1. OOPT- Opportunity for UK anaesthetists
Dr Sara Scott, ST3 in Anaesthesia, Northern Deanery
Dr Gemma Nikhols Consultant in Anaesthetics, Bristol
Dr Sanjay Deshpande, Consultant in Anaesthetics, Newcastle

2. BKL Walawalkar Hospital
Applications are invited for post CCT anaesthetists or post ST5 trainee anaesthetists (OOPT only) to act as visiting registrar in anaesthesia and intensive care at the Bhaktashreshta Kamlakar Laxman Walawalkar Hospital, Dervan, Maharashtra, in India.
This is a six month commitment designed to provide experience in the fields of Anaesthesia and Intensive Care in a rural setting
A team of doctors and nurses visit the hospital every year for the past twelve years.

3. BKL Walawalkar Hospital
B.K.L. Walawalkar Hospital (BKLWH) is a 500 bedded multispecialty hospital providing comprehensive treatment for patients coming from the surrounding area.
The hospital strives to provide the best treatment for patients in specialties including;
Medicine (including TB)
Surgery and Onco-surgery
Dermatology
ENT
Ophthalmology
Orthopedics/spinal surgery
Paediatrics
Psychiatry

4. BKL Walawalkar hospital
The services aim to provide patients with free treatment with the latest medical facilities.
In 2015 the hospital opened a medical school, having secured permission from Indian Medical Council and the government.
The medical school has recently admitted 100 new students.

5. Anaesthetic department
The anaesthetic staff consists of 2 professors, 3 lecturers and 3 resident.
The hospital has 9 Operating rooms equipped with piped gases, Draeger anaesthetic machines, monitoring equipment, plus equipment donated by hospitals in the North East of England.
Nerve stimulators, an ultrasound machine and epidural and spinal equipment are available.
Life box has donated portable pulse oximeters.

6. Postoperative care
In the past three years the visiting team included a Pain Sister providing education to the local staff on Acute Pain Management.
There are guidelines available for the management of acute postoperative pain.
There is a step down unit (1:1 nursing and monitoring, with medical cover) which admits patients following surgery for 24 hours.

7. Role
The post commences as soon as the candidate is selected. The successful candidate should be post CCT and hold the FRCA or equivalent qualification.
They should be able to demonstrate enthusiasm and motivation to work in a challenging environment.
Monthly salary is Rs 70,000 (approximately £1000) plus free accommodation & food.
The candidate will need Medical Council of India registration.

8. Experience in Anaesthesia
Peri-operative care of patients in a developing world setting.
Teaching and training anaesthetists, theatre staff and medical students.
Competency, skill and support required to sustain the safe and effective provision of anaesthesia in a resource poor setting.
Provision of safe anaesthesia in a challenging environment to a wide variety of patients.
Enhance experience in the field of paediatrics, obstetrics, and trauma.

9. Experience in ITU
Recognition and management of the factors which may lead to deterioration in sick patients.
Manage the initial resuscitation of critically ill patients.
Appropriately request and interpret investigations.
Critical appraisal of the evidence for investigations and treatment in a low resource environment.
Lead a ward round and plan care for 24 hours.

10. What we gained UK team gains are invaluable, more than staff in Dervan
View a different healthcare system
Achievements from limited resources
Viewing a different spectrum of diseases, its pathophysiology and management
Meeting all the staff and to experiencing the work the trust has done for the community

11. What we gained
Working abroad increases our understanding of diversity and acceptance of other cultures
Team work is promoted
Change our sense of priority in life by witnessing other peoples’ suffering and sharing their hardship
Appreciate the standard of care in our local environment (NHS)

12. What we gained Encourage us to become less wasteful
Manage resources in a better way
Improve knowledge of global health issues
Promote collaboration with international health workers
Opportunity to educate others

13. Poster presentation at NEICS, Newcastle 2016
Making a Difference at Both Ends: experiences in a rural Indian intensive care unit
Scott S, Cope L, Hunter M, Dunphy A, Deshpande S

