“You’ve got to wear white for three months.”

Margaret is a senior ODP at Great Ormond Street Hospital in London. She trained as a nurse and then in anaesthesia in Ghana.

How do you celebrate a safe C-section in Ghana?

It’s a big celebration! You’ve got to wear white for three months. There has been so much fear that you won’t make it through alive, so everyone is celebrating, rejoicing. “Thank God you’ve come out of surgery successfully,” everyone tells you.

Here you don’t have that tradition – it’s just an everyday fact of life.

Is surgery so unsafe?

There’s a lot of fear, anxiety. People believe that you go into surgery and you don’t come back – because really that happens a lot.

They think it’s the operation that killed you, but surgery is essential when you need to do it. It’s education, transportation, poverty – all these things that delay treatment. By the time you’re ready it’s too late.

What are the barriers to safe surgery for women in Ghana?

Resources, equipment – poverty. Most patients come and they have nothing – but they still need to provide everything. Relatives are sent to the cash and carry to buy the medications, they have to donate the blood before any treatment takes place.

In the U.K. you get emergency care without hesitation. If you need something in the theatre your hands reach out to it, there it is. We have monitors; we have drugs; we have a cupboard of machines to help with difficult intubation, or locating a vein. What do I do back home? How do I get help?

Is equipment a big issue?

Most of the equipment sent to Africa is second-hand – some isn’t even working but it’s dumped on us. There’s a lack of everything. We reuse everything.

Patients die for lack of basic monitoring equipment. Women go into labour and they don’t even have a place to rest their head – a bed is like equipment to put their heads on.

What is it like to deliver care in this setting?

It’s tragic. Tragic for the patient and tragic for the nurse. You are going to let a patient lose their life for no reason – you could have saved them easily with the right equipment, access. So you withdraw; your spirit is demoralized.

And telling the families is so hard. It’s difficult enough to get a surgery. They get there and think – please, now it’s going to be ok.

Why did you train in anaesthesia?

First I trained in nursing. I’m the type who really loves caring for people. But at the time I was working in theatres we didn’t have enough anaesthetists – so I decided I could be a role model for my colleagues. At the time I was the only female who trained as a nurse anaesthetist on the course.