Lara Herbert, Lifebox Fellow 2016

What motivated you to apply for the Lifebox Fellowship? 

Working in a low-resource setting has been a long-standing ambition of mine, but I wanted to ensure I had the technical skills, maturity and support to deal with the complex challenges I would undoubtedly face.

The Lifebox fellowship was appealing to me because it is a well-supported, RCoA recognised, post-FRCA fellowship that compliments the overarching goal of Lifebox: to make surgery safer globally. I liked that Lifebox is a surgery and anaesthesia focused NGO with simple and sustainable aims. I was also impressed with the Lifebox pulse oximeter and the work that Lifebox had done on implementing the WHO checklist globally.

Finally, I had very itchy feet and needed an adventure!

How did your interest in global anaesthesia develop? 

Having been born and brought up in Zimbabwe, I have a healthy dose of the “African Bug!” I have also always had a keen interest in global health challenges.

Anaesthesia is a wonderful specialty which is patient safety focused and easily transferrable to low-resource settings. I was inspired to become an anaesthetist by my military anaesthetics colleagues whilst working as a Royal Navy MO on the front line in Helmand Province, Afghanistan.

Since then, I have gravitated towards like-minded anaesthetics colleagues, attended thought-provoking DWA conferences and courses and written articles for ATOTW and Update in Anaesthesia.

After finishing my exams, I became involved with SAFE a training initiative of the Association of Anaesthetists of Great Britain and Ireland (AAGBI) and the World Federation of Societies of Anaesthesiologists (WFSA) – and was invited to instruct on SAFE Obs in Nairobi. I am currently working on delivering the first SAFE Obs course in Zimbabwe.

Being a Lifebox Fellow in Mbarara, Uganda has fuelled my passion for global anaesthesia, because I’ve realised that although there are many barriers, it is definitely possible to impact positively and improve patient safety in low-resource surgical settings.

What are some of the biggest challenges to providing anaesthesia in a low-resource setting environment

  • Lack of local government financial backing/support for health care
  • Lack of staff
  • Lack of drugs and medical equipment. Patients often have to buy their own medical supplies, and pay for their investigations. Medical equipment is often faulty, not serviced and not calibrated. Regular power shortages
  • The nature of disease: Patients often present late with severe disease. They don’t have the benefit of pre-optimisation for (often major) surgery
  • Lack of good systems in place in the hospital to make the patient journey safer. For example, attendants/ family carry children back to the ward after surgery, and there is no reliable way of ensuring specimens reach the lab

What do you like about working with Lifebox, and what are your goals for this year?

By working for Lifebox, you become part of a small, but dedicated and passionate team. It feels personal. Your views are listened to and you feel valued.

I like that Lifebox’s aims are clear, sustainable and surgery & anaesthesia focused. I am also a strong believer in their product… The Lifebox pulse oximeter is brilliant! I still haven’t managed to break it and use it on a daily basis in Mbarara.

I also like the idea of setting up links, collaborating, sharing ideas and learning from our anaesthetic colleagues in low resource settings.

My goals in Mbarara Regional Referral Hospital are to facilitate the opening and running of a PACU (post anaesthesia care unit), to resurrect Morbidity and Mortality meetings here, and to continue encouraging use of the WHO checklist.

What does safe anaesthesia mean to you?

Safe anaesthesia means delivering anaesthesia without doing harm.