Reports

Workshops Reports "Tools & Skills"

LOCAL ANESTHESIA IN SURGERY

REPORT WORKSHOPS CENTRAL AND NORTHERN REGION MALAWI
September – October 2010

introduction
This was the 3rd workshop in Central and the 2nd in Northern Region of a series of workshops dealing with basic surgical skills at district level. Not only skills are instructed, but the provision of the essential instruments and equipment required to carry out those skills is an essential component of the philosophy. By going on outreach to run the workshops at each individual hospital we accomplish one of our main goals: the teaching to be available to all staff members of whatever level who wishes to participate. Attendance requires no payment, but neither does it generate financial ‘compensations’ for the participants. The interest which this teaching generates is an indication of the need for postgraduate training in the hospitals at district level.
In spite of the availability of local anesthetic drugs in District and Mission Hospitals in Malawi, the simple techniques of its application and the advantages, it is only used for minor procedures like wound repair. Due to wrong techniques the idea has settled that it does not work for other surgical procedures and the careless use of large quantities of high concentrated lignocaïne, resulting in signs of overdose has raised unjustified questions about its safety. The workshop on Local Anesthesia in Surgery is intended to clear up misunderstandings concerning local anesthetics, to train proper techniques of its application and to stimulate its safe use in surgery.

outline workshop
For every workshop in Central Region (CR) instructors (Clinical Officers) were recruited from the Surgical Department of Kamuzu Central Hospital Lilongwe, two instructors (Anesthetic Department of Kennemer Gasthuis, Haarlem, Netherlands) joined in from the Netherlands and one coordinator, specialist in  surgery, completed the number of four instructors per workshop. In 6 northern Hospitals the presentations and practicals were given by local Clinical Officers together with the visiting surgeon.   
The introductory Power Point Presentation, given by one of the Malawian instructors dealt with all ins and outs of local anesthetic drugs available in Malawi, its risks, the way to prepare correct solutions, to prevent overdoses and the way to inject properly. This was preceded or followed by an indispensable instruction about how to prepare, inform, monitor and observe patients undergoing surgery under local anesthesia.
For the practical session the participants had to split up in small groups. First the way to prepare Lignocaïne solutions of different concentration had to be shown. Thereafter different types of local anethesia could be practisized on skin dummies and imitation fingers under supervision of the instructors: infiltration anesthesia, field block anesthesia, digital anesthesia, penal anesthesia and inguinal anesthesia for hernia repair. In a limited number of participating hospitals we were able to perform hernia and scrotal surgery under local anesthesia in theatre.

materials, tools, job aids
Every participant received a plasticized pocket card with the main points of attention concerning local anesthetics and a printed instruction about how to prepare diluted solutions of Lignocaine.
For every Hospital we brought with us 30 flacons of 10 ml lidocaine 2 %, numerous 20 ml+10 ml syringes, 16/21/23 Gauge needles and an illustrated handbook on circumcision under local anesthesia.
Certificates of Attendance were issued to all participants, enabling them to collect points in the ongoing CPD (Continuing Professional Development) program of the Medical Council of Malawi.

Data workshops Local Anesthesia September / October 2010
1    try out workshop at Kamuzu Central Hospital
14  workshops in District and Mission Hospitals in Central Region, 6 in Northern Region:

 
Coordinators    3   (of which 1 Malawian)
Instructors      8 (of which 4 Malawian)
Transport SIMAVI cruiser total kilometres (preparation + workshop visits):         5416 km                      

November 2010
Dr. J.J. Petit, malawi.kom