A Year of African Anaesthesia

Nigel:
Having spent almost a year in Africa as an anaesthetist, first in Malawi for 4 months and now in Liberia with Mercy Ships for what will be 7 months, there is both a satisfaction and frustration.

Teaching local biomedical students in Liberia about the working of anaesthetic machines on Mercy Ships.

Firstly, I have learned that it was God who was willing to use me as his hands for this time and it is through his strength that I am here, not my own. I have been fortunate enough to have been born in a country where achieving a medical training was an opportunity at my door as long as I was willing to work at it. My training was free and I only had a small amount of debt after 5 years of study. Back then, and still now, a job is pretty much guaranteed and the financial reward is handsome.

In Africa, even if I wanted to become a doctor, the chances are as slim as becoming the next president. Such is the daily struggle just to earn a simple living and put food on the table.

The next thing I have observed is how ‘easy’ it is to practice in the West. Don’t get me wrong, medicine at home has its own stresses in terms of complex patients, quality assurance, targets to meet and departments to run on a fixed budget. This however is relative to the situation in Africa.

Two Malawian anaesthetists prepare a patient for surgery at Biet Cure Hospital.

Here, the majority do not have access to even basic medical care. 70,000 people die each day needlessly of causes such as water, basic sanitation, AIDS and easily treatable conditions. Where there is a hospital, it works on a system of payment and bribes for your treatment. The anaesthetic facilities are basic and the conditions the anaesthetists work in are difficult. The equipment is out of date and often non-functional, there is often little or no monitoring of the patient, drugs are scarce and techniques are kept simple. Looking after a patient for even moderately complicated surgery is beyond their boundaries. Recovery rooms in these hospitals do not even have oxygen!

Queens Hospital, Blantyre (Malawi), anaesthesia cart with draw-over apparatus and a brick to hold the syringes.

In Malawi, there is only one anaesthetic doctor and in Liberia there are none. As in most of Africa, nurses provide this care in harsh circumstances and I stand and watch them in complete admiration. The 3 nurses I helped teach in Malawi (and let’s face it, I learnt much from them too) still did not earn enough to travel or buy a house. They would tell me that their wages went to feed and clothe their extended families which could be up to 10 people. I can go home, find a job, work with other doctors and a trained assistant and have all the drugs and equipment that I need at my disposal. If something does not work, you simply swap it for one that does. I know my patients are going back to a ward where they will be cared for properly. It makes me angry when people complain about the NHS (National Health Service) in the UK. You do not need to travel far to have a reality check.

Our friends, Polina and Patricia, in Malawi.