Intersurgicalmagazine

Article for Intersurgical UK John M Allwood West Middlesex University Hospital

For the past 10 years I have been running

several anaesthesia related projects in

Ukraine . My previous form includes a very

lengthy spell at MSAVLC (medical and

scientific aid to Vietnam , Laos and

Cambodia .By way of an introduction the

state of most of the hospitals and health

care institutions is inversely proportional to

the modern , state of the art stadium ,

currently being showcased nightly on our

tv screens during Euro 2012 .Dilapidated

run down infrastructure often walks hand

in hand with obsolete equipment , and

the average monthly salary of a senior

clinician is roughly £250 .

The BBC was saying that back in 2010 that

hospitals budgets in ukraine , nosedived

after a 75% reduction in state financing

,the effects are noticable and impact

heavily on the delivery of healthcare at a

local level , with acute shortages of

equipment ,drugs and resources to

upgrade and repair buildings .When I

first arrived back in 2002 it was

commonplace to see IV cannulaes re-

sterilized between patient use , however a

reassuring glance into the peroxide

sterilizing tank confirms that this practice

has been confined to history . and

toothpaste employed as a fixative for ecg

electrodes as they journeyed from patient

to patient. Neccesity is the mother of

invention and adapting old lemonade

bottles for redivac drain substitution is just

one example of local ingenuity and

invention from many that come to mind.

Equipment generally is used carefully and

sparingly to prolong their lives , Single use is

not in the medical lexicography in this

part of the world .The clinicians are well

trained and educated and very well up to

Illustration 1: One of the main operating rooms ternopil regional Hospital

Illustration 2: getting ready for the next operation , auoclave in trauma theatre Ternopil Regional Hospital 2011

Article for Intersurgical UK John M Allwood West Middlesex University Hospital

date with our techniques and approaches

to the delivery of “western” healthcare

due to the advance in social media sites

and availability of information which is

avidly digested ,and any visit is always

well anticipated and attended

On a practical level, most of my on the

gound time is in western ukraine ,in the

cities of Ternopil and Chortkiv about

400km southwest from the capital kyiv.

and normally reached by an overnight

train journey. My purpose is spent

organizing airway orientated workshops

and talks in conjunction with the local

medical universities and departments of

anaesthesia .

The medium of communication is English,

my first 1 hour lecture back in 2002 took 3

hours with “ lost in translation issues “

restricting the flow of the topic's ,

however now both the content and

delivery has been streamlined and we

have a well seasoned pool of English

speaking anaesthetists on hand to assist .

As interns , junior anaesthetists spend 2

years on their basic anaesthesia training ,

so there is always a fairly quick turnaround

and new mouths to drink at the fountain of

knowledge The benefits are immense and

not only allow local practitioners the

tactile pleasure of using contemporary

airway devices , but learning their

significance in our airway algorythm's

and which is my basic template for the

delivery of learning. Depending on the

Illustration 3: a well attended resuscitation and airway management study morning at chortkiv medical college

Illustration 4: Putting the knowldege into practice

Article for Intersurgical UK John M Allwood West Middlesex University Hospital

location and learning group complexion

and level of expertise numbers can vary

between from 3 to 6

senior clinicians or up to 150 when we do

a general airway management study

session for nurses. Locations are usually in

the hospitals themselves or in a dedicated

lecture theatre ,and have even been set

up in hotel rooms when circumstances

have dictated this option .The learning is

delivered on a practical hands on basis

Powerpoint is used sparingly with a

reliance instead placed on the spoken

word and the showing of instructional

product CD roms , for more advanced

sessions we use real time operating lists ,

though this is normally for senior

practitioners and university faculty

members ,the rationale is that they can

then cascade the learning to the the

more junior / inexperienced team

members in their native ukrainian

language , and besides it keeps numbers

to a minimum during busy operating

sessions.

illustration 7: Dr Olexiy Kuybida at regional Hospital

ternopil during iGel Study session

Illustration 5: senior clinicians study session on airway devices Chortkiv Hospital

Illustration 6: completion of airway management study morning ternopil regional Hospital

Article for Intersurgical UK John M Allwood West Middlesex University Hospital

In addition to anaesthestists and nurses we

also offer teaching to a group of

professionals called Feldshers , they crew

the local ambulances , assist at births and

a whole lot more besides .

It might be of interest to say that in places

like the small hospital in Bukachivtsi , which

is reliant on Feldshers , in winter time , the

temperatures here plummet to -35

celcius , the roads become impassable ,

so they use the horse and cart as the

rescue ambulance.

As a follow on to local teaching and

learning I have set up and successfully run

a programme whereby ukrainian

anaesthetists come to london for further

training. To date 4 have arrived and we

have a waiting list of future participants For

the future I have new projects in the city of

Zaphorizhe in eastern Ukraine coming up ,

which I am excited about , and a return to

Ternopil later in the year .In finishing this

short article ,it has to be said that without

intersurgicals help and assistance these

projects would be difficult to facilitate and

through this article I would like to express

my immense gratitude to the company

and to Andy Masterman ,for all the kind

help over the years if anyone would like

any further information I have had several

feature articles published and would be

happy to provide copies upon request.

I would also like to thank mr Carl

Hollinshead and Dr Ali Rahmaty in ably

assisting me in my ventures and to Dr

Tetyana Potupalova Dr Maxsym

Doroschenko ,Prof Alexander Olenyiuk

and Dr Olexiy Kuybida or all their help and

assistance .

John Allwood june 2012

this article has been written exclusively for

intersurgical UK , all images copyright john

allwood

Illustration 8: front enterence Local hospital in Bukachivtsi