Live from Burkina Faso!

We’re back in West Africa for #SaferSurgeryBurkinaFaso – and our trusty team is keeping us up to

We’re back in West Africa for #SaferSurgeryBurkinaFaso – and our trusty team is keeping us up to date on the latest!

Tune in below as Dr Angela Enright reports from behind the scenes of our life-saving safe anaesthesia training – with warm humour and some National Geographic moments along the way…

T-minus 1

Well we’re off with only a few missteps. Airline delightfully cancelled their flight from Paris to Ouagadougou leaving Faye and vast quantities of supplies in the lurch. She has now rerouted and hopes to be on the same flight as Angela and Sylvie to Ouagadougou.

Then there were the travails of Benjamin. He tried to fly out from Kigali this morning only to have officialdom deny him access to the flight because there were not sufficient stamps on his letter of invitation. Our friends in Burkina Faso came through and the letter they sent this morning had enough stamps to meet requirements, so he is now rebooked to join us on Sunday. Remy had better be prepared for his departure on Sunday…

 

2016_Burkina Faso_Angela Enright_Angela at the airport

Day 0

Early in the morning as we waited to access our mountain of equipment at the hospital (being ‘early birds’ of course), we saw a small owl who by some amazing feat had flown or fallen into a large garbage container. How he managed to do so, I am not sure – but there he was cowering at the bottom of the empty bin. He may have been a barred owl but, not being the ornithologist type, I could not be sure.

2016_Burkina Faso_Angela Enright_owl in bin

The very nice gardeners took the container away, lifted off the big top – and away he went! He must have been quite relieved.

2016_Burkina Faso_Angela Enright_owl in bin_close up

Later on this afternoon, we had an encounter with some bats who were doing a wonderful job gobbling up mosquitos, to great applause. Finishing up our wildlife day, some people had ‘poulet au bicyclette’ for supper. Visions of chickens cycling madly down the streets gave rise to all kinds of chicken jokes…

Our final two team members arrived – Benjamin exhausted after all his contretemps with the Rwandan authorities and Remy minus his luggage which Air France kindly left in Paris – fortunately most of it not required for tomorrow. I think we are as well prepared as we can be, although our equipment is still in boxes. Unusually we could not find a key to lock the designated room door. Mostly the situation is that one cannot find a key to open the door. But there you are. We’re here, we’re happy and we’re ready to go.
More animal and bird tales to follow.

 

Day 1…

…is in the bag! We started early and our Burkinabé friends were ready to go right on time – and we finished on time too. Remy was the timekeeper and kept things moving extremely well and with humour.

Our equipment room is impressive, better equipped than many ORs. Airway mannequins, NeoNatalie and Resusci-Annes which caused great hilarity as we tried to inflate them. But everything worked including my home-made fiberoptic scope which was a great success.

 

2016_Burkina Faso_Angela Enright_Resuscitating NeoNatalie

 

Our ‘formateurs’ (teachers) were impressive as they dealt with situation after challenging situation. We had impossible airways, high spinals, maternal and newborn resuscitation. Having a virtual pulse oximeter on my laptop was a great addition as we could have that dreadful bass sound booming out. Of course we always ended with the oximeter singing soprano – much to everyone’s relief.

 

2016_Burkina Faso_Angela Enright_Benjamin with difficult airway
Perhaps the funniest incident of the day was introducing the group to ‘how to teach a skill’. Step 1: show it. Step 2: show it and describe it. Step 3: show it and have a participant describe it. Step 4: have the participant show it and describe it. Our participant chose ‘dance’ – and he chose the Professor to describe it and then do it.

 

2016_Burkina Faso_Angela Enright_Prof Nazinigouba trying to avoid having to dance
There was no sitting back and relaxing after that.

 

Day 2

 

Happy International Women’s Day!  A national holiday here in Burkina Faso.

 

2016_Burkina Faso_Angela Enright_Awa in her special IWD 2016 dress
Women are not allowed to go to market or do any work – the men are supposed to do everything. I like this idea. At the end of our very busy day, the Professor presented all the ladies with bouquets.

 

2016_Burkina Faso_Angela Enright_Faye_Angela_Sylvie with flowers
Today was Day 2 of the Train the Trainers’ Course. We thought it went well, though the newly trained could hardly speak at the end of the day, they were so tired. We’ll see what they learned tomorrow as they begin their SAFE Obstetrics teaching careers in the morning.

 

2016_Burkina Faso_Angela Enright_Drisse_Faye_Cheik
We have put an enormous amount of planning and organization into getting this course ready for prime time in Burkina Faso. It wasn’t quite the Global News crew but we did have a print journalist and photographer with us all day. They were enormously interested in what we were doing and sat in on various workshops. They took lots of photographs of the mannikins, the equipment  and the participants.

 

2016_Burkina Faso_Angela Enright_equipment room_suitecases with airway mannikins
If it goes to print before we leave, we will be sure to bring home a copy of the paper…

 

Day 3

 

The many faces of concentration…No words necessary.
2016_Burkina Faso_Angela Enright_many faces of concentration_teaching
Day 4

 

One good thing about being awake at 04:30 is that the internet works well. Often in the evenings it is impossibly slow and difficult to access.

 

Yesterday we completed Day 1 of the providers’ course. We had 32 registrants, most of whom were nurse anesthetists from a wide variety of places and with a very wide variety of practice.

