Spring 2008
SASWR Spring Meeting Report
Guernsey June 5th – 7th 2008
Dr Ed Morris, Honorary Secretary
My wife tells me that I go away too much. It was therefore with some trepidation that I revealed that the ‘home’ spring meeting of SASWR was in fact to be ‘overseas’ this year, in Guernsey, under the joint auspices of the Plymouth and Guernsey departments. Her mood improved appreciably when I showed her the brochures and publicity which Martin Wolfe of Guernsey had liberally distributed to members during the previous November’s meeting; after I had invited her to accompany me all was forgiven.
It seems that many members had had the same idea, and the presence of almost as many guests as delegates made for a meeting which was enormously successful both from a scientific and social perspective. Huge thanks must go to Martin Wolfe and his team of assistants from Guernsey who worked immensely hard to choose venues, plan activities, and show off their beautiful island. The Plymouth department provided many of the speakers and also the crews for a sponsored sailing challenge of Olympic proportions – of which more later.
Martin had chosen the Old Government House Hotel in St Peter Port as the venue for the meeting. Formerly the residence of the Lord Lieutenant of Guernsey, it was a splendidly appointed building with views over the harbour and an excellent level of service. For many members this was their first trip to the Channel Islands, and with truly excellent weather the island – for me reminiscent of an earlier, more innocent age of mainland British life – was at its best.
On the first evening the Government of Guernsey (yes really) had organised a ‘Vin d’Honneur’ for our delegates and their guests. Guernsey has seen a decline in the ‘Bucket & Spade’ tourism which supported it during the latter part of the last century, and is keen to portray itself as a conference venue. The minister of Tourism, Carla McNulty-Bower, welcomed us to Guernsey during the reception in the Candie Gardens museum. Afterwards members split into groups and explored St Peter Port’s variety of excellent restaurants and (allegedly) its two nightclubs.
The Scientific meeting opened with a welcome from the president, Sir Peter Simpson, who thanked the organisers for their hard work. The 50 members present stood in remembrance of several members who had died in recent months, Including Andy Dewar, Claire Ackroyd, Cecil Gray and Peter Baskett.
Martin Coates of Plymouth chaired the first session, entitled ‘Strategies to cope with….’ Three speakers with very different areas of expertise explained how they dealt with challenges with which many of us will be familiar. Simon Courtman of Plymouth described his management of the ‘pre-cooperative child’, calling on his experience of anaesthetising children for dental and other lists. Beautifully illustrated with both videos and anecdotes, his talk covered both psychological and pharmacological strategies for anaesthetising disturbed or distressed children with the minimum of fuss. Tony Davies, also of Plymouth, followed by describing his approach to the management of perioperative pain in opioid-dependent patients, giving some useful information about the cost and equivalent doses of street opioids and those used for medical purposes, and examples from his own practice of how attention to detail and close liaison with outside agencies can smooth hospital stays for this group of patients.
The session finished with Richard Telford of Exeter addressing the complex and topical issue of ‘the patient on clopridogrel’. The increased use of drug-eluting stents and the risks of stopping clopidogrel had to be balanced against the risk of bleeding: Richard concluded that (neuraxial blockade aside) it might be sometimes be safer to manage the increase in surgical bleeding than to stop clopidogrel, depending on the nature and site of the surgery. Much food for thought.
After much food at lunchtime delegates settled down for an entertaining afternoon session hosted by our colleagues in Guernsey and entitled ‘Clinical Practice in Guernsey – all a bit different’. For those of us with no experience of the Guernsey healthcare system three speakers gave a fascinating insight into the benefits and challenges of working for a system distinct from the NHS.
