Emma Joynes, Lifebox Fellow 2017

Name Emma Joynes
Title  Lifebox Tanzania Fellow
Location Kilimanjaro Christian Medical Centre
Training ST5 Anaesthetics
Dates February 2017 onwards

What motivated you to apply for the Fellowship?

I have a sense of adventure, love to travel and I have had a soft spot for East Africa ever since I did my medical elective here in Tanga as an undergraduate. This fellowship offered an exciting and unique opportunity for me to gain anaesthetic experience somewhere completely different. I do not doubt that the next 6 months will be very challenging in many different ways, however I hope it will be equally as rewarding. I am sure it will offer me the opportunity to develop new skills, form new relationships and get a different perspective on medicine and anaesthesia.

How did your interest in global anaesthesia develop?

I did a global health degree as an undergraduate and my dissertation focused on child and maternal health in South Africa. I developed my interest in Africa and in child and maternal health from there. I intend to pursue this interest during my placement at KCMC through quality improvement projects focusing on surgical safety and safe obstetric anaesthesia.

I recently attended a THET conference in Dar Es Salaam on global health partnerships. Seeing the results from successful partnerships between high and LMICs (lower middle income countries) really demonstrates how we can learn from one another and develop sustainable projects in the long term.

What do you think are some of the biggest challenges to providing safe anaesthesia in a low-resource setting?

There are many barriers that you see on a daily basis, but I do think one of the biggest challenges is a lack of education and training. If someone is giving an anaesthetic when they’ve had only a year’s training compared to someone who has had 15 years of medical training there’s bound to be a significant difference. One of the key elements to providing safe anaesthesia is to ensure the workforce receive adequate training in order to do this job. Tanzania is not alone with a lack of anaesthetic healthcare providers and this huge challenge is something, which needs to be tackled on a global scale to enable safe delivery of both surgery and anaesthesia in LMICs.

Are you planning to do some teaching while you’re there?

Absolutely, one of my main objectives is to get involved with the local nurse education here at KCMC. I will be responsible for organising the nurse teaching every morning from 7.15 to 8am, with the aim of developing teaching for the student nurses. My main goal is to help provide a sustainable teaching programme, which can be run and delivered by the local anaesthetic faculty. On a larger scale, the nurse curriculum is being developed at KCMC and on a national level to improve nurse anaesthetic education.

What would you like to achieve during your time at KCMC?

I think there is potential for a lot to be achieved at KCMC, and I am only a small piece in the puzzle. I hope through making small steps towards change that I can help to make a difference to a few fundamental projects during my 6 months here. I have a lot to learn from the local faculty here, who have shown a huge amount of innovation. This is born through a lack of basic resources, and I have learnt to do anaesthetics with limited equipment and to use drugs I have only previously read about in textbooks. If nothing else I will certainly be able to think on my feet by the end of my placement. I hope that through making a few small changes I may help in developing some of the quality improvement projects, which have already been introduced here. I plan to teach on the SAFE obstetric anaesthesia course in a few months and to attend a national anaesthetic conference. I’d like to visit some of the remote satellite hospitals, maybe with visiting consultants who’ve been involved in Lifebox education and pulse oximeter distribution.

What does safe anaesthesia mean to you?

On an individual level, safe anaesthesia involves seeing the patient through the whole patient journey – from the ward, preoperatively, intraoperatively and post-operatively, and to ensure the highest standards of care are maintained throughout. Patient safety is paramount, and involves input from equipment, monitoring, education and perhaps most importantly input from a multi-disciplinary team of dedicated and motivated individuals.

Safe anaesthesia in my mind goes hand in hand with safe surgery, and the delivery of safe and affordable healthcare, which should be accessible to all.