An angel in the theatre

She is one of the smiling faces that will greet you the moment you get into the theatre room. Looking at this confident, soft-spoken and smiling face reassures you that whatever is going to happen in the operating room will not be painful and will give you back life. Her voice will gently melt your surmounting fear. 

From Argentina, Dr. Mirta Estela Ramos de Vigna came to Malawi 15 years ago where she has served and saved thousands of lives. Many simply call her “a kind and gentle lady and an angel in the theatre”. Yvonnie Sundu talks to this amazing woman.

When was your first operating theatre experience?

When I was 13 years old, I was allowed to go into a theatre. I wanted to see what really happens there since I wanted to become a surgeon.  I found doctors doing a plastic surgery on a patient’s nose.

 Unfortunately, I fainted after seeing a lot of blood that was coming from the nose. Then I vowed not to be a doctor. But after a while I told myself I could do it.

After high school, I applied for a place at a medical school. That is how it all began.

Who is an anaesthetist?

An anaesthetist is a physician trained in anaesthesia, which is the science of putting to sleep patients during an operation so that they do not feel any pain or discomfort during the surgical procedure.

How did you become an anaesthetist?

After I graduated in medicine at the University of Rosario, Argentina, I was not decided then on becoming an anaesthetist but I wanted to specialise in preventive medicine or plastic surgery. But it happened that I decided to marry a surgeon, Dr Leonardo Vigna, and the next best thing was to specialise in anaesthetics. We are a team and we work together. It has been a great career choice for me and I am enjoying it!

What kind of training do you go through to become an anaesthetist?

Upon graduating from medical school, a physician must complete an accredited residency programme in anaesthesiology.

What has been your experience while working in Malawi?

Since we came in 1997, we worked for the first three years at Blantyre Adventist Hospital. Later, we came to Mwaiwathu. My experience has been mixed. Sometimes when an old and terminally ill person dies after surgery, I feel bad but I know we had done all we could.

When a young person dies, it is so heartbreaking. It is also frustrating to not being able to help because the situation is beyond me! I feel very bad and sad to lose a young person.

What do you like about your job?

I will say I am enjoying being able to give patients the assurance that the procedure is going to be okay and as painless as possible. With female patients, especially during labour and at delivery, it has been a marvelous experience.

Personally, I don’t see why women should be in pain when they go through labour and delivery. The idea that a labour ward is the only part of the hospital where pain is “acceptable or necessary” is disappearing from modern obstetric practice.

I am able to offer them complete labour pain relief with regional anaesthesia techniques like the lumbar epidural block which is achieved by administration of local anaesthetic into epidural space with a single injection or through a catheter for repeated injections. If this is not possible because of medical reasons, most of the time I offer them a similar regional block using a spinal anaesthesia.

The most attractive prospect for the mother and patient is that she remains awake so she can watch her own delivery, and is able to happily interact almost immediately with her newborn baby.

Doesn’t working together with your husband sometimes strain your relationship?

Like every normal couple, we have our arguments. But we make it a point not to bring them to the theatre room. Furthermore, the advantage of working together is that we know each other’s professional limits and capabilities. We are able to understand each other.

How did you and your husband meet?

We grew up in the same area and went to school together. In high school, I was president of our graduating class, he was the treasurer. Now my husband says that I am both president and treasurer of our home! We dated for five years and then got married after finishing the medical training.

What have been your best moments in your profession?

An accident victim was brought in when I was alone. His lung had collapsed. I knew that no matter how hard I tried to save him, he needed a surgeon. So I called my husband. A few days while recovering, he told my husband that he wanted to become a priest for he believed that God had saved him for a purpose.

After recovering, he became a priest and went to South America. We became friends. He used to write to us in Spanish. After being consecrated, he went to Brazil as a missionary and fluently speaks Portuguese.

When we communicate with him, it gives us joy. We were able to save him with God’s help, of course.

Who are the most difficult patients to deal with?

The most difficult patients to deal with are the ones that need surgical procedures in combination with several chronic diseases. And working with little premature babies is a real challenge.

Some are so premature and low in weight, with severe respiratory distress that require very intense monitoring and ventilator support and they give a lot of work and many sleepless nights!

But there is nothing nicer than to see these little ones come through the rough times and then see them after some years coming to visit us with their parents and with a great smile. This is a very gratifying experience!

Have there been times when you have thought of quitting?

I have never thought of quitting… I love my work, it’s a pleasure.

Is anaesthesia safe?

Generally, there is a risk that 1 out of 10000 anaesthetic administrations could have some complications. However, the risk is reduced greatly if the patient is healthy. The danger of a healthy patient to have a complication would be in the order of 1 out of 50000 anaesthetic administrations.

Why are patients required to sign anaesthetics assessment forms before undergoing an operation?

We want to become familiar with the present surgical illness and medical conditions that the patient may have. We want to establish a doctor-patient relationship; develop a management strategy for pre-intra and post anaesthetic care. We also try to obtain informed consent for the type of anaesthesia and writing the results of the pre-anaesthetic evaluation in the hospital file.

As a couple, you have busy schedules. How do you both make time for each other?

It has been quite easy. We both work as a team in the same hospital. Outside of work, we both have quite similar interests so we are constantly having fun together and or with friends.

How many children do you have?

We have a son Paolo and a daughter Pamela. We are very close even though we live very far away in different continents but always in touch by email, or “Skype”. My biggest pleasure is when we have the chance to see them personally.

Why do people have to stop eating and drinking hours before an operation?

A full stomach puts the patients at risk of pulmonary aspiration which could happen during the induction of anaesthesia. If food or drinks get into the lungs and pulmonary aspiration occurs, this can be a life-threatening situation.

Pulmonary aspiration is the entry of material such as food, drink, or stomach contents into the voice box and lower respiratory tract (wind pipe to the lungs).

Is it true that people who take alcohol take longer to sleep off?

Alcoholics have a more tolerance to anaesthetics. In other words, they require more anaesthesia to produce loss of consciousness than in other patients who consume less or no alcohol.

Is anaesthetics a great career opportunity for students in a medical field?

Having a person’s life in your hands while they are being operated on is like being at the cockpit of a space flight. It’s more than just putting a person to sleep…it’s a challenge to assure others that anaesthesia is nothing to be afraid of.

Furthermore, it is very rewarding to see a person relax and sleep while undergoing medical procedures, which without the anaesthetics would be excruciatingly painful and impossible to do.

As a career, being an anaesthetist can be very demanding and requires a lot of discipline and hard work. One must be very alert and ready at all times for the unexpected emergency. Quick reactions and fast decision making is a talent which one must acquire over time in this profession.

Being able to accompany others through moments of extreme anxiety and helping them to recover is an opportunity which gives me a great reward.

It is a career I would certainly recommend for those who are studying medicine.

Most women who have been under your care have great praises for you. Why do you think this is so?

Mmmm…Lucky me I guess…

How you would like to be remembered?

I would like to be remembered as the most friendly and loving mother and grandmother. And also as many of my patients say “a kind and gentle lady”

Do you have any regrets in your life?

I regret not having spent more time with my kids when they were growing up. They grew up so quick and soon! There were times when I worked more than I should have.

 What is the best way to relax for you? What do you like doing in your spare time?

I enjoy spending time in the garden. It is very relaxing for me. Sometimes I get into my hammock and read books while listening to music. I also enjoy playing tennis, swimming, aerobics, and going on hikes.