Makerere Anesthesia Educational Projects August 2013
I am currently a second year anesthesiology resident at Stanford and early this year I explored the development of an educational project for anesthesia residents at Makerere University College of Health Sciences with Dr. Emma Ayebale, the GPAS Senior Scholar. Initially, the plan was to develop several teaching modules on Trauma Anesthesiology given the high incidence of trauma in Kampala. However, when I arrived I was introduced to two very enthusiastic second year anesthesiology residents: Dr. Fred Bulamba and Dr. Cornelius Sendagire. They told me that instead of working on trauma, they would like to spend time putting together some resources for the incoming first year residents. The new cohort was due to arrive two weeks later, so the pressure was on…
After brainstorming, we decided to develop several videos that the first year residents could reference during the first weeks to help them become adjusted and to augment their learning in the OR. Our first video focused on setting up their anesthesia equipment for a standard case. After a few false starts getting into the OR, we were finally able to film. We learned a lot from our first video and were more efficient with the following ones. Cornelius and Fred had an exceptional ability to explain how they prepared and the video came out pretty well. Our second video was a short piece on OR safety to reinforce handwashing, use of personal protective equipment, handling sharps, and knowing where to locate the fire extinguisher.
Initially we planned to prepare some videos demonstrating procedures such as arterial lines, central lines, and spinals. However, after some consideration, we thought it was better to utilize the existant NEJM procedure videos and film a short commentary by Dr. Mary Juliet Nampawu describing some special considerations and tips for getting these procedures accomplished at Mulago.
In parallel to the videos, we had two other projects we worked on for the first years. First, Fred and Cornelius had discovered one of the tools we use at Stanford during our first month, the “CA-1 Handbook” which contains about twenty topic outlines ranging from “Difficult Airway” to “IV anesthetics” to “Monitoring.” We adapted and augmented these slide sets to include information that was specific to their working environment. For example for the “Inhalational Anesthetics” section, we added information on Halothane and Draw-Over Vaporizers, and for the section on “IV Anesthetics” we made sure that the section on ketamine was more comprehensive. At the end of each topic outline we included a case scenario to serve as a discussion starter when the first years are working with consultants or senior house officers (SHO’s). The second parallel project we worked on were four short workshops to be completed during the first week. These included an Airway Workshop, Introduction to OR Setup (using the video we created), Introduction to Drug Preparation, and a Review of Resuscitation and Defibrillation. We placed all of the content on thumb drives as the internet in Kampala can at times have low bandwidth and can be expensive.
Although we were nervous that the strike at Makerere University would delay the arrival of the first years, happily it did not. It was fun to see SHO’s teaching the first years, and the content was very well received. At the end of the week, several of the first years approached Cornelius and Fred about helping to prepare for next year. Building off that enthusiasm, we decided to make two more videos on important intra-operative problems: hypoxemia and hypotension. Dr. Mary Juliet Nampawu and Dr. Cathy Namutebi prepared these two videos with Cornelius acting more as the organizer and director.
In addition to these educational projects I was able to gain some practical experience on this trip as well. Mike had a great idea to refurbish the GPAS office and the anesthesia classroom, so I had a go at painting, air conditioner trouble shooting, and furniture assembly. During the third week I ran into Robert Dickinson, a biomedical engineering specialist, who works with Gradian Healthcare servicing the Universal Anesthesia Machine (UAM). After going with him to work on one of the machines in OB, he invited me to a training he was conducting for local biomedical technicians nearby. At the training we went through each part of the machine and how to fix it. It was quite the education.
As the month has come to an end, I’ve been thinking about next steps for some of our projects. With regard to the videos, the residents were starting to design their own as I was leaving and the content was well received, so I would like to see if we can support them in making further content. With regarding to hosting content, while the thumb drives worked well, I’d like to work on hosting the material in a cohesive way that integrates the videos with further reading and possibly questions. With regard to the First Year Handbook, after these first years work through it and gain more experience, we will continue to edit it to make the content more site-specific. We would also like to compile more case scenarios, which may eventually be compiled into a workbook that could be used to add diversity to the Thursday teaching sessions. Lastly, we would like to see if I can get some more resources for the workshops that could be stored in the new “Skills Lab” at Makerere. Some resources that would be useful include an airway mannequin and a practice defibrillator.
Overall, it was a very interesting month, I was most impressed by the knowledge and skills of the residents I met and their enthusiasm to teach their colleagues at a high standard in the face of significant limitations. I was also thankful that their group was so inviting and friendly in allowing me to help them carry out their great ideas. I am also grateful to Dr. Tindimwebwa, chair of the Anesthesiology Department, and Dr. Mijumbi, Clinical Head at Mulago Hospital for inviting me into their department for the month. I’d also like to thank GPAS and our sponsors for support of this project.