A conversation with: Supporting health research projects with Dr Deral Nand

The Pacific Community (SPC) supports opportunities for capacity development of health experts who specialise in specific health areas while furthering their studies.

Meet Dr Deral Nand who is based in Suva, Fiji at the Colonial War Memorial (CWM) Hospital and is completing his final year in Master of Medicine in Anaesthesia. He is undertaking his research project and SPC has supported his research work with funding from the Australian Department of Foreign Affairs and Trade (DFAT) to procure a neuromuscular monitoring device. This machine will be used to monitor the depth of paralysis in patients undergoing surgery and requiring general anaesthesia with paralysis.

Tell us about yourself

This is my 8th year of medical practice. I joined the department of anaesthesia, intensive care, and hyperbaric services (CWM) in 2017, prior to which I served as a medical officer in Vunidawa hospital, Naitasiri, where I have paternal links from. I started the specialist programme in 2018 sponsored by the Fiji Ministry of Health. I am currently completing my final year of Masters in Anaesthesia training which was supposed to be completed last year but due to COVID 19 pandemic, all speciality training programmes for local doctors were suspended to ensure service delivery was not affected for the people of Fiji.

Apart from my roles as a full-time clinical anaesthetist, and master’s student, I also look after patients in intensive care, undergoing hyperbaric therapy, and patients requiring perioperative and pain services. I am also an active medical officer with Fiji's emergency medical assistance team (FEMAT) 

Outside of work I thoroughly enjoy nomadic travel, being in nature/outdoors, scuba diving, and I enjoy keeping physically and spiritually fit.

Give us a brief background about your research

The final year requirement for successful completion of our specialty training is to conduct, compile, present and possibly publish research. I took this opportunity to conduct a study which would not only help me complete my masters but improve an important area in my specialty, which would eventuate to the improvement of service delivery and reinforce standards of care.

As part of general anaesthesia, a component is paralysis - where we paralysis patients with paralytic agents, to ensure we can secure the patient's airway (endotracheal intubation) and provide adequate surgical conditions for our surgical colleagues to operate. The recommended is the use of quantitative/objective neuromuscular monitoring devices.

The situation in Fiji and many developing nations is that we do not have these monitoring devices available and the average incidence worldwide of residual paralysis is around 40%.

What support have you received from SPC and how has this contributed to your research project?

SPC has hugely contributed by making provision for the procurement of this monitoring device which cost close to 5k AUD, as a research device and for the anaesthetic department in CWM Hospital. If it wasn't for this contribution, this research would not have been possible.

How will this add value towards health service delivery at CWM?

The monitor guides or shows us how deeply blocked the patients are when paralyzed with a paralytic agent, guides our dosing intervals when the paralysis starts wearing off and when to top up, and also when to give reversal agents so that the effects of the drug can be counteracted. 

This study will greatly benefit Fiji and the Pacific Islands as a cohort because of how we conduct anaesthesia. Monitoring the effects of paralytic agents has purely been based on knowledge/clinical parameters and experience which has proven by many studies and recommended by many anaesthetic bodies as not safe. The recommended standard is using a objective/quantitative monitoring device. It will provide firstly a documented/researched incidence of residual paralysisit will raise awareness that these devices are needed and hopefully procured by governments and anaesthesia providing centres to ensure standard of care, it will reduce morbidity and mortality and it will improve service delivery, reduce resource consumption and overall economic costs.

Dr Deral Nand will complete his research project at the end of this year and SPC will continue to support health professionals with capacity development.

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