Heading back to Rwanda last week saw my third visit with Lifebox, only this time I was not alone. Somehow, an aspirational idea to combine my Lifebox checklist and pulse oximeter work with a surgical skills workshop had gained traction since my last visit. So, with additional support from the Association of Surgeons in Training, Royal College of Surgeons of England and the Royal College of Physicians and Surgeons of Glasgow, five colleagues were also flying out from various corners of the UK to join me during my trip.
I flew out ahead in order to fit in some follow-up time at CHUK prior to the course, and stayed on afterwards to visit Kibagabaga hospital too. The hustle and bustle of CHUK, the central University teaching hospital in Kigali, has always provided both a challenge and an inspiration during my visits. With so much going on, this busy hospital has much to gain from checklist implementation. Yet that busyness also makes the implementation all the more difficult, and there remains much work ahead to ensure everything is done to reduce avoidable patient errors.
Thankfully the conversation around my checklist work there has been facilitated by the relationship we have built supplying them with Lifebox pulse oximeters. On that front I’m certainly being recognised now, and on this visit no sooner had I arrived in the theatre block then staff started bringing me oximeters to check. Repairs were made, batteries swapped, probes replaced and several new pulse oximeters donated. The machines at CHUK are looking pretty beaten up now, but it is pleasing to see they are clearly being well used.
Kibagabaga always provides a contrast to CHUK, and it was great to see some familiar faces and hear how their work with the checklist is progressing. I was particularly pleased to be able to spend a morning observing surgery and see them putting the checklist into action. The original adapted checklist they developed with Lifebox is still on the wall, and the staff were clearly comfortable with using it.
In addition, I was pleased to donate a further pulse oximeter following their request on my last visit.
The weekend training course focussed on students just starting their final attachments before clinical practice. In Rwanda, newly qualified doctors are usually sent to district general hospitals where they will be performing c-sections and emergency surgery with little supervision from the outset. This is despite minimal practical training in basic surgical skills and related topics – including patient safety.
During the weekend we trained over 50 final year students in basic surgical skills, with a special session dedicated to Lifebox’s work around the surgical safety checklist and pulse oximetry. My colleagues, previously unfamiliar with surgical practice in such settings, noted the response when I asked who had experience of preventable patient safety problems. A retained swab had been witnessed by the majority of participants.
Although overall awareness of the checklist was high, an understanding of the individual items and particularly the rational for these was very variable. Having an opportunity to talk them through the checks was certainly valuable and I was impressed by the student’s appreciation of the issues and their general enthusiasm.
Overall, given the complexities of this particular trip, we were pleased at how successful and well received it was – certainly promising for running another joint training session in future. In the longer term, expanding this for those just finishing training and starting practice is perhaps the right point for such training to be given. Changing the practice of established healthcare practitioners is difficult work. Catching them before or as they are starting their careers raises the hope of embedding safe surgical practice right from the very beginning.
The separate surgical skills blog featuring daily contributions from all the visiting team focusses on the backdrop to current healthcare provision, including the lack of basic surgical skills training and the impact of this. For those interested in that aspect, the training weekend blog is available here: http://www.asit.org/news/FSS_Rwanda_2014.