 

Our newly minted teachers rose really well to the challenge. We began with the pre-test 2016_Burkina Faso_Angela Enright_journalistof knowledge and skill. Can you imagine having to demonstrate your skill in maternal and neonatal resuscitation, management of eclampsia and rapid sequence induction in front of foreigners, your teachers and 4 journalists videotaping the whole thing?

 

Intimidating?

 

You bet it was.

 

Then during the day we covered Lifebox, with beeps high and low emanating from the rooms. There was also a great deal of waving of checklists, hopefully leaving enough in the air that people will remember to use them. Everyone got a laminated poster with the Hypoxia Action Plan and the checklist to bring home.

 

Then we had general anesthesia in many dimensions – preparation, management and recovery with special emphasis on the pregnant patient. One very startling piece of information we learned was that there is almost no Succinylcholine in Burkina Faso. A few places have Rocuronium and an occasional Vecuronium but Pancuronium is the relaxant du jour. It makes rapid sequence induction somewhat challenging.

 

Probably the highlight of the day was Faye with her cricothyrotomy station. The model (that is the cricothyrotomy model, not Faye) was great and she loves to teach it. We had difficult airways and failure to intubate and lots of practice with laryngeal mask airways. Thank God for Archie Brain, not just for the LMA idea but for the LMAs he sent me years ago which I am still delivering all over the globe. They save lives.

 

Today we tackle the challenges of spinal anesthesia – anatomy, physiology, complications etc. Then the ‘sick’ obstetric patient who will arrive in all kinds of trouble for us to manage. There are lots of motorbikes here and one sees many pregnant mothers driving around them. Trauma is a major challenge.

 

2016_Burkina Faso_Angela Enright_simulation training
Let’s see what the day brings.

 

ps – What do a crunchy bar, red food colouring and a Lifebox have in common?

 Come back to tomorrow’s blog and we’ll give you the answer!

 

Day 5

 

They are all used to teach how to take better care of mothers and babies in our SAFE OB course! We use red food colouring to simulate blood loss, Crunchie bars to teach interosseous access and Lifebox pulse oximeters to monitor everyone.

 

This indeed is progress. The last time we were here two years ago, hardly anyone had heard of an oximeter much less used one. Yesterday and today in every session when asked about monitoring, EVERYONE answered – I would use a pulse oximeter. So hooray for Lifebox and hooray for the Canadian Anesthesiologists’ Society who started this great ball rolling. It is so heartening to see such progress. We are thrilled.

 

2016_Burkina Faso_Angela Enright_train the trainer success
There is still much work to be done but everyone has been working hard for the past two days learning how to make anesthesia safer for the mothers of Burkina Faso and their babies. This morning we focused on spinal anesthesia and its complications and this afternoon on identifying and managing the sick mother. We dealt with cardiac arrest, sepsis, convulsions and other life threatening conditions.

 

I hope when our 32 participants return to their home hospitals that they will see fewer and fewer of these cases as they now know how to anticipate, prepare for and treat them.

 Day 6

2016_Burkina Faso_Angela Enright_Bertille_one of the organisersFinished!  Well…all but the formal speeches. They begin tomorrow morning as we all line up for the Minister of Health and the Canadian Chargé d’Affaires (the Ambassador is in Canada). Our hosts have arranged a formal presentation of the Lifeboxes, all of the SAFE OB Course equipment and all of the diplomas for the teachers and participants. There will be all kinds of media there. We have had much attention all week including TV interviews. We have not seen any on screen as we have been very busy running the course.

 

And that is where the real work was done. Our Burkinabé colleagues outdid themselves in their teaching, their organization, their support and cooperation for the SAFE OB course. It has been fantastic – but we expected no less, since we had experienced the same dedication on out previous trip delivering Lifeboxes. We cannot speak highly enough of them and their wonderful hospitality and friendship for us. We came from all over the world – Victoria, Montreal, London, Boston and Kigali and we are leaving feeling like family.

 

Our participants were amazing. They never complained about the rigorous pace we set. They came on time, they participated actively, they asked questions, they played roles in scenarios …and they learned. That was so obvious as the days went on and they began to feel confident in their knowledge and skills. By post-testing time today, they were able to demonstrate a marked improvement in their performance. When this is transferred to their daily practice, the mothers and newborns of Burkina Faso are going to benefit immensely. They have worked very hard and will proudly accept their certificates tomorrow.

 

Finale

We finished up our SAFE OB course on Friday evening having trained 15 Teachers and 32 providers. Sylvie, who was teaching the course for the first time, was astonished and thrilled to see the difference in performance in both the skills and knowledge tests. We knew what to expect but were equally pleased. Everyone just relaxed on Friday night but turned up in force for the formal presentations on Saturday morning.

 

And formal they were – we had the Minister of Health for Burkina Faso there and the Canadian Chargé d’Affaires with all of the protocol that entailed. We had speeches from all – President of the SARMU-B, Remy for Lifebox, me and of course the Chargé and the Minister. Then we had presentations of the diplomas to the teachers and the graduates of the programme, the Lifeboxes to the anesthetists of Burkina Faso and finally the equipment from the SAFE course to the SARMU-B so that they can continue to teach the course throughout the country.

 

That afternoon, Remy, Faye and I headed on to Côte d’Ivoire to run a Lifebox course. It has been hectic and we’ll try to blog and get photos to you as son as we can.