In March 2016 Dr Heidi Doughty was awarded the MWF Dorothy Ward International Travel Fund. Based in Birmingham, Heidi works as a part time Consultant in Transfusion Medicine and describes her professional passion as ‘Good Blood in Bad places’. She travelled to Bergen, Norway in August 2016 to research the use of whole blood in massive haemorrhage.
Why Bergen?
I chose to visit Bergen because the hospital based blood service there had recently introduced the provision of whole blood for the local Air Ambulance. The project is part of a larger programme of transfusion innovation due to the collaboration between Haukeland University Hospital, the pre-hospital community including the military, and the University. The visit gave me an opportunity to build on my own work as well as visit a transfusion system that is very different from the UK. I wanted to look at their transfusion support for haemorrhage and consider the implications of re-offering whole blood alongside component therapy in the UK.
I was extremely fortunate to secure professional leave from NHS Blood and Transplant. However, Norway is relatively expensive. Two cups of coffee and a cookie in a café may cost over £20. So, I needed to carefully consider the living costs. I used a combination of special offers for the flight and my sponsor, Prof Tor Hervig, had secured well-priced student hostel accommodation near the hospital. It was to be a 10 m² room with: duvet but no bedding; wash basin but shared bathroom; and internet but no Wi-Fi. I needed to rethink my packing list. So I took essential eating utensils, Ethernet cable and radio. However, I confess that I arranged to borrow local hospital bedding. The room may have been small but the hostel gave me a room with a wonderful view and an introduction to the most hilarious group of international students.
Bergen fish market
Getting down to work
I recommend arriving before a weekend to orientate. I had been met at the airport by one of the female consultants, Torunn. Her kindness and support really made the difference. We spent the Friday on formalities, Saturday – baking at her home and on Monday I was ‘good to go’. The most important time in any new project is the first face to face meeting with the ‘boss’. It provides the reality check. Tor had been injured. Many staff were away for their summer holidays or getting ready for conferences. I have MS and although well at the moment, I get tired. However, we had Tor’s small research team including the computer genius, Joar, who immediately secured Wi-Fi connectivity for both my laptop and Smart Phone. This meant I could remotely access my work emails and documents. The Bergen team asked me to review the impact of their Acute Transfusion Package introduced in 2007. They had extracted 13 years of data but offered it to me for analysis to provide a new perspective and lead on publication.
I reviewed the data in the context of the international literature. This was really interesting as I was not familiar with the early Nordic papers and guidelines. They were really early adopters of the new paradigm of massive haemorrhage management. In the blood bank, I followed the journey of the ‘whole blood’ from the donor, through platelet sparing white cell filtration to quality control. Most of the procedures were written in Norwegian so I learnt to use Translation software. I was also introduced to their new Multiplate Analyser ® designed to analyse platelet function. During the second week I visited some of the areas dealing with massive haemorrhage including Emergency department, ITU and the Air Ambulance. The most novel activity for me was writing a travel blog for MWF. It was a really interesting combination of reflective note writing and capturing the moment.
Looking across the waterfront to the historic Bryggen area
Capture the moment
One of the things that have learned during my travels is to ‘capture the moment’. This includes collecting and dating evidence such as policy documents, procedures, your own notes and photographs. In addition, back-up all electronic records. I found it useful to summarise my initial thought and findings in a PowerPoint presentation for the project team. I also integrated some of the findings into my presentation on UK practice given to the whole Department. This generated a more dynamic exchange and ideas. An unexpected area of interest was my experience of transfusion support for the Olympics because they were preparing for a 2017 sporting events.
Travel not only broadens the mind, it enlarges your professional and personal networks. The travel fellowship has built upon my past knowledge and should inform future developments. It was only 2 and half weeks and I wish it had been longer. However, I am confident that I will continue to work with the Bergen team and revisit. This visit was designed for my benefit but I hope I added value for them as a mature practitioner from the UK. Such travel fellowships continue the strong tradition in Medicine of taking a European and global outlook. All of us, but especially our patients, benefit. I strongly recommend my colleagues to apply because to quote “You will travel to learn and return to inspire”.
Air ambulance coming into land
