Gassing in Guyana
This is a guest post written by Dr Victoria Clarke - anaesthetic registrar in London and voice of the Anaestheasier podcast - about her recent trip to Guyana.
If you have a similar story you'd like to share with our audience, please get in touch!
The invitation
An opportunity to join an anaesthetic charity teaching trip presented itself to me - quite by chance - and needless to say my heart jumped at the opportunity faster than you can say atropine.
A fleet of anaesthetists from the USA, Canada and the UK were all heading on down to Guyana to teach anaesthetics in a variety of sub-specialties.
For some it was a few days and for others it was a couple of weeks.
- Vaccinations done
- Reference letters sent
- Online meetings conducted
- Suitcase packed
Before I knew it, I was flying out of Heathrow with Guyana ahead.
Now I’d love to say it was that simple but is anything ever?
A layover in Barbados with a sportingly long delay made things a little more interesting. I had always wanted to go to Barbados so I’m officially ticking this off my bucket list, even if I never did manage to leave the airport.
New thing to add to the bucket list, next time - leave the airport.
The second leg of the journey was a small trip in an even smaller plane which slung us over from the Caribbean Island to mainland South America where you’ll find Guyana situated on the Northern coast of the continent.
Turbulence - tick - to say the trip was bumpy would be, the now nauseated and shaky, understatement of the century.
The differential diagnosis for the sweat on my brow includes but not limited to:
- 30° heat
- 60% humidity
- 0.2mg flight-induced endogenous adrenaline
To feel solid ground under my feet again left me with a cocktail of utter relief and gratitude that I had survived, and with that little white-knuckle ride completed, I had made it.
I was in Guyana.
The delay and roller coaster plane ride saw me arrive at Cheddi Jagan International Airport around midnight.
Making my way through passport control and then customs, I wandered out of the airport to find the sign I was told would have my name on it. There were people everywhere, horns going, heat, chatter, noise and a hint of chaos. How exciting. Looking anxiously through the crowd, I spotted the sign.
The hospital driver who picks up medical staff and carts them to the hospital accommodation was patiently waiting for me, stood in a crisp white shirt and chinos. I was genuinely impressed how cool he appeared in the heat.
He apologises, “Sadly we have to wait; we got one more to come in”.
Waiting in the heat, I could tell I'd have to be strict with myself and stay on top of water intake. 20 minutes later the North American anaesthetist we were waiting for, came out.
“So sorry, the flight was delayed”,
“Don’t worry mine was too, I only beat you by about 20 minutes”.
He was here with a different charity and we chatted for a while, but exhausted we soon let the silence fill with the music of the radio and new noises from outside and beyond, carried in on the breeze coming through the rolled down windows.
Guided by the Demerara River on our left, we drove to the capital Georgetown, where the river plunges into the vastness of the Atlantic Ocean. The lights bounce off her rough surface and, in the moonlight, you get glimpses of how vast and wide she truly is.
This is where the rums of El Dorado are born, infused with the warmth of the heady, hot nights.
The houses we passed are a concoction of styles with no real uniformity. The one type of house that appears with more regularity stands on tall stilts and is made of beautiful wood. Under these elevated houses you often see hammocks and chairs where casual life encounters happen in the height of the heat, protecting those underneath from the beating sun.
Dogs, goats and chickens also find solace from the day here.
Flooding is a normal occurrence here, as Guyana is decidedly at sea level in addition to which it also has an impressive rainy season, earning it the nickname "Land of many Waters".
Creeks, canals, trenches, The River and The Sea - there's water everywhere, rippling the quiet heartbeat of the country.
No wonder there is such vastness of green; the water feeds the earth here and pineapples, mangos and coconuts grow in abundance. The air is sweet with it.
The road is bumpy and long.
The taxi driver told us the road is always under construction and the same heavy trucks fixing the road are also ruining it. “Lord, what can you do” he mutters to himself.
We were staying at two different places, so after my new colleague stepped out into the heat of the night, we headed onwards to Project Dawn, the hospital accommodation where I was staying.
It was well after 1.30 am by the time I arrived. I collected my key from the security office and found my room where I was met by air conditioning and a freshly made bed.
