Delivery of the SAFE Obstetric Anaesthetic Course (AAGBI©) to the upper regions of Ghana. By Dr. Malvena Stuart Taylor, Consultant Anaesthetist, UK.

Nurse Anaesthetists during the delivery of the SAFE Obstetric Anaesthetic Course (AAGBI©) to the upper regions of GhanaIn June and September of this year I went out to Tamale, in the Northern Region of Ghana to help direct a 3-day intensive course to nurse anaesthetists in the upper regions of this country. Whilst Ghana is the 3rd richest African country, this wealth is predictably concentrated in the south around its capital city Accra. As a result the healthcare system is overstretched and under-resourced. In 2009 a partnership was formed between Ghana Health Services of the Upper East Region, Afrikids, an NGO charity based in this area and Southampton Hospital, UK, where I work as a consultant anaesthetist (the G.A.S. Partnership).

Having made field trips to the UER for the past 2 years I was ambitious to help deliver this course to improve the knowledge and skills of the nurse anaesthetists in the 3 most northern regions of Ghana. This was particularly important in the field of maternal care where mortality rates have not dropped in line with Millennium Development Goals. My plan was to deliver an annual refresher course which would enable the 60 or so NA’s to develop their clinical skills without the need to travel 600km with appalling road conditions in order to attend their historical annual updates in Accra.

My apprehension on the 1st day revolved around the fact that we had no idea how many candidates would turn up, if or when they would turn up and most importantly how they would take to a very intensive and hands-on training programme for 3 days.

Despite the heat, breakdown of the air conditioning, long days and frequent electricity failures their enthusiasm and commitment to learning could be seen on their faces every moment of the course. To quote 2 candidates:

"Continue organizing this course at least twice a year so that every anaesthetist can attend."

"The methods used in the course were really enjoyable. It prevented sleeping after a heavy lunch and it is all-inclusive with lovely teachers. Congratulations."

We carried out pre- and post-course evaluation of knowledge and skills and in the majority of cases significant improvements were seen. Furthermore each candidate felt much more confident in managing what can often turn out to be very challenging cases and without the backup that we enjoy in this country.

However the benefit did not stop there. I believe I can speak for every faculty member that joined me (7 overall) in saying that the engagement of the Ghanaian staff was unprecedented and really quite moving. At personal levels we reported how our own non-technical skills developed in an environment where we were never quite sure what type of challenge would be presented to us.

Quoting one of our trainees who was part of the faculty: "The opportunity to travel to Africa and work with such a fantastic team to deliver this course was incredible.  The motivation and enthusiasm of the candidates was terrific.  Their hunger for knowledge was extremely impressive.  As well as developing my teaching skills I also feel that I learnt a lot from the local candidates. The capacity and extent of their clinical commitment with at times limited resources was extremely impressive."

The course was designed by members of the Association of Anaesthetists of Great Britain and Ireland (AAGBI) and was very appropriate in its structure for the audience and environment in which we were teaching. My own hospital gave permission for us to take time out either as annual leave or as special leave whereby we paid back time clinically so that service commitment was maintained. We were supported financially by THET, the AAGBI and by G.A.S. In addition each faculty member paid for personal costs such as vaccinations, visas and local accommodation.

With regard to challenges there were remarkably few. Preparation of the course was aided by having the experience of a colleague who had directed this course before. As an Advanced Life Support instructor I was already familiar with the logistics required to run a tight course. The faculty members were amazing in tolerating all climatic challenges with a smile and their fatigue only hit them on returning home.

The main difficulty revolved around supporting local staff to attend the course without having to be on-call during the night’s in-between. Therefore some candidates turned up late, having been up all night with emergency surgery. Also the attendance for the 2nd course was affected by lack of suitable transport to bring the candidates across flood plains (it was during the tail end of the rainy season).

In conclusion the programme was a great success both from the candidate and faculty point of view. It has inspired the wonderful NA’s to take ownership of their own learning in collaboration with UK support and the faculty returned to the UK seeing our own NHS in a new light.