Volunteer anaesthetist Ian Fleming on what it's really like to deliver surgical training

Ian Fleming, a consultant anaesthetist at King’s College Hospital, has been an Orbis volunteer since 2005. Over the past 15 years he has trained fellow anaesthetists in countries including Syria, Cambodia, Bangladesh, Nepal, China, and Vietnam, both onboard the Orbis Flying Eye Hospital and within local hospitals.

This blog post from anaesthetist Ian Fleming, written after a trip to Hue in 2015, offers a glimpse into the process...

Ian Fleming

Volunteer anaesthetist for Orbis

I nev­er under­stood why col­leagues said anaes­the­sia is stress­ful”. Then I start­ed vol­un­teer­ing to help train local anaes­thetists on the Orbis Fly­ing Eye Hos­pi­tal… Watch­ing some­one else do some­thing, and stop­ping your­self from inter­fer­ing or tak­ing over is dif­fi­cult. But teach­ing a for­eign trainee, through an inter­preter, with fif­teen peo­ple watch­ing, includ­ing a film crew – that real­ly piles on the pressure.

Training Onboard the Flying Eye Hospital – Ian's Story

"It’s August 2015 and I’m in the Central Hospital in Hue, Vietnam on an Orbis Flying Eye Hospital programme, teaching local anaesthetist, Dr Hòa the finer points of an anathestic technique called Subtenons anaesthesia.

It’s 35°C and 90% humidity outside. I’m still sweating slightly even with the air con on. Dr Hòa’s watched the lecture, seen the demo and practised several times on sheep’s eyes in the wet lab we ran, which is an opportunity for trainees to hone their skills in a controlled environment. I’m not sure which of us is more nervous. The patient has given her consent and we have prepared her eye with topical numbing and sterilising solutions. Dr Hòa picks up the forceps and scissors. Always a difficult moment for us needle and syringe loving anaesthetists as subtenons is a bit “surgical”. My usual joke about “don’t worry about buying the equipment, just steal them off the surgeon” backfires slightly, half of those watching us turn out to be local surgeons!

I worry he is going to be too tentative, he is. A small prompt, through the interpreter, reminds him to take a decent bite with the forceps. His hands are shaking a bit, but he steadies himself. He makes a small incision and passes the subtenons cannula perfectly. He injects slowly, just as I taught him. Now the hard part, waiting to see if it has worked. Now he looks really nervous.

Two minutes pass and we check to see if the procedure has gone to plan. Through the interpreter we ask the patient to try and open her eyes and to look left and right. She cannot. A perfect block! (this is a technical term). The look on his face says it all and reminds me why I come out and teach on Orbis programmes.

We walk the patient through to the OR (Operating Theatre - got to get used to American jargon) and the operation goes smoothly. It takes a while, nearly two hours. However the patient is comfortable throughout and the surgeon complements Dr Hòa on an excellent block. I am confident he’s going to do excellent work and not only go on to ensure hundreds of operations can go ahead smoothly, but train many of his contemporaries using the skills and expertise I have been fortunate enough to share with him."

Ian Fleming

Our wonderful volunteer anaesthetist on why the Orbis emphasis on training is so important

Every­thing takes longer on an Orbis pro­gramme because they are teach­ing pro­grammes. Every­one is dou­bled up. I’m teach­ing, so are the sur­geons and the nurs­es. Some­where else in the hos­pi­tal, Orbis Bio­med­ical engi­neers are teach­ing their local coun­ter­parts how to repair and main­tain the equip­ment — equal­ly impor­tant mem­bers of the Orbis fam­i­ly”, with­out whom it just wouldn’t work. The fact that Orbis recog­nis­es this, in its aim to erad­i­cate pre­ventable blind­ness world­wide, that you need to sup­port every part of the oph­thalmic path­way is why I am still here, ten years on, vol­un­teer­ing on my twelfth pro­gramme with them.

Ian shares his story of volunteering for Orbis.

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