Reflections from the Intensive Care Unit – Ruth Tighe

I graduated from Nottingham Medical School in 2004 and after many years out exploring countries and specialities, I finally decided on Anaesthetics/Intensive Care Medicine.  In the past most of my experiences working abroad have been aimed at improving my clinical skills, to ensure I have been exposed to extreme cases to hopefully make me a better registrar.

I would have always claimed global health was an interest but until January 2015, I wasn’t planning to adventure out to Africa again until I’d become a consultant.  But then the idea of Sierra Leone came up via one of my best friends, Ling – Emergency Co-ordinator for the King’s Sierra Leone Partnership and I couldn’t resist.

I chose to work with King’s because it proposed a unique way of developing intensive care in a low income country that has no post-graduate training and less than 5 anaesthetic doctors in country. The King’s approach thinks more about the system and the professionals you are working with rather than your own skill progression.  King’s encourages a gentle approach via role-modelling for staff working in the main governmental tertiary hospital, to instil comprehension and propagate behaviour patterns that will continuing after I’ve left. Essentially it is about being incredibly patient, building relationships, and working together to spot holes in the functioning of the Intensive Care Unit. Most solutions are achieved without huge changes in practice; the focus is rather on training, education, and monitoring outcomes to demonstrate efficacy.

Although we are mostly volunteers, we are trying to tackle large-scale projects to impact on the entire health system. One of my first tasks as Critical Care Co-ordinated was to support the ICU to improve the provision of oxygen in Connaught. My first four months were focused on the development of the first fully functioning oxygen factory in the country. The results have been impressive. In the three months since we got the first piped oxygen in the country, we’ve seen mortality drop by nearly 30%.  My dream is that my colleagues and I can start a program that shares our experiences with the five non-functioning factories in the districts so that all of Sierra Leone would have access to simple oxygen therapy. Our next project is to implement non-invasive ventilation and again hopefully see another fall in mortality and potentially expand this out to districts. It is incredible to work in a system where simple changes can produce such a drastic change in outcomes.

While I’m not necessarily getting awake fibre-optics or ECMO experience, I am getting more teaching, management, research, and quality improvement opportunities than I thought possible. Being passionate about this cause easily motivates me to work hard to get one project finished so I can start the next one.

Sierra Leone has been through a lot, yet there is an overwhelming sense of gratitude that they’ve come through the war and Ebola. Everyone here has such a strong faith, which is probably what holds them all together through such tough periods.

My respite is knowing I get weekends surfing at Bureh Beach – every week by the time Friday comes I’m so excited to get back in my new-old defender and bounce along the coast, hang out with friends to attempt to stand on my foamie board in the white water – it washes away any stresses from the previous week and gets me refreshed for the next.

I’d be lying if I said this wasn’t stressful.  Witnessing the poverty and the needless deaths of people who can’t afford their health care is extraordinarily draining. But any time it starts to break me, I reflect on our wonderful NHS (long may it last!),  and that I am lucky to be healthy, to have received a full education, and to be trained in a job that I love that lets me travel the world!