ASA: The global anesthesia crisis in low-income countries

A guest column by the American Society of Anesthesiologists, exclusive to

Many are unaware of the global anesthesia crisis in low-income countries around the world. Some countries have less than one physician per 10,000 people and even less than one anesthesiologist per 100,000 people. The ability to provide safe anesthesia for surgery, labor and delivery, and other procedures, as well as for acute and chronic pain, is nearly absent in many countries.

As an anesthesiologist providing care and evaluating the options for safer anesthesia in many poor settings, I have seen the reality. Mothers dying while awaiting a C-section. “Stillborn” babies because it took too long for the anesthesiologist to arrive. Young trauma victