Spring 2007
One hundred and two members, partners and guests travelled to Budapest in May for SASWR’s triennial overseas scientific meeting, this year held jointly with the Society of Anaesthetists of the Central Hungarian Region. Despite the disappointment of Easyjet cancelling their direct flight from Bristol to Budapest after the meeting venue had already been decided, members arrived by several ingenious routes to a city which, freed from the grasp of communism over 15 years ago, is forward looking, energetic, and remarkably beautiful. Thanks to a link initially provided by Tamas Veto, a Hungarian SHO working in Bristol, the local society had embraced our request to hold the meeting at the former centre of the Austro-Hungarian empire wholeheartedly. Their then-president Dr Laszlo Vimlati had attended the Society’s Bristol meeting in November 2005, and had assembled a local organising committee which had worked hard with our own representatives to put together a scientific programme that was relevant, interesting and embraced both the similarities with and differences between our two health systems.
Social Programme
A large part of any overseas meeting of the society is the social programme, and this trip did not disappoint. Most of the guests stayed in the Marriott Hotel in central Budapest, with impressive views of the River Danube and the Castle district of Buda. The friendly bar there played host to an informal welcome reception on the first evening, and to several impromptu gatherings later in the week. On Wednesday morning 60 of us boarded coaches for a brief tour of the Pest area of Budapest – a chance to look at the baroque architecture of the long boulevards, get our bearings, and see the impressive Hero’s square – before crossing the Danube to be dropped in the spectacular castle district on the Buda side of the river. Three knowledgeable tour guides walked us around the famous fisherman’s bastion and old castle, which now serves as a museum and administrative buildings. The drizzle in the air failed to dampen our mood as the tour culminated in the splendid cathedral– a mixture of eastern and western church architecture. As the skies brightened most members then took the funicular railway and walked back across the Chain Bridge to the hotel.
The weather remained bright for the President’s Reception on Wednesday evening, which took place on a boat which cruised along the Danube. The President, Dr John Carter, and his wife were joined by officers of the Hungarian Society and with a finger buffet, a musical duo playing in the background, and apparently limitless supplies of Hungarian sparkling wine, the event was a chance to catch up with old friends and to make new ones in advance of the scientific meeting.
Thursday saw an all day coach trip to the hills above Budapest, first to the mediaeval village of Szentendre, with winding streets, old churches, and a variety of museums. Whilst the scientists among the party marvelled at the ‘miniature museum’ with its microscopic woodcarvings, and the traditionalists climbed the steps to the 15th century catholic church, a procession of other (mainly female) members set off purposefully in search of the renowned ‘Marzipan museum’; there was some disappointment when it was discovered that the museum was not actually made of marzipan but merely described the history of that delicacy. A short trip by coach took us to the Nagyvillam restaurant perched high on a hilltop overlooking the Danube valley; the views were spectacular and a long lunch of local food and wine ensued. One of our travelling party (the guest of one of our speakers) was, it transpired, a professional opera singer from New York, and so as the bemused waiters looked on we were treated to an impromptu rendition of several opera standards by Mr Doug McConnell. The crowd yelled for more and there were several encores before it was time for the rather somnolent coach journey home.
In addition to the organised social events, members got together to explore Budapest themselves in the evenings which were not otherwise filled. Several members visited Budapest’s famous spas, and there was an organised tour of the parliament building for partners during one of the academic sessions. The city has fine restaurants, many impressive buildings and a vibrant social life. Rumours that the Hon Treasurer and Hon Sec were seen falling out of a nightclub in the company of a large group of trainees early one morning are almost certainly ill-founded; the story of the ex-president of the Society who received an on-the-spot fine for fare dodging (he claims to have simply misunderstood the complicated tariff system) is almost certainly true. What is in no doubt is that all present from SHO to retired members, enjoyed each others’ company in a beautiful setting.
Academic Meeting
The academic meeting took place in the ornate Danube Palace Theatre in central Budapest, a stone’s throw from the Danube and only a few minutes’ walk from the conference hotels. Originally a concert theatre, it has been renovated in recent times to a conference centre, and the setting for the meeting itself was the original theatre hall, complete with 19th century carvings and decorations – but fortunately 21st century sound systems and air conditioning. Around 60 UK delegates and between 30-50 Hungarian anaesthetists attended the meeting over the two days. The meeting was opened by the presidents of the two societies, Dr John Carter and Dr Barbara Volgyes. In recognition of our thanks for their hospitality, our president presented the Hungarian Society with an engraved ornamental bowl in Bristol Blue Glass.
The first session on Regional Anaesthesia saw talks from Dr Tibor Pataki of Hungary and Alex Brederode, from Southmead Hospital in Bristol. After discussing some of the more popular approaches to upper limb nerves in Hungary, and explaining how blocking those nerves could reduce morbidity even when used in combination with general anaesthesia, Dr Pataki stressed the importance of organised training schemes in regional anaesthesia, and predicted the increasing importance of ultrasound in regional anaesthesia. In his talk on lower limb blocks, Dr Brederode was able to show a video of ultrasound in action during a femoral nerve block, and discussed the risks associated with regional anaesthesia. He emphasised that in contrast to upper limb blocks, nerve blocks for lower limb surgery rarely remove completely the need for sedation and opiates as adjuncts.
