By Dr Sarah Loftus

In this blog, Sarah reflects on her experiences being part of the team building the SCALE Critical Care partnership.

Sarah is a ST3 Anaesthetic trainee currently based at Lister Hospital, planning to pursue joint Intensive Care Medicine/Anaesthesia specialty training. She has developed an interest in global health during her undergraduate training. Before training in Anaesthesia Sarah completed a Diploma in Tropical Medicine and Hygiene at LSTM.

My fellowship so far has involved working on the SCALE critical care partnership between Uganda and the UK in order to strengthen workforce capacity. But what does that mean?

Picture 1 – Members of the SCALE Critical Care team in Kampala in June 2022

Critical care is an integral part of healthcare, it allows close monitoring and organ support to ensure patients can survive severe illnesses. Currently many are dying from illnesses in lower income countries, not because of the lack of knowledge or medicine but due to a lack of high-quality critical care support. Additionally, surgery, a historically neglected area of healthcare development in lower income countries, is often not possible or dangerous without high quality post-operative care.[1] The kind of care needed to monitor and support people after major operations is delivered in critical care units.

It is vital to develop critical care in lower income countries to improve global health equity. Increasingly, the global community is realising that healthcare should always be thought of in terms of global health. Where someone is born should not define your odds of surviving an illness. Moreover, when healthcare is neglected in any country, this has ripple effects on the rest of the world, as we have seen during the COVID-19 pandemic. The world is so connected now, a developing disease outbreak in one corner of the globe can no longer be ignored as it isn’t affecting those in high income countries. We are forced to consider it and react; it should not have taken the threat of affecting individuals in high income countries to drive action but whatever has shifted the balance is worth being grateful for. The SCALE (strengthening workforce through global learning) Critical Care partnership is part of a wider group of partnerships across multiple specialties between different sites in the UK and Uganda. The Critical Care arm focuses on supporting development of the Ugandan Critical Care service and strengthening the established UK service through bi-directional learning, virtual grand rounds, and simulation. Other elements of the partnership include the development of bi-directional fellowships and collaborative research work. The model of this partnership aims to build from the bottom up, growing and developing with the critical care service itself, aiming to adapt to its needs rather than try to predetermine them.

In June 2022, I was part of a team who visited Uganda to meet key stakeholders in the partnership and build all important relationships with partners. We also visited four critical care units at Mulago National Referral Hospital, Kawempe National Referral Hospital, Kiruddu General Hospital and Mbarara Regional Referral Hospital. Working together with Ugandan partners we assessed the needs and infrastructure of existing critical care departments to best gauge what activities would be practical and beneficial in the next stages of partnership activity. There was also opportunity to discuss funding plans and sign an Memorandum Of Understanding between the partnership organisations including the Ugandan Ministry of Health, Cambridge University Hospitals NHS Foundation Trust, CGHP, and the Uganda UK Health Alliance.

Visiting Uganda, I saw they have in some regards a very different but in others similar healthcare system to the UK. Largely our Ugandan partners are seeing similar diseases and conditions, just on a different scale and with a much younger population. Hospitals are full and healthcare workers are overworked and tired, the conditions are worse for both patients and staff in Uganda, but the themes run parallel to the UK. Our Ugandan partners are managing to deliver an enormous healthcare service with skeletal staff. There is a great deal we can learn from the healthcare systems in other countries such as Uganda and it is a great privilege to be invited to see and support another healthcare system.

As with any privilege it is important to be mindful of it and to ensure that we do our partners justice and work together collaboratively. Working in this way, sharing learning and expertise will lead to improvements in patient care and outcomes in both locations as well as build better research links. One way the partnership has started this is by organising virtual medical and nursing grand rounds where we share learning from different cases, one from each partner country with education on the topic and time for questions on clinical management.

My learning so far….

Since starting the global health fellowship, I have developed much more confidence in professional meetings. I now recognise that you do not need to be the most senior person to be able to contribute and add value to discussion. I have also developed my public speaking and writing skills by presenting at conferences and writing articles and now blog posts!

The visit to Uganda also exposed me to another healthcare system and highlighted various learning points such as how maintaining versatility allows for improved service potential. It is commonplace in Uganda for children and adults to be cared for in the same ICU and so the staff are competent in caring for both paediatric and adult patients. Whilst this seemed a daunting concept, it allows for much more adaptability in the workforce and healthcare system. A theme of my learning from visiting the hospitals there was that when faced with adversity if you have the skills and experience to be flexible, then you will have much greater potential. Inspired by this experience I have pledged to make an effort to continually push myself beyond my comfort zone to develop and learn new skills.

Next steps….

We are continuing virtual grand rounds for doctors and nurses. In addition, there was recently a successful virtual simulation run by nurses and we hope to run more virtual simulation, expanding to include the wider multidisciplinary team. On the visit to Uganda we saw our partners were delivering some highly thought-provoking simulations challenging hierarchy and gender roles which would be great to learn from. In February a nursing team visited Kampala to deliver training and later this year Doctors will visit to begin building a research partnership and later to deliver an internationally established foundation course in intensive care. Two Ugandan MTI Doctors have arrived in Cambridge and are working at CUH in critical care and we are supporting them to get the most out of their time here. All of our work in this partnership aims to bring about impactful and sustainable improvements in critical care practice in both the UK and Uganda.

  1. [1] Alkire BC, Raykar NP, Shrime MG, Weiser TG, Bickler SW, Rose JA, et al. Global Access to Surgical Care: A Modelling Study. The Lancet Global Health. 2015;3(6).

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