Gary Yarwood, a consultant anaesthetist on the island, took us through a potted history of both the States of Guernsey and its medical provision. He explained how the different medical specialties were formed into ‘groups’ who then sold their services to the health authorities. From 15 doctors on the island in 1947 there were now 38 consultants and a similar number of GPs, who between them delivered all of the health care on the island and arranged transfer of specialist cases to the mainland. This theme was expanded by Jim Chandler, the newest anaesthetist on the island, whose talk ‘Nice work if you can get it’ gave examples of a typical working day. The rather long working week, and the challenges of keeping up to date with CME, often taken away from Guernsey, was stressed but the overall impression was of a group of colleagues with a splendid quality of life and a very satisfying medical practice. Several enquiries about vacancies were apparently made by members later on that evening……
Another fascinating talk was given by John Beausire, the Chief Ambulance and Rescue Officer of Guernsey, who talked about Patient Transfer by Sea. He explained the need for a marine-based ambulance service in a group of islands where planes cannot always be landed and some areas have only basic roads and often no motorised transport. After whetting our appetite with photos of his crafts and the rather splendid access they gave to isolated parts of Guernsey and its surrounding islands, John invited members to join him for a trip on the sea ambulance the following day – an offer which was taken up enthusiastically by a dozen or more delegates.
The Society Dinner was held in the dining room of the Old Government House Hotel, with a splendid menu based on local ingredients, impressive service, and an inspiring view of the English Channel through a picture window. It was the English Channel which had been the setting for the Intersurgical Prize for the most elegant sail from the mainland to Guernsey, and Mark Ellis of Intersurgical was on hand to award a cheque for £100 to the successful crew of ‘Bertie’, which was collected by Colin Berry and Andy Burgess. Their immediate response was to ask that the prize be donated to a charity in memory of ex-president Peter Baskett: an offer which was warmly received by other diners.
Sir Peter Simpson spoke after dinner, again thanking the Guernsey and Plymouth departments for their role in the planning and organisation of the meeting, as well as entertaining us with several anecdotes gleaned from his journeys through the corridors of power. Martin Wolfe of Guernsey responded on behalf of the hosts with a toned-down version of the joke he had initially suggested telling – but wisely run past the Hon Sec first – I am sure he will be happy to relate the uncensored version to members if contacted directly.
Saturday morning saw a Tri-Service presentation in keeping with the military heritage and expertise of our co-hosts from Plymouth. All three talks were received by the non-military members present with respect and appreciation of what our colleagues are doing on our behalf overseas.
David Birt, RN, talked of competencies for the military anaesthetist and explained how training of such officers was changing to take into account the significant amount of time that military doctors currently spend away on active service. The understanding and support of civilian training schemes was important in this area. Robin Berry of the RAF spoke about the care and transfer of injured military personnel and gave moving examples of the challenges and success stories that he had encountered during his time in Afghanistan. Finally Major Paul Moor, an SpR in the South West School, spoke of the innovations in trauma management which were arising with experience of modern warfare, including the concept of ‘C-ABC’ – in which arrest of major haemorrhage may initially take priority over airway management in the injured soldier – and novel methods of haemostasis. His talk was illustrated with a film of battlefield medicine in practice, and was well received.
After coffee many members were joined by their partners for the Guest Lecture, given this year by Mr Ben Remfrey, MBE, a former Royal Engineer who had founded the Mines Awareness Trust in 1999 in response to a massive need for mine clearing expertise and education in Kosovo. Based in Guernsey, the charity has now grown to be one of the largest in its field and has undertaken work in several other parts of the world, including Rwanda and Sudan. It was a fitting choice of guest lecture for a meeting with such a military theme.
The charity supports both training of mine clearing personnel, and the education of local people about the dangers of mines. Members were incredibly moved by the stories, photographs, and videos that Ben Remfrey told and showed: the success of his organisation in clearing enormous tracts of land and returning them to safe agricultural use was inspiring and much respected. It was no surprise that as well as a gift from the Society in thanks for his time, a retiring collection by members present amounted to several hundred pounds. Further details can be found at www.minesawareness.org
Another meeting over, the vast majority of delegates took the chance to extend their stay in Guernsey and explore more of the St Peter Port and the surrounding area. John Beausire’s ambulance craft was kept busy by members taking up his offer of a trip around the coast of Guernsey in it – Tricia McAteer is even rumoured to have taken the wheel at one stage – and the restaurants of the port did a roaring trade from members on the Saturday night. After the meeting in Bristol in November, the spring meeting will take place at the Cotswold Water Park 4 Pillars Hotel in Gloucestershire, under the auspices of the Cheltenham and Gloucester departments, on 21st and 22nd May 2009, and I do hope to see many of you there.