After coffee Peter Ritchie from Cheltenham chaired a lively session on Medical Education, which benefited from speakers from the UK, Hungary, and Cheltenham. Sir Peter Simpson, recent president of the European Society of Anaesthesiology, spoke of the role of that organisation in drawing together European training, education, clinical practice and research and predicted further integration of national and European societies in the future. Prof Laszlo Vimlati, president of MAITT (the Hungarian national anaesthesia and intensive care society) gave a brief history of the specialty in Hungary and outlined the anaesthetic training programme in that country, which interestingly includes a practical in-vivo assessment of ability in its final examination. Lastly Dr Wolf Vogel, an attending anaesthesiologist from Connecticut, USA, explained the nature of anaesthesiology training in North America with an outline of the matching scheme used to place accredited trainees into permanent positions – a very pertinent topic in the light of the recent MMC / MTAS developments! Much discussion followed the three talks, particularly around the subject of integration of qualifications within Europe, and the necessary alignment of training schemes.
After a lunch which matched the ornate surroundings of the dining area, the meeting continued with a session on Intensive Care Medicine. Dr Csaba Hermann, one of the youngest ITU directors in Hungary, spoke about the recent establishment of a surgical HDU and associated outreach team in his own hospital. Many of the challenges he faced – arranging staffing of the unit and ensuring regular surgical review of patients, as well as establishing funding for the outreach service, were depressingly familiar to the UK delegates. James Pittman of Exeter followed with an extremely informative lecture on the measurement and manipulation of preload, with particular reference to measurement techniques such as systolic pressure variation, central venous saturation, and the oesophageal doppler, referring both to the advantages and pitfalls associated with such techniques. In the question session afterwards Dr Pittman and Professor Wolf entered into a discussion which they clearly both understood, but which went straight over the head of your correspondent!
A special trainees’ competition had been integrated into the meeting at the request of the Hungarian Society, who had been impressed by our own prize during their earlier visit to Bristol. Of nine UK submissions, three were chosen for oral presentation and the remaining six were exhibited as posters during the meeting, along with a similar number of Hungarian projects on display. The two prizes – judged by Dr Kerri Houghton and Prof Andy Wolf from the UK, and Dr Volgyes and Prof Darvas from Budapest – were won by Dr Gavin Werret of the Plymouth School (for an audit of epidural usage in Australia before and after a large regional anaesthesia study was published) and Dr Vera Juhasz of Budapest, for her comparative examination of the inflammatory response to oesophagectomy and other intra-abdominal surgery.
Gala Dinner
The historic surroundings of the library of the Hungarian Academy of Sciences, an elegant building on the bank of the Danube River, was the venue for the gala dinner that evening. A champagne reception and typically witty grace from Surgeon Captain Andy Burgess were followed by a sumptuous four course dinner with musical accompaniment. After dinner it was realised that at least a dozen of the Society’s ex-presidents were in attendance and they were rapidly corralled for a photograph; apologies to Martin Coates who wasn’t quick enough to get into frame and so may need to be ‘photoshopped’ in at a later date. Socialising continued back at the Marriot hotel later in the evening, with the Hon Sec being persuaded to host a round of drinks on the society’s behalf, to the delight of the fifty or so members assembled and the bemusement of the long suffering waiter.
The morning after
The meeting continued the following morning with an excellent turnout to hear Dr Steve Coniam of Frenchay Hospital and Prof Lajos Bogar of Hungary talk on different aspects of pain management. Dr Coniam gave wise advice on the management of acute pain in chronic opioid users, with some useful insights into equivalent hospital and ‘street’ doses of opioids, and Prof Bojar presented the results of a national 3-day audit of postoperative pain relief which had raised important points for debate about where the responsibility for postoperative pain relief lies, and the usefulness of intravenous opioid analgesia in the early postoperative period. After coffee the final clinical session on patient safety featured talks by two national experts on the subject: the aforementioned Dr Bogar and our own Mike Durkin from Gloucester. While Dr Bogar focussed on the history of patient safety, discussing root cause analysis, models of safety systems from the aircraft industry, and stressing the need for a ‘culture of safety’, Dr Durkin described the development of patient safety organisations such as the NPSA and described the success of various pilot schemes which were taking place, particularly in the South West of the UK.
The final presentation of a very wide-ranging meeting was the guest lecture, given by Bugar Meszaros Karoly, the director of the Hungarian Institute of Architecture. In an impressively illustrated lecture, he talked about the history of Hungarian interior architecture, with particular reference to buildings used as pharmacies and libraries, both medical and general. We were left in no doubt that Budapest has a rich medical history and continues to make a significant contribution to medical knowledge in Hungary, Europe, and further afield.
Many members stayed on to enjoy a final evening in Budapest before returning to the UK, taking the opportunity to sample more of the city’s bars, restaurants, and entertainments. Another highly successful overseas meeting has passed, confirming the enthusiasm of our members to travel, learn, and socialise together on a regular basis. Whisperings of a trip to Rome in Spring 2010 are currently being investigated by your committee – start saving AirMiles now!