Uganda Anaesthesia Fellowship Programme

In October 2010 the OAA agreed to the suggestion by Dr Isabeau Walker, International Relations Committee of the AAGBI, to fund three Anaesthesia Fellows in Uganda to the tune of £3000 per annum. DAS and World Anaesthesia had agreed to do the same.

The selection panel decided to appoint four Fellows rather than just three. The OAA is supporting Dr Peter Agaba and Dr Aggrey Lukibire is supported jointly by DASand the OAA.

In April 2011 all 15 anaesthesia trainees in the Uganda MMed training programme were offered free 'guest' membership of the OAA so that they are able to access the members' area of the OAA website and receive the International Journal of Obstetric Anesthesia four times a year.

One of the trainees is also offered a free bursary to attend the Three-day Course on Obstetric Anaesthesia and Analgesia in November 2011. The bursary covers registration, flights and accommodation in London.

BACKGROUND

Uganda Anaesthesia Fellowship Programme

Uganda is a low-income country with a severe workforce crisis. Physician salaries are low and many postgraduate trainees leave the country or are attracted into externally supported specialities such as public health or HIV. Anaesthesia has not attracted postgraduate doctors into the speciality in recent years and there are now fewer than 20 physician anaesthetists (350 non-physician anaesthetic officers) for a population of 30M. In 2006 there were only two physicians in training in anaesthesia in Uganda.

The AAGBI/GPAS Uganda Anaesthesia Fellowship has been established as a collaborative project between the Association of Anaesthetists of Great Britain and Ireland and the University of San Francisco California Global Partnerships in Anesthesia and Surgery. The aim of the project is to increase the number of physician anaesthetists in Uganda necessary for the development of the specialty and to train the physician and non-physician workforce of the future.

Postgraduate training in anaesthesia in Uganda

There are two three-year MMed programmes in anaesthesia at present, one at Mulago Hospital Kampala, the other at Mbarara University Hospital. Postgraduate trainees in Uganda are required to pay university fees, and most do not receive a salary whilst they are training.

The aim of the AAGBI/GPAS Fellowship programme is to provide trainees with an income to pay their university fees and to provide moderate support for living costs when the trainee does not receive a salary from the employing hospital. The Fellowship funds trainees to a maximum of £3000 per annum for each year of training.

Trainees are appointed by interview after their internship year. They have regular assessments, annual written and oral examinations, and are required to complete a research project in their final year. They have an annual appraisal with a member of the AAGBI or GPAS. When accepting a fellowship, trainees sign an agreement to work following training in sub-Saharan Africa for the period of time that they receive funding from AAGBI/GPAS.

Outcome of the Fellowship training programme

The first trainee Arthur Kwizera graduated in 2009 and is now employed in Mulago hospital. He has actively recruited trainees into the programme and there are now 12 postgraduate trainees in anaesthesia, seven fully funded and four partially funded by the fellowship programme. The aim of the Ugandan Society of Anaesthesia is to recruit 10 trainee anaesthetists per year over the next five years, and the AAGBI would like to support them in this aim.

Proposal to the OAA

We would like to propose that the OAA joins the AAGBI programme to sponsor one trainee for a period of three years (£3000 pa, total £9000); we firmly believe that this training programme will secure the future of anaesthesia in Uganda.

‘My story is just a small part of the good that the AAGBI has achieved and it begins in August of 2007. At that time, I had just started anaesthesia training and I did not receive any income from the hospital. I was moonlighting in private hospitals around town in order to make ends meet. I had no time to read and to prepare for my tutorials, and sometimes I would have to choose between a shift that was offering to pay or my training at the hospital. I was contemplating quitting the course when I met Dr Sarah Hodges who told me about the AAGBI fellowship; I tore up my letter of resignation and decided to fight on. The fellowship has eased my personal life considerably, I have been able to make full use of training opportunities and I have improved my skills. It has also motivated me to involve myself in anaesthesia advocacy. I constantly talk to doctors and medical students about a career in anaesthesia, even if they are third year undergrads, because I believe by doing so I am sowing a seed in each one of them. In the last two years I have been able to help recruit other trainees into anaesthesia.

All the above goes to show the knock on effect of helping just one person. We need a critical mass of anaesthetists in this country (we are currently less than 20 for a population of 30M). It is much easier to recruit good quality trainees if they know that they do not have to worry about how to survive without an income. Because of the support I received from the AAGBI, a number of prospective trainees now seriously consider anaesthesia as a career option. If we can achieve a critical mass of just 10 anaesthesia residents per year for the next 5 years, we shall have a big enough voice to be heard by policy makers. This means that safe anaesthesia will become a right for every Ugandan and not for a privileged few.’

Dr Arthur Kwizera
AAGBI Anaesthesia Fellow, University of Makerere, Uganda.
September 2009