Ruth Tighe, Lifebox Fellow 2016

Although your Lifebox Fellowship at Kilimanjaro Christian Medical Centre is just beginning, you could say your relationship with the hospital goes way back…

Yes – it came about in a strange way!  I read about KCMC when I was 16.  There were two books that I found so inspirational – one called Half the Sky, and another called Three Cups of Tea. The author’s dad helped set up KCMC.

He did this phenomenal stuff, in this absolutely stunning place and I remember thinking – if I did medicine, maybe I’d get to visit this place.

Why did you apply for the Lifebox Fellowship?

I was working with the King’s Sierra Leone Partnership, and a colleague sent through the advert, suggesting it would be a good next step.  I’m incredibly sad about leaving Sierra Leone – it was the most difficult decision; ‘why am I moving to Tanzania when the project is still here?’

But there’ll be more opportunity to improve clinically – and when it comes to organizations supporting safer anaesthesia and surgery – the operations taking place right now – there’s nothing else like Lifebox. It’s the NGO – and if this is something I want to do for the rest of my life, these are the people I should know – the people I should work with, the organisation I should be with.

How did your interest in global anesthesia develop?

I’d never really travelled before I was 18, so throughout medical school I took every opportunity to find a job that would take me abroad. I knew when I did my house jobs I wanted to go to Australia, but I thought that was just so I could learn to surf! When I got there it just seemed…like a hot England.  A challenge in its own way, but no different to being a doctor in the U.K.

I know we’re taking about anaesthesia, but for me the part I love is emergency – working with the really, really sick patients. I knew if I wanted to get good at being that kind of a doctor I’d have to go somewhere else. So in 2010 I set up an 18-month placement in a big trauma center in South Africa.

We were in theatre 24 hours a day – it was the biggest shock to the system, but exactly what I’d gone out for. Incredibly hard, but I remember thinking – this is what I want to do.

So what did you do next?

After South Africa I went to a small mission hospital in Malawi – an elective paediatric facility. There was still clinical and service provision, but there was also more humanitarian project stuff, and I thought – this is something I want to be a part of for the rest of my life.

But I always felt that if you want to implement anything, if you want to be useful, you should be a consultant. So I went back to continue my training.

And then Ebola happened. I had a friend working for the amazing King’s Sierra Leone Partnership. I said, ‘can I help?’ – and she said ‘no, but as soon as this is finished, everything is going to be decimated.’ So I went out to help with post-ebola recovery.

You don’t need to be a consultant to do this work – you just need to be massively open-minded and form good partnerships. To meet people, find out where they’re at, what they could expect – go with small steps together, rather than ‘oh my god this is horrific, how do you guys work in this condition’ – which is obviously a terrible approach.

What are you looking forward to as you start your Lifebox Fellowship? 

I’m excited to be a part of an organisation that rates anaesthesia and thinks it’s important. I massively agree with the place in practice for nurse anaesthetists. Even in the UK we’re talking about the space between NA and MD – but all you have to do is go to a place where there’s no choice, and realize these guys are so so valuable. If you can help them to make their practice as safe as they can be, that has to be the plan – at least for the next 20 to 30 years, till we make more physicians.

I’m looking forward to learning from everyone – from the staff, other NGOs, learning more about global anaesthesia and medicine.  There’s so much to take away from other people’s lessons – and your own. In a selfish way I’m excited to see how my skills with partnership and training have improved – to see how what I learned in Sierra Leone is transferrable.

And the challenges? 

You actually caught me learning my first Swahili words because I think the language will be a challenge!

And of course, if you didn’t meet any challenges it would just be another job, turning up from 9 – 5. The challenges are what makes the job more rewarding, and I don’t think you can expect this sort of job to not be rewarding for yourself too.

Do you think Global Anaesthesia is starting to get recognition as a legitimate career track? 

In anaesthesia, people can see it’s a professional field – they get that just as you might do teaching or research when you reach this level of training, global anaesthesia is another specialisation.  Especially in our deanery – along the South Coast they’ve given people the time they need to develop their work.

But outside of medicine – even I think in the other specialities – they see you going off ‘on a humanitarian thing’, a phase of your life that you’ll grow out of.  The question is just when!

I tend to laugh along, because not everyone wants to hear about the plight, the politics – but when they do, I can explain my choices and my progression.

That I started off trying to improve myself clinically, then saw the humanitarian aspect, then development structures, through to higher policy engagement and education – people really do get it.

So – reason to be optimistic!

Well it’s nice to be, perhaps, a bit of an example – that this is possible.  People send me emails now – friends of friends who want to do this kind of work, and it’s great to be an advocate for this amazing step in your career.

In the U.K. we get so fixed on training.  ‘I can’t leave’, people say – but you can! I’ve taken five years. If you feel you can’t, perhaps you haven’t asked enough, or found the right place.

And there’s so much benefit in all directions.  We constantly hear we’re not preparing doctors for the skills they need in higher posts.  But I learned more this year about non-clinical things – all the skills you need to be a consultant, teaching, planning, implementation – than ever before. This will be the best preparation.

One of the things with this kind of work is you’re very quickly exposed to a small circle of very inspirational people.  Like Andy Leather at Kings – you cannot believe what they’ve achieved, while having medical careers as well.  That’s the kind of integration you need – it’s completely possible, and the NHS shouldn’t be frightened of it.  Potentially with this new wave of people, that’s what will happen.