Aiming to take away the pain

Despite its 14m. population and a poor track record in road safety and obstetrics, there are only around 30 trained anaesthetists in the whole of Zambia. But all that is changing thanks to a scheme in Lusaka, where locally-born doctor Michelle Le Cheminant is helping to advance the country’s first proper training programme for anaesthetists. She told Martyn Tolcher why the work so important – and how everyone can help

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Dr Michelle Le Cheminant and trainee Lupiya Kimena. Michelle is around half-way through her placement in Zambia.

EVEN taking into account the States’ increasing financial constraints, Guernsey continues to provide its citizens with a well-funded, first class health service operated by a small army of highly trained doctors and nurses.

Aiming to join its ranks next year is a locally born anaesthetic doctor, Michelle Le Cheminant, but right now Michelle is in the heart of Africa, working as a volunteer lecturer in Zambia where fully trained health professionals like her are in very short supply.

Since February she has been based at the UTH (University Training Hospital) in the capital city Lusaka, where she is helping to advance Zambia’s first proper training programme for anaesthetists.

‘The country has a terrible lack of anaesthetists, with perhaps only 30 trained anaesthetic doctors for the whole of Zambia,’ she said. ‘It’s hard to believe that they haven’t had a single doctor trained in anaesthetics since independence in 1964.

‘All anaesthetics have been provided by clinical officers, which are nurses that have had some anaesthetic training. The mortality and morbidity rate around the time of surgery is very high.’

But thanks to people like Michelle and her fellow volunteers with the Zambia Anaesthetic Teaching Project (ZADP), the situation is starting to improve as more trainee African doctors come to the fore in the field of anaesthetics.

‘We’ve got 18 trainees on the programme and six that have completed the programme are now starting to take up jobs in the country,’ she said.

‘But just looking at this one hospital alone, it’s probably one of the only hospitals in the country that has any doctors who are anaesthetists – and this is a massive hospital.

‘It’s got 1,600 beds, does 18,000 surgeries a year and 20,000 deliveries, so when you compare it with Guernsey, that has 10 anaesthetists, there are about 30 in the whole of Zambia for a population of 14 million.’

Educated at Castel Primary School and Ladies’ College, Michelle spent three years studying medicine at Cambridge, followed by another three years of study at King’s College London medical school.

Now aged 33, she started training to be an anaesthetist seven years ago. As part of that training she was encouraged to go abroad to gain experience of health care services in other countries, and when the chance came to work with ZADP she jumped at it.

Her six months placement in Zambia began in February and is due to end in July. Now roughly half-way through her stint, she has a pretty good idea of the scale of the task the country faces in improving the standard of its anaesthesia services.

‘Anaesthetics here is only just becoming a well-respected speciality for a doctor. Previously I think it was seen as more of a nursing job,’ she said.

‘In this centre we have probably enough anaesthetic trainees to ensure that almost all the anaesthesia is delivered by a doctor but this is the tertiary referral centre for the whole country so this is as good as it gets.

‘Even here, probably at night, some of the anaesthesia has been given by clinical officers who have some anaesthetic training but are not trained to the level we would expect.

‘Here, most of the anaesthetics are being provided by trainees and these trainees have to learn a lot more quickly than we would expect of a trainee in the UK.’