Anesthesia Champion: William Banda

Gradian works with wonderful, committed anesthesia providers around the world whose hard work often goes unnoticed. We are happy to introduce you to them as we continue this monthly series “Anesthesia Champions.”

In this month’s post, we have asked William Banda, from Lilongwe, Malawi, a few questions about his experiences. Mr. Banda is a Clinician and Anesthetic Clinical Officer at Kamuzu Central Hospital in Lilongwe, Malawi (where we currently have 4 UAM’s) and since 2010, he has served as the head of the Lilongwe campus of the Malawi School of Anesthesia. William Banda has played an important role in the development of the UAM in Malawi — and for that we are grateful to call him this month’s “Anesthesia Champion.”

Q & A with William Lackwell Banda

1) How did you choose to specialize in anesthesia and where did you train?

I chose to train in Anesthesia by Chance not by choice.We have have very limited opportunity in our Country, so when an advert came out in the papers for an upgrading course (upgrade to a degree program), I just tried my luck since competition is so high. I was called for the interviews and luckily, I was successful and did my anesthesia upgrading for 18 months and I was the best overall as well as best in Practical.

I have had no opportunity to do any formal training like BSC [a degree qualification program in anesthesia] because all the Universities do not recognise the clinical officers but they only want to train doctors for the anesthesia. My training are just informal and I do alot in my own with support from other specialists and am able to work like many specialists in the world.

I am…also a CNA [Certified Nurse Assistant] supervisor. I have a lot of interest in the equipment so am among the top two or three in the country who can advise the government which machines are good for anesthesia and intensive care.

Though I came into the field by chance, it turned out to be the most interesting for me and I like, love and enjoy my work. Am very proud of myself and how much contribution I have made towards the help to the poor Malawian as well as the elite group.

2) What do you see is the greatest challenge to the safe, reliable delivery of anaesthesia in Malawi?

Our greatest challenge in Malawi is the equipment and manpower.

a) Our anesthesia machines have outlived their life span. When the government and other donors brought in equipment, maintenance has been a huge challenge and some of the consignments are broken and cannot be repaired. We need to replace the old machines which could actually belong in a Museum!

b) Due to economic hardships,we have less Doctor anesthesiologists so we are struggling when we need a consultant for second opinion. Our staffing is so pathetic and we work long shifts without promotion and no incentives which brings down the morale for the anesthetist. A demotivated anesthetist is a dangerous anesthetist.

 3) Can you share an experience where your equipment failed, jeopardizing the safety of the patient?

We have had several incidences where life of the patient was in danger.

a) One day during an Cesarean Section, a patient under General anesthesia could not be ventilated because the ambu valve jammed and the bellows could not be moved because of the lost magnet. This is so frequent in our set up.

b) Many hospitals have damaged Halothane vaporizers so they cannot give general anesthesia. So patients requiring this are referred to long distances for the service which has huge budgetary burden on the already poor country and risk for the patient who needs an operation there and then like Eclampsia.

4) What impact have you seen the UAM have in the hospitals involved in the study?

Very big impact.

a) This machine comes with an oxygen monitor, which reduces the risk to the patient, where you may give anesthesia without monitors in many circumstances.

b) This machine is easy to use and the concentrator is robust and requires minimal service like no weekly changing and cleaning of the filters.

c) The breathing circuits are strong and silicone made so they last long.

d) Oxygen supply is adequate that we rarely use the oxygen cylinders which are there for only back up.

 5) What feedback have you received from the anesthesia providers about the UAM?

The biggest feed back from the user is incoperation of the ventilator in the UAM.* Each user has no problem with this machine apart from the ventilator request. Majority of anesthetists work single handed especially at night and week ends. In tertiary hospitals we have major surgeries taking long and we need to have patient well ventilated. With hand ventilation for 4 to 6hrs, it can be a challenge.

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*Gradian has plans to add a ventilator within the next year. A new UAM with a ventilator will be presented soon.