intersurgicalmagazine
TRANSCRIPT
Article for Intersurgical UK John M Allwood West Middlesex University Hospital
For the past 10 years I have been running
several anaesthesia related projects in
Ukraine . My previous form includes a very
lengthy spell at MSAVLC (medical and
scientific aid to Vietnam , Laos and
Cambodia .By way of an introduction the
state of most of the hospitals and health
care institutions is inversely proportional to
the modern , state of the art stadium ,
currently being showcased nightly on our
tv screens during Euro 2012 .Dilapidated
run down infrastructure often walks hand
in hand with obsolete equipment , and
the average monthly salary of a senior
clinician is roughly £250 .
The BBC was saying that back in 2010 that
hospitals budgets in ukraine , nosedived
after a 75% reduction in state financing
,the effects are noticable and impact
heavily on the delivery of healthcare at a
local level , with acute shortages of
equipment ,drugs and resources to
upgrade and repair buildings .When I
first arrived back in 2002 it was
commonplace to see IV cannulaes re-
sterilized between patient use , however a
reassuring glance into the peroxide
sterilizing tank confirms that this practice
has been confined to history . and
toothpaste employed as a fixative for ecg
electrodes as they journeyed from patient
to patient. Neccesity is the mother of
invention and adapting old lemonade
bottles for redivac drain substitution is just
one example of local ingenuity and
invention from many that come to mind.
Equipment generally is used carefully and
sparingly to prolong their lives , Single use is
not in the medical lexicography in this
part of the world .The clinicians are well
trained and educated and very well up to
Illustration 1: One of the main operating rooms ternopil regional Hospital
Illustration 2: getting ready for the next operation , auoclave in trauma theatre Ternopil Regional Hospital 2011
Article for Intersurgical UK John M Allwood West Middlesex University Hospital
date with our techniques and approaches
to the delivery of “western” healthcare
due to the advance in social media sites
and availability of information which is
avidly digested ,and any visit is always
well anticipated and attended
On a practical level, most of my on the
gound time is in western ukraine ,in the
cities of Ternopil and Chortkiv about
400km southwest from the capital kyiv.
and normally reached by an overnight
train journey. My purpose is spent
organizing airway orientated workshops
and talks in conjunction with the local
medical universities and departments of
anaesthesia .
The medium of communication is English,
my first 1 hour lecture back in 2002 took 3
hours with “ lost in translation issues “
restricting the flow of the topic's ,
however now both the content and
delivery has been streamlined and we
have a well seasoned pool of English
speaking anaesthetists on hand to assist .
As interns , junior anaesthetists spend 2
years on their basic anaesthesia training ,
so there is always a fairly quick turnaround
and new mouths to drink at the fountain of
knowledge The benefits are immense and
not only allow local practitioners the
tactile pleasure of using contemporary
airway devices , but learning their
significance in our airway algorythm's
and which is my basic template for the
delivery of learning. Depending on the
Illustration 3: a well attended resuscitation and airway management study morning at chortkiv medical college
Illustration 4: Putting the knowldege into practice
Article for Intersurgical UK John M Allwood West Middlesex University Hospital
location and learning group complexion
and level of expertise numbers can vary
between from 3 to 6
senior clinicians or up to 150 when we do
a general airway management study
session for nurses. Locations are usually in
the hospitals themselves or in a dedicated
lecture theatre ,and have even been set
up in hotel rooms when circumstances
have dictated this option .The learning is
delivered on a practical hands on basis
Powerpoint is used sparingly with a
reliance instead placed on the spoken
word and the showing of instructional
product CD roms , for more advanced
sessions we use real time operating lists ,
though this is normally for senior
practitioners and university faculty
members ,the rationale is that they can
then cascade the learning to the the
more junior / inexperienced team
members in their native ukrainian
language , and besides it keeps numbers
to a minimum during busy operating
sessions.
illustration 7: Dr Olexiy Kuybida at regional Hospital
ternopil during iGel Study session
Illustration 5: senior clinicians study session on airway devices Chortkiv Hospital
Illustration 6: completion of airway management study morning ternopil regional Hospital
Article for Intersurgical UK John M Allwood West Middlesex University Hospital
In addition to anaesthestists and nurses we
also offer teaching to a group of
professionals called Feldshers , they crew
the local ambulances , assist at births and
a whole lot more besides .
It might be of interest to say that in places
like the small hospital in Bukachivtsi , which
is reliant on Feldshers , in winter time , the
temperatures here plummet to -35
celcius , the roads become impassable ,
so they use the horse and cart as the
rescue ambulance.
As a follow on to local teaching and
learning I have set up and successfully run
a programme whereby ukrainian
anaesthetists come to london for further
training. To date 4 have arrived and we
have a waiting list of future participants For
the future I have new projects in the city of
Zaphorizhe in eastern Ukraine coming up ,
which I am excited about , and a return to
Ternopil later in the year .In finishing this
short article ,it has to be said that without
intersurgicals help and assistance these
projects would be difficult to facilitate and
through this article I would like to express
my immense gratitude to the company
and to Andy Masterman ,for all the kind
help over the years if anyone would like
any further information I have had several
feature articles published and would be
happy to provide copies upon request.
I would also like to thank mr Carl
Hollinshead and Dr Ali Rahmaty in ably
assisting me in my ventures and to Dr
Tetyana Potupalova Dr Maxsym
Doroschenko ,Prof Alexander Olenyiuk
and Dr Olexiy Kuybida or all their help and
assistance .
John Allwood june 2012
this article has been written exclusively for
intersurgical UK , all images copyright john
allwood
Illustration 8: front enterence Local hospital in Bukachivtsi