The WFSA was extremely grateful to receive generous donations to our Fund a Fellow fundraising campaign over the festive period at the end of last year. We would like to thank everyone who made a contribution to the education of young anaesthesiologists living and working in low resource settings, and we hope that hearing stories like Dr Akelisi Yockopua’s below will encourage more people to give what they can to this valuable campaign. If you have not yet donated and would like to do so, please click here.
The knowledge and skills that I learnt during the fellowship were invaluable and have transformed my approach to working and teaching trainees, as well as other health care providers. As a trainee in obstetric anaesthesia in Kuala Lumpur, there were several objectives that I set myself before taking up my Fellowship, and am happy to say that I achieved during the six months.
i. To learn safe and better quality ways of providing anaesthesia care to obstetrics patients.
ii. To learn about advanced technology to facilitate easier and better quality care to obstetrics patients.
iii. To learn better and safer ways of managing complicated obstetrics patients.
iv. To understand and adjust to ways of managing obstetrics patients based on the skills and equipment available in different settings.
v. To learn and understand ways of carrying out research in line with assisting postgraduate trainees.
Day to day work
Thinking back to my day to day duties, on average there were about 5-6 patients per day which required caesarean section in both elective and emergencies in the Obstetrics Operating Theatre, and epidural referrals accounted for about 1 patient per day. During my mentor Prof YK Chan’s teaching days in the operating theatre (OT), she normally took me through case scenarios, discussing important knowledge and skills related to the case, and she allowed me to be hands on with patients.
I assisted with procedures ranging from managing of severe Pre-eclamptic (PET) with difficult airway requiring general anaesthesia, severe pregnancy induced thrombocytopenia, major placenta praevia Type 4, elective CS of BMI > 45 + whereby USS had to be used before regional either spinal or combined spinal and epidural, just to name a few.
It was quite challenging at times but, as I had been working with similar case scenarios under extreme circumstances and with limited staff cover at my institution in Papua New Guinea, I was able to perform well. The main difference in practice was the level of care at different stages based on available consumables, equipment, and technology.
One important piece of equipment introduced at UMMC, which is not currently available in my hospital in PNG, was the ultrasound scan (USS) for use in obstetric and gynaecological cases to facilitate easier and more effective spinal or epidural procedures.
I also saw new ideas and concepts being used in clinical practice, including “Chan’s Ball”. This simple intervention assists mothers to be more comfortable and in a better position while sitting up for a spinal or epidural procedure, and I look forward to using it in the future on my own patients.
The invaluable knowledge and skills gained will definitely be put to great use in my hospital in Papua New Guinea. I will ensure the lessons learnt will be transferred across to the trainees and health care providers treating obstetric patients, not only in Port Moresby General Hospital (PMGH), but also throughout the country. Eventually I hope to train more health care providers in other parts of the Pacific Region some of the skills and techniques I learned.
I also want to introduce new ideas and techniques at the administration level so they will be understood at all levels in order to provide a prompt response whenever medical staff ask for assistance. In all, the aim is for safe and better quality care to be achieved at all levels.
Since returning to my hospital in PNG I have begun to implement the above. I have also set up a more efficient system where all emergency cases coming through to the OT are now categorised to make it easier for our anaesthesia team and nurses to prepare accordingly. This makes it easier for all staff to understand what is happening with each patient, and better care for the patients themselves.
With the introduction of SAFE (Safer Anaesthesia From Education) courses in PNG in recent years (the most recent one in Port Moresby in 2016 facilitated by me, Professor Terence Loughnan and a team from Australia and New Zealand with the support of WFSA and ANZCA!), I am very optimistic that we will be able to increase the number of workshops held annually, expand our training efforts to other parts of the country, and also to other parts of the Pacific region in the future.
If you would like to donate to the Fund a Fellow campaign to help train more young anaesthesiologists like Dr Akelisi Yockopua, please click here.