Reducing the surgical death rate in Ethiopia

Anaesthetic doctors play a vital role in preventing unnecessary deaths occurring before, during and after surgery. Ethiopia currently has one anaesthetist for every 5.3 million people, which amounts to 17 in the entire country. VSO volunteer Dr Tom Bashford spent one year at a busy urban hospital alongside local health workers sharing simple practices that can mean the difference between life and death.

Putting people to sleep?

People often think an anaesthetic doctor's sole purpose is to put people to sleep for operations. But in many cases, they are critical in keeping people alive before, during and after surgery.

As the only anaesthetic doctor at Yekatit 12 hospital in Addis Ababa, Dr Tom Bashford helped to improve the entire cycle of surgical care in a country where such specialist medical skills are rare.

There are fewer anaesthetists in the whole of Ethiopia, a country of 85 million people, than in the London hospital where Dr Bashford had been working before his VSO placement.

During his one year working alongside the hospital team Tom introduced simple, but life-saving practices. He set up a High Dependency Unit; and after observing the way operations were being carried out, he implemented the routine use of the globally-recognised WHO Safe Surgery Checklist.

The turning point

"The turning point came early on in my placement when we operated on a boy called Binyam", recalls Tom.

Binyam had a huge tumour on the side of his face which started to bleed heavily during an operation, putting his life in danger. Blood arrived from the lab just in time to save his life, but Tom observed how it should have been available before the operation. "I can't imagine a child being at such risk in the UK, Binyam had come so close to dying", said Tom.

Binyam's surgery prompted Tom to teach colleagues how to use a Safe Surgery Checklist; a simple piece of paper that is shown to reduce surgery related deaths by as much as 50% in the developing world. Tom saw firsthand how it can save lives in trained hands, by making sure a plan B and plan C are in place before an operation, in case plan A fails.

Life saving equipment lying in cupboards

Tom also identified that patients were dying or suffering brain damage after surgery on the wards because their oxygen levels were dropping and over-stretched staff weren't spotting this until it was too late.

In the UK, pulse oximeters, simple devices that clip on the finger and measure how much oxygen is in the blood, are used routinely. Tom found despite having been donated the necessary equipment, many of the staff needed training in how to use it effectively. He leaves behind a team with the skills to keep patients alive through surgery and crucially, able to train more staff to do the same.

Tom said, "Part of our role as long-term volunteers is that you can take these things out of the cupboard, you can confidently explain to people how they're used, how they can work, and how they can benefit their patients. And then you can support that use over a number months until they come completely routine and as useful to them as they are to us at home."

"I gained my medical skills in the UK and I'll almost certainly spend my whole career looking after people in Britain. But there's such a desperate need for these skills in poorer countries like Ethiopia. I wish more people could give up a year or two to share what they know. I've seen what a lasting difference it can make."

Dr Tom Bashford volunteered as an anaesthetic doctor with VSO Ethiopia from July 2011 – July 2012. Since returning to the UK he has been awarded the prize for National Patient Safety by the Association of Anaesthetists for Great Britain and Ireland for his work in Ethiopia.

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