By Dr Sue Catling All over Phebe hospital there are cupboards and offices full of the stuff they get sent by Charities – most of it technical and complex state of the art kit. Trouble is, they don’t use it. Partly this is down to unfamiliarity and lack of training- unsurprisingly! Take for example the defibrillator .... There it was, state of the art modern defib, sitting in a dark alcove and obviously never had its cable unwound from the original packaging. Complete with three pin plug. As we say - as much use as a chocolate teapot. So using... Continue reading

One student told us her story: and has given us permission to write it down. Both her parents were killed in the war and she and her siblings only survived by hiding in the bush whenever necessary. They had no clothes and slept under banana leaves . They walked miles to find water, and often had to keep walking because the water was contaminated by dead bodies. Sometimes they were so thirsty they had to push the bodies aside and drink the water. When asked how come she could still smile she said – I’m alive. In the classroom today... Continue reading

By Dr Sara Hunt Teaching today was against a background of a child screaming non-stop as it had a circumcision with just “ local infiltration”as anaesthetic i.e. local anaesthetic injected around the site of operation. This is very ineffective as it doesn’t block the specific nerves and the child will have experienced severe pain. It would never be acceptable in the UK. This was a very difficult situation for us. We felt we had to question the method, but this would be confronting something that is obviously a regular part of the local practice. Presumably some of their own sons... Continue reading

By Dr Sue Catling Tonight we heard a woman screaming …….. Labour?grief?what? We don’t know what it was about, but none of us really felt we wanted to go and properly investigate. Its funny - you tuck yourself into your mosquito net, you spray DEET and Raid and feel safe, and then you hear something like this - a woman screaming, louder and louder , on and on, tearing the night apart. And you think: if this was the UK I’d run out there and investigate, she obviously needs help- is she being attacked, murdered, raped. Or is it grief... Continue reading

By Dr Sue Catling. So, nobody told me that Phebe Hospital contains the isolation unit for Lassa fever cases from all of Liberia and Guinea. (For those of you who don’t know Lassa Fever is an acute viral hemorrhagic fever whose symptoms include fever, facial swelling and bloody vomiting among many others. On average 15-20% of hospitalized patients die. It’s a pretty horrible one.) Originally set up by charitable donation with all mod cons and barrier nursing, the unit has now deteriorated to a building with no facilities, with “keep out” signs . Apparently there are no barrier nursing packs,... Continue reading

By Dr Sue Catling and Dr Sara Hunt The students can do some things well e.g. spinal anaesthetics, ketamine anaesthetics, but they lack the resources to do a full spectrum of anaesthesia at the moment. They are so keen to learn and they have the intelligence and ability to do things right – surely this is the huge resource that we can encourage. Not knowing what I’d find out there, I'd brought with me 6 Uk spinal needles and the drugs to give a safe spinal (just in case any of us got appendicitis). But, while I would have been... Continue reading

By Dr Sara Hunt and Dr Sue Catling 26 yr old man with compound fracture of tibia and fibula after falling from palm tree. Horrible injury, with bone coming through the skin and the lower leg almost turned round the wrong way. Despite the pain the patient was uncomplaining and, although he had lost a fair amount of blood, this hadn’t been life –threatening up to now! The surgeon had to put it back in place and fixate it- an excruciatingly agonising procedure - without an anaesthetic. The anaesthetic student planned to use just morphine for this procedure which would... Continue reading

(By Dr Sue Catling) Tried to use all modern teaching techniques as in UK, but some interesting differences e.g. handing out prizes of books, pens, and sweets! At first I thought this was going to be embarrassing and feel very condescending, but the students were very comfortable with it and indeed clearly expected it – next time we’ll bring even more wine gums and humbugs!! Student s fed back that they particularly liked the small group discussions – which are of course the most demanding to teach – you really have to know your stuff to face 14 eager faces... Continue reading

(By Dr Sue Catling) So most casualty depts. have a plethora of signs over the door : no smoking, no hot drinks, no mobile phones etc. Phebe hospital has this one... .......no AK47s , no bullets. So we had a good laugh and took a photo, and we were already imagining the various lectures/talks where this could be added in as a hilarious “funny slide” (every good lecture needs one!) Then we saw this .... It’s the graves of the 3 doctors who were shot by the rebels when they swept through Phebe. It’s right at the front of the... Continue reading

(by Dr Sara Hunt) Apart from the deep seated medical problems of the country, there were a few basics we had to grapple with first…. - Communications: No internet at all. Much to technophobe Sue’s delight our I-phones don’t work (Dave and I gutted!!). Sues ancient Nokia seems to be working beautifully – I’m sure we will be reminded of this on a daily basis. (come on O2- get with the programme!) - No grid electricity. On the drive from the airport were houses and lots of people … but it was pitch black. People just sat around fires and... Continue reading

By Dr Sara Hunt The three of us are going to be teaching thirteen students. The group is a mixture of 2 absolute novice nurse anaesthetists, 8 students who are now in the second and final year of the course (all of whom are familiar to Dave and myself because of our trip last year) and three new students from the teaching hospital in Monrovia. It’s lovely to see old friends again especially Mother’s Of Africa sponsored student Martha Yollain. On the first day we split the group into two teams for some quick fire questions. The results are impressive.... Continue reading

(by Dr Sara Hunt and Dr Sue Catling) Phebe Hospital houses the original Anaesthetic Nursing teaching programme for Liberia, however there is now only one medically qualified anaesthetist in the whole country. A teaching programme has just started but currently all the anaesthesia is delivered by the nurse practitioners who are unsupervised by medical anaesthetists. The aim of training is that they will perform at the standard of trained medical anaesthetists….so our teaching was to be of the standard delivered to UK anaesthetic trainee doctors. We taught daily in the recovery area of the operating theatres, (pic 1 : teaching... Continue reading

Introductions (by Dr Sara Hunt) I think we had better introduce ourselves before we go any further. My name is Dr Sara Hunt and I have the grand title of “trip lead” for the 10 day teaching trip to Phebe Hospital. It has to be said that at some points during the organisation of this trip I had wished I wasn’t trip leader, but I suppose everyone feels that way when you’re organising such a complicated trip! I’m a consultant Anaesthetist in the University Hospital of Wales, Cardiff. This will be my second visit to Liberia with Mothers of Africa... Continue reading

The first Mothers of Africa teaching trip of 2010 was from 8-17th February to Phebe, Liberia - a country on the West coast of the continent that is still recovering from a civil war that left hundreds of thousands dead and devastated the economy. Three consultant anaesthetists from the Welsh NHS (Dr Sara Hunt, Dr Dave Place and Dr Sue Catling) left their usual work for two weeks to live with and teach Liberian anaesthetic nursing students in the hope of improving their medical education, and ultimately kick-starting Liberia’s anaesthetic service. The following posts are aimed at giving you an... Continue reading

Mothers of Africa is a Medical Educational Charity that trains medical staff in Sub-Sahara Africa to care for mothers during pregnancy and childbirth. Did you know.... A Boeing 747 of mothers die in childbirth every single day in Africa. In Africa a woman’s risk of dying from treatable or preventable complications of pregnancy and childbirth over the course of her lifetime is 1 in 22, compared to 1 in 7,300 in developed regions. In a country like Benin, there are 11 anaesthetists in a country of 11 million. There are 140 anaesthetists in Cardiff alone! Goal 5 of the UN’s... Continue reading