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Aid Worker ProfilesGerry Bashein, Anesthesiologist What is your professional background?I did my internship at the University of Washington and have spent my entire medical career there, becoming a full professor in the Department of Anesthesiology in 1993. Describe the different roles and responsibilities in your assignments? Did you work outside of your specialty?Anesthesia for general surgery was a part of each assignment, but some missions included a significant proportion of obstetrics—in Liberia, Sudan, and Sri Lanka—or trauma—in Nigeria, and Indonesia. In Indonesia, I was also in charge of the intensive care unit for both medical and surgical patients. In Sri Lanka, I provided relief coverage for the emergency room doctor. What did you find most challenging about your work?I had to deal with illnesses that I don’t normally handle as an anesthesiologist in the U.S. The lack of lab facilities, x-ray, and specialists to discuss medical issues with presented different challenges. Without a lab to do bacterial cultures and other tests and measurements, we gave antibiotics, fluids, electrolytes, etc. empirically. Blood was always in short supply. There was limited or no banked blood. I lost a patient who had a pelvic fracture because we couldn’t get blood in time. What were some of the alternatives you devised to work around what you lacked?In the field, you come to rely on clinical judgment and the ability to take a history and do a physical examination. The surgeons or other physicians in the project were often helpful, but there were times when none of us knew what was wrong with the patient. People occasionally died, and we didn’t know why. There were no autopsies. That’s one of the tough things about working in the field without technology or tests. What were some other medical challenges you faced?All of my experience has been with adult patients, so treating children was a challenge. Luckily, most of the children had problems that were relatively simple and easy to care for. However, in Liberia, I had to anesthetize a one-day-old child who was born with an imperforate anus and had to have a colostomy. In Indonesia, a 25-year-old man acquired tetanus from a trivial thorn wound in his heel. As he continued to deteriorate over the next few days, the surgeon did a tracheotomy. I ended up transporting him, ventilated and paralyzed, to the teaching hospital, which was a couple of hours away by ambulance. He made a full recovery. On all of my assignments, I have been impressed with the caliber and the dedication of the expatriate professional staff and their cohesiveness in helping each other when the going got tough. How did you learn how to care for cases outside your specialty?In every project, MSF keeps medical field guidelines and pertinent textbooks that I consulted frequently. With our tetanus patient, I got help from the internet, and the surgeon got advice by telephone from a colleague in Australia. On all of my assignments, I have been impressed with the caliber and the dedication of the expatriate professional staff and their cohesiveness in helping each other when the going got tough. What was the workload like?Generally, anesthesiologists working alone are on-call 24/7, although in the busier projects— Liberia, Nigeria—I had help from local anesthesia providers). In Liberia, the workload was very heavy and often at night. When there was quiet time during the day, I would go the house to take a nap. On the other hand, in Indonesia the work was almost always in the daytime. What were living conditions like?Imagine a boarding house. You have your own room, but everything else is shared. The food is generally good, although the variety is limited. I really enjoyed having dinner with my colleagues and hearing “field stories” from MSF missions all over the world. It was good to have cooking, housekeeping, and laundry services, because we were often too tired to do these chores. There was poor or no broadcast TV on most projects I’ve been on; reading and movies on DVD provided entertainment. The living compounds usually had a slow and unreliable Internet connection, and telephone access was also variable. Some of my assignments were in insecure places, so we didn’t have freedom of movement, and the security restrictions made leisure time less pleasurable. In general, you couldn’t go out and walk around wherever and whenever you wanted to, although in Indonesia, Sri Lanka, and Sudan we were relatively free to walk about during daylight hours. In Nigeria, we were hardly allowed to walk around at all. In any case, because we were on-call all the time we could not range very far and had to carry a VHF radio or cell phone to keep in touch. What advice can you give to someone wanting to try field work?The ability to make do with what you have and to be flexible are paramount. Having a good sense of humor and being a good team player are also very important. Has working with MSF inspired you to pursue additional training?I periodically review pediatric emergency care material and have taken the pediatric advanced life support and the advanced trauma life support courses, because neither pediatrics nor trauma is a part of my practice at home. What recommendations do you have for anesthesiologists interested in MSF?I took a short course on giving anesthesia in the developing world before I went into the field, but it’s not a necessity. Really, the best way to prepare would be to read as much as you can and just get out there. How do you incorporate field work with your work schedule at the University of Washington?I have reduced my regular working schedule to 50 percent of full-time, in part to allow more time to go on assignments as I progress toward retirement. Voices from the FieldRead other first-hand accounts from MSF aid workers and patients Tags: Anesthesiologist, Sudan, Nigeria |
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