It was, without question, one of the best sleeps I have ever had.
Day one
Like any new job, Day 1 was mainly filled with - “excuse me could you tell me how to get to….”.
As you turn the corner into the main hospital forecourt, you’re met with an excitement and flurry of people, nurses, doctors, ambulances, students, patient seating areas outside and the most fantastic turquoise blue paint coating the building.
Behind you, in faded red paint “Maternity Unit”, a separate and gorgeous wooden structure with red roofed windows and brilliant white paint hugging its walls.
Walking through the halls you catch glimpses into offices with large wooden and faded desks weathered by time and heat, on top of which sit stacks of paperwork filled with patients’ stories. It’s a reminder that this place has been here for well over a century, working away serving the country of its needs.
Wards are out of sight, down meandering corridors with beautiful blue written clinic signs indicating hanging on the walls.
A hospital always feels familiar and safe, and this was no different.
The unspoken rules and etiquette of individual theatres and hospitals were not lost here either and it was exciting to see the personality that Guyana Public Hospital had.
The three anaesthetists, including myself, who went during the first part of the trip were here to cover paediatrics, regional and obstetrics.
Our main job was to help and guide with techniques, practices as well as teach residents and consultant anaesthetists through interaction with them in theatres. We would also be giving lectures and seminars in the Health Education Centre.
Some poor second and fourth year resident anaesthetists had exams approaching, a tale as old as time. The key for this group of trainees was exam prep with lots of case-based discussions and the classic fun of ensuring basic sciences were anything but basic in teaching.
A true generalist
In Guyana you find a system efficient in producing practicing anaesthetists who are expected to take on the challenges of many specialities.
Being the main hospital of Guyana, they see anything and everything and their anaesthetists are expected to cope and get on with it.
- They have a four-year residency program which may sometimes involve fellowships abroad
- They have two major sets of exams - in second and fourth year
- It is a rigorous programme with high expectations
It’s an effective system and one that has been established for several years now.
This programme is seeing overseas applications too due to the fact that some of the other Caribbean islands, for example Grenada, do not offer anaesthesia training.
The Day
The day starts like any other theatre system, with The List.
Who, what, where and why all clearly indicated on the board - Finding our respective theatres, we head in and keenly observe.
We are not there to clinically intervene but to teach in theatre and suggest or guide practice as we see appropriate. It’s very collaborative and the interaction is two ways.
It’s an international conversation of practices, techniques, knowledge, and ideas.
Whilst we’re here, the Education Centre on a Tuesday afternoon is where you’ll get a seminar by a Professor of Anaesthesia giving talks on paediatric anaesthesia. If you make your way to the designated regional block area, you’ll find a regional anaesthetist from Boston giving one to one advice on how to perform an array of different blocks for patients. If you then walk over the road to the Maternity Hospital you’ll find me, in the seminar room doing case-based discussions and teaching sessions with the residents rotating through their obstetrics block.
The hospital is filled with interesting cases, treating anyone who walks through those turquoise doors.
It’s a busy anaesthetic department, working away in their 5 main theatres and 2 obstetrics/gynae theatres. Obstetrics is going through an incredible evolution there too. Epidurals are not the normal practice for a variety of reasons, but the desire is to set up a service which provides this as an option for labouring women.
There are passionate senior residents overseeing this and proposing a real way that this could be established. They have several labour rooms, and the maternity hospital has a natural and effective flow system which makes a mother’s or patient’s journey through those halls both sensible and effective.
You’ll also find the NICU, Maternal HDU and second Critical Care Unit there. It’s ready for action and boy does it see it. A variety of complex obstetric and gynaecological patients being treated with MDTs and complex decision making is occuring.
This is a department with ambition and drive.
My time was sadly too short at Guyana’s Public Hospital but in my brief time there I have seen the passion and motivation that exists within their walls and theatres.
An innovative group of consultants and senior residents training the next set of anaesthetists to eventually take over. The teaching opportunity was simply incredible. I cannot overstate the warmth and friendship that I felt whilst there. I sincerely hope I get to go back again, so we can learn a little more from each other, like all good friends do.
Until next time, Guyana.
