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

July 2019

Ian Fleming, a consultant anaesthetist at King’s College Hospital, has been an Orbis volunteer since 2005. Over the past 14 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.

The Flying Eye Hospital is off to Vietnam next month, and once again some of our fabulous volunteer medics will be sharing their skills with local eye health teams. This blog post from anaesthetist Ian Fleming, written after a trip to Hue in 2015, offers a glimpse into the process...

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.

Ian Fleming

Volunteer anaesthetist for Orbis

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."

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 Fleming

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

Ian shares his story of volunteering for Orbis.

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