Archive for the ‘Dr Rob Conway’ Category

A Medical Elective in Andavadoaka, Madagascar

Diving & Marine Medicine Course, MaldivesExpedition & Wilderness Medicine has long been linked with award winning marine conservation charity Blue Ventures through facualty member Dr Rob Conway.

Here we highlight a medical elective scheme they have been running at one of their field bases in Madagascar…

Read the article on Blue Ventures website and find out more ….

Liz and I arrived at Coco Beach at the beginning of September, ready to undertake our medical elective (a six week placement in a “healthcare setting that differs from the NHS”- cue a mass exodus of fourth year med students to the 4 corners of the globe…). The plan was to join up with the FISA (family planning) project set up by BV in 2007 and conduct our own research project focusing on the clinic’s interaction with young people in the local area. Our first 3 days fortuitously overlapped with the end of Medical Director and family planning project founder Vik’s latest stay, so we were rapidly immersed in a crash course in family planning, dive and expedition medicine and the importance of making the most of our idyllic setting and local rum! His enthusiasm was contagious and we were soon planning our own project. However we were both surprised and a little daunted to learn that the educational intervention to be developed as a consequence of our research would be a play; written, produced and directed by us! Drama not being a core module in our particular medical course, we were initially politely positive about the idea but Vik’s unfailing enthusiasm and the sincerity and concern with which he spoke about the issues facing the young people of the region won us over.

We have attended family planning clinics here in Andava as well as the satellite clinics in Belovenoke in the north and Tampilove in the South, collecting the demographic info from patient records and hearing the stories of the women who come to access contraception and counselling from Fanja (the Malagasy lady who runs the clinics). I am continually shocked by the number of children many of these women have had and by how young an age- I’m beginning to feel that I have some catching up to do! The journeys to the clinics make the ease of my daily trip to the hospital in Brighton almost laughable. Normally reached by motorized pirogue (the local fishing boats), Belovanoke is, it transpired one morning when the expected boat captain failed to arrive, a 6-hour round-trip by sereti cart (i.e. a high wooden cart on dodgy looking wheels and no suspension pulled by 2 zebu in dire need of Imodium). The mattress we were cunningly advised to put on the floor softened the ride a little but nothing can prepare you for the flying zebu poo and the inadvertent head-bashing when you are thrown on to your fellow passengers. We finally arrived home battered, bruised, sunburnt and more than a little delirious.

On another memorable occasion the usually wet and choppy pirogue trip to Tampilove was stopped in its tracks by the unforeseen low tide. We spent the following hours trekking through the mangroves, sitting and waiting for the channel to fill and finally pushing the boat whilst dodging evil-looking sea urchins and slimy algae patches. On the upside, it seems pirogue-pushing is an excellent workout for the thighs…

We have now run 2 focus groups with the young people of the village and, having asked them about their use of family planning and the dynamics of their relationships, we have constructed the basis of our play. It has been designed to let teenagers know that the clinic service is available to them and that if they complete their education and have children later on, they have that choice. It is to be performed by ‘vazaha’ (us!) in order to create a bit of a spectacle and attract as much attention as possible. The latest batch of vols have proved suitably enthusiastic and, all going well, our directorial debut should go ahead on Saturday 10th October.

Of interest

Diving & Marine Medicinal CME course in the Maldives

Expedition Medicine Course, Keswick

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Dr Rob Conway writes about his time working in rural Kwa-Zulu Natal

Dr Rob Conway, one our regular lecturers on our famous Maldives based Diving & Marine Medicine course  flew directly from Male to Johannesberg last year take up a post in  South Africa at the rurally located Ngwelezane Hospital.   The position was organised through African Health Placements .

Life without pre op.

Anaesthesia in a rural Hospital in Kwa-Zulu Natal

It struck me as I was watching my wife hold a beating heart in one hand and stitching it up with the other that this was one thing that every newly wed couple should do. We have been working in

image (c) Dr Rob Conway

image (c) Dr Rob Conway

Northern Kwa-Zulu Natal, South Africa, in a busy district general hospital called Ngwelezane.

I was desperate to get back to Africa and I thought that South Africa might offer both the experience with some form of supervision that I desired. I was keen to do anaesthetics and not a more generalist role that many of the more rural and remote hospitals require doctors to perform. The planning took 12 months and was helped by a charity called African Health Placements (AHP) who facilitates doctors placements in rural South Africa.

Ngwelezane has approximately 500 acute beds and 8 ICU beds. The catchment area covers a population of 4 million people in an area the size of England, and contains 22 referring hospitals. This means that the workload at Ngwelezane is incredibly demanding, with a high emphasis on trauma, emergencies and paediatrics. There is also a nearby maternity hospital where I do mainly regionals for caesareans and crash GA’s are not uncommon.

