for participants, requiring active participation and engagement. However, candidates are reassured that by the end of the course, they will be equipped with the core skills and knowledge to manage multiple emergencies. The feedback is excellent which makes the effort and the project so worthwhile. The usual CAI team consists of three to five Fellows who act as faculty, plus we try to bring one resident anaesthetist each year. The feedback from the residents is outstanding and it has often been described as the highlight of their anaesthetic training years. We have also managed to incorporate local faculty,
Figures 1-3: Top to bottom, Tom Schnnitger, Brian Kinirons and Ellen O’Sullivan demonstrating skills at various stations on a recent course in Malawi.
which makes a huge difference to the success of the course. The ultimate plan is that there will be less requirement for so many CAI faculty and an increase in local faculty as increased numbers of medically trained Malawian anesthesiologists graduate. On average, we train 35-40 per course and venue. At the conclusion of day two, we run a short MCQ, followed by the presentation of certificates which is always a joyful and satisfying occasion for all.
In the past few years, CAI has been involved with sponsoring a small number of Malawian resident doctors each year onto the four-year MMED Anaesthesia program. This has proved successful with the improved recruitment of doctors into the specialty. However, more recently our College’s emphasis has moved towards supporting the development of CANECSA, which holds great promise to significantly increase the numbers of medically trained anesthesiologists in Africa. Building anesthesiology training in the ECSA (East, Central and Southern Africa) region is a collaborative approach towards building the local anaesthesia workforce. The collaboration includes CANECSA, COSECSA, CAI and RCSI (the Royal College of Surgeons of Ireland). Currently for the entire CANECSA region, there are only 0.25% physician anaesthesiologists per 100,000. We are hopeful that CANECSA will prove as successful as its sister college COSECSA (The College of Surgeons of East, Central and Southern Africa) which has overseen the rapid expansion of surgical training in Africa and now has over 800 graduates from its college, and an impressive 80-90% retention of graduates locally.
CANECSA was founded in 2011 following a meeting in Arusha, Tanzania at which Ellen O’Sullivan and CAI played a significant role.
The constituent countries include Republic of the Congo, Kenya, Malawi, Eswatini, Rwanda, Swaziland, Tanzania, Uganda, Zambia, Zimbabwe, Namibia and more recently Ethiopia. With its success, the number of countries involved continues to expand each year. CAI has helped in developing the rollout of a new curriculum, a training programme,
the conduct of examinations, train the trainer courses, an electronic logbook, and an e-learning platform. The administrative headquarters and secretariat are in Arusha, Tanzania. It has taken some years to organise this programme but the first in-person graduation (from the four-year training programme) took place at an elaborate ceremony at the inaugural scientific meeting of CANECSA in Harare in November 2023. It was a memorable event and a historical occasion for the specialty of anaesthesia in Africa. The second CANECSA conference and graduation is due to take place in Blantyre in Malawi in early December this year.
CAI is proud of its Global Health programme, its long association with Malawi and more recently with CANECSA which holds great hope for the ongoing development of our specialty in Africa.
Patrick Seigne
CAI Global Health Lead Consultant Anaesthesiologist, Cork University Hospital, Cork, Ireland
26-27 June 2025 | Hilton,London Wembley
Matt Newport, Consultant in Anaesthesia & Prehospital Emergency Medicine at the Royal Blackburn Hospital, is the first keynote speaker announced for the Association's 2025 Resident Doctors Conference. Matt, who has worked in Pakistan, Afghanistan, Namibia, Tanzania and Ukraine and has recently spent six months in Gaza will share his experience of trying to make a difference in challenging conditions
Join us at the Hilton, London Wembley on 26-27 June 2025 to hear Matt's stories from the frontline and connect with your peers over two days of learning, hands-on workshops and cutting-edge demonstrations to empower and inspire you.
Exclusive member early rate: Book now and save up to £105!
Here, we present a selection of our best videos from our online learning platform Learn@.
Cases studies: The anatomy of harm from undetected oesophageal intubation
Tim Cook
From innervation to innovation: Lessons learned from hip analgesia
Philip Peng
Category 1 caesarean section - too fast and furious?
Anaesthesia in Radiology
The child with congenital heart disease
Stephanie King
Featuring Sir Julian Hartley, Chief Executive of NHS Providers, and Dr Tim Meek, President of Association of Anaesthetists, this podcast explores the role of modern consultants in healthcare systems, HIT lists and whether or not the NHS is ‘broken’.
Listen on Podbean: https://rapidsequence.podbean.com
From fruit bat migration and scorpion bites to building partnerships overseas and working with minimal resources, the Global Anaesthesia 4-part series explores helpful advice and learning experiences for anaesthetic residents looking to undertake an international placement. Hosts Dr Jan Man Wong and Dr Fiona Linton are accompanied by two GASOC UK anaesthetic representatives who share what they’ve learnt from their time working with Mercy Ships, at BKL Walawalker hospital in India and on Global Anaesthesia Development Programmes in Zambia and Ethiopia. Esteemed guests include Dr Katherine Horner, Dr Tamryn Miller, Dr Sanjay Deshpande, Dr Anna Wilkinson, Dr Anna Janowicz, Dr Emma Coley and Dr Michelle White. https://www.rcoa.ac.uk/events-professional-
Coffee and a
Joined by Dr Matt Wiles, Editor in Chief of Anaesthesia, the Coffee and a Gas hosts discuss the top 10 most impactful papers of 20232024 in Anaesthesia, including ‘Duration of cardiopulmonary resuscitation and outcomes for adults with in-hospital cardiac arrest: retrospective cohort study’ and ‘Mortality and morbidity after total intravenous anaesthesia versus inhalational anaesthesia: a systematic review and meta-analysis'.
Listen on Podbean: https://coffeeandagas.