14. Challenges in a rural ICU
Making a difference at both ends: Experiences in a rural Indian intensive care unit
Scott S, Cope L, Hunter M, Dunphy A, Deshpande S
SVJC Trust
The SVJC Trust
The SVJC Trust was established in 2006 and achieved charity status in Each year, a group of volunteers travel to BKL Walawalkar hospital in Dervan, India to work alongside local staff to provide healthcare to a rural population.2 Over recent years, the role of the charity has expanded to include work within the intensive care department. This can be challenging due to limited resources and differing patient healthcare beliefs. This report describes a case of postpartum cardiomyopathy and highlights some of the difficulties experienced whilst working in a rural environment.
Description
A 26-year old previously fit and well female, presented 10 days postpartum with progressive shortness of breath and extensive oedema. She had had an uneventful pregnancy and a normal vaginal delivery. On assessment she was hypotensive, tachycardiac, tachypnoeic and oliguric. She was drowsy and responsive to loud voice only.
Bedside ECHO showed global dilatation with severe tricuspid and mitral regurgitation.
Abdominal and pelvic ultrasound were grossly normal; chest x-ray showed extensive bilateral pleural effusions.
An arterial blood gas on 15 litres of oxygen showed:
pH pO2 60mmHg pCO2 26.4mmHg
Dobutamine and furosemide infusions were commenced and CPAP was initiated. Blood tests were limited and invasive monitoring was unavailable due to resource restriction, therefore clinical examination was the predominant means of assessment.
K+ 5.75mmol/l HCO3- 5.8mmol/l BE -23.5mmol/l
Over the next 48 hours the patient underwent an extensive diuresis, her acidosis normalised and her biochemistry began to improve. The furosemide and dobutamine were weaned and an ACEI was commenced. The patient and family were counselled about the risks of further pregnancy.
Initial bloods revealed:
WCC 24,400/cumm Hb 10gm% platelets 91,000/cumm PT 44.1s creatinine 1.55mg/dl.
Peripheral IV access was difficult; ultrasound guided internal jugular and subclavian central lines were sited.
Discussion
Peripartum cardiomyopathy (PPCM) is a rare condition which typically presents from the later stages of pregnancy until the first six months postpartum.3 The pathophysiology is poorly understood, however it is believed to be linked to abnormal prolactin metabolism.4 There is marked geographical variability in the incidence of PPCM and the true incidence is unclear.3,4 Patients typically present with symptoms of left ventricular dysfunction with no underlying cause.4 Diagnosis is often delayed due to variable clinical presentation and lack of awareness.3 Mortality is variable with studies quoting between 0 and 28%, however, most surviving women have some residual left ventricular dysfunction.4 Management strategies are similar to that of severe cardiac failure.3 Patients must be counselled about the risks of future pregnancies.
Challenges in a rural ICU
Environmental Social Personal
- Medication availability Religious beliefs Language barriers
- Basic monitoring Financial constraints Team integration
- Staffing levels and experience Patient expectations Unfamiliar pathology
- Access to investigation
References 1. 2.
3. Hilfiker-Kleiner D, Schieffer E, Meyer G, Podewski E, Drexler H. Postpartum Cardiomyopathy. Deutsches Ärzteblatt International 2008; 105:
4. Capriola M. Peripartum cardiomyopathy: a review. International Journal of Women’s Health 2013; 5: 1-8

15. Opportunities for UK medical students to do Electives at the BKL Walawalkar Hospital, Dervan in India
Applications are invited from medical students to consider electives at the BKL Walawalkar Hospital in Dervan, India.
In previous years medical students from Newcastle, Cambridge and Preston have done electives at the above hospital and gained valuable clinical experience. A few students from Sheffield, Dundee, etc. have accompanied a yearly camp arranged by a medical team from the North East of England for the past twelve years.

16. The future of Dervan

17. Contacts
Jim Carter , Consultant Anaesthetist, James Cook University Hospital , address :
Sanjay Deshpande, Consultant in Anaesthesia and Intensive care, South Tyneside NHS FT
Gemma Nickols, Consultant Anaesthetist, Southmead Hospital, Bristol,

18. Resources https://www.rcoa.ac.uk/system/files/TRG-IP-IndiaOOPE.pdf
Anaesthesia journal is available in the Walawalkar Hospital library.
Oxford Text book of anaesthesia (10 copies) donated by the AAGBI and available for staff in theatres and in the library.
Pulse Oximeters - Life Box ( donated by AAGBI)
AAGBI guidelines laminates available in every theatre.
WHO check list is encouraged at all times.