As it turned out Ngwelezane was struggling. The anaesthetic consultant I had liaised with had left, as had two of the four surgical consultants and all of the medical consultants. There was chaos in the department, which was staffing two sites with 8 staff, many of whom had done under 6 months of anaesthetics.

After a month of plotting how to escape early, I began to enjoy the job. The work is varied and interesting, making for an amazing experience. The nurses sing the day in and their voices drift across the hospital as you check your machine and draw up emergency drugs for the day ahead. There are general, orthopaedic, eye and ENT lists. We deal with emergencies or urgent cases and there is little planned work. Workload is high, hours are long and lists are generally overbooked, as there is a huge volume of work to be done here. As an example, this weekend I have anaesthetised 2 gunshot abdomens, 2 perforated duodenal ulcers, 3 children under the age of 5 and been involved in the triage of a mass casualty motor vehicle accident. I helped with the treatment of an organophosphate overdose, not to forget the numerous other surgical and orthopaedic patients.

There is currently no pre-operative assessment, we just do not have the resources and lists for the following day are not released until late afternoon making organising difficult. Although the cohort of patients are generally much younger and fitter than those that I saw in the UK, the majority have underlying HIV infection and TB. There are also the high risk patients who turn up to theatre without the relevant investigations and it is down to us to make the decision to postpone these patients for further investigations.

Anaesthetists here do not have the extended role that I experienced in the UK. You rarely step outside of theatre and are not involved in either acute trauma in the emergency department or critical

image (c) Dr Rob Conway

image (c) Dr Rob Conway

care in intensive care. Sometimes, however, we get the opportunity to help, such as when two packed buses collided and around 40 people arrived at the hospital, many of them children. I was involved in the care of a young girl, age unknown probably 4, who had bilateral open tibia and fibula fractures and a head injury. Her mother had died in the crash and we had no way of contacting a guardian. It was the weekend, no one was around to ask for advice, and I had to make a decision to wait to see the outcome of her head injury prior to rushing to theatre. I still feel that I was not in the right position to do this but I had no one to ask. After two successful trips to theatre we located an aunt to look after her. Her story is not uncommon.

Christmas was insane. My wife and I were working a 24 hour on call every third day. It was relentless, each one consisting of at least four penetrating trauma laparotomies and a number of stabbed hearts. The Zulu’s are tough, stoical and very appreciative of treatment and it amazes me that they can survive to hospital with a stabbed ventricle. I had never really contemplated the anaesthetic considerations for someone with a stabbed heart beyond fixing the defect. After inducing him I turned to the machine and then back to the patient. The next thing I know the surgeon is cracking open his sternum, grabs his beating heart in his hand, looks at me and says “He’s not going to like this”. Mental! He was right, the capnography disappeared and he went into some strange rhythm that I’m pretty sure is not compatible with life. The surgery was quick, the access was large and we filled him with lots of fluid as no blood was available. He went home four days later.

image (c) Dr Rob Conway

image (c) Dr Rob Conway

I have seen many weird and wonderful things that are too numerous to include here. The 30cm worm crawling out of someone’s abdomen intra-operatively, the hippo attack, the major trauma, the snake bites, the rare tropical diseases, the use of halothane, ketamine and the fact that I am left to anaesthetise children on my own. A lot of the time I am unsure if I’m doing the right thing and at times it has helped to debrief on doctors.net to ask advice from others who may know better. There are also many non-clinical roles that need to be filled and I have responsibility for the out of hours rota and annual leave as well as looking after the interns.

If there is one thing that would keep me here it is life outside of work. Kwa-Zulu Natal is a gem. We work long hours but are paid well and you can live a fabulous life, if you overlook the lack of security. We have a beautiful home overlooking the Zulu hills minutes from the beach in a small village called Mtunzini. Within two hours there are world class game reserves, two of the worlds top 10 dive sites and surf. A little further away are the Drakensburg or Mozambique and you are only a short flight to Cape Town.

Having had some time to reflect I realise that I have certainly had my ups and downs. The experience, especially the exposure to trauma and paediatrics, has been amazing. This environment has highlighted the value of training as I am out of my depth every day. I want to be both confident and competent in my work and proud of why and how I do it. Would I recommended Ngwelezane, well it depends on what you want out of your time here. If you are after training then not currently, but that may change. If you require a hands on, raw, frightening and yet exhilarating African experience then I don’t think I could recommend anywhere better.

Of interest

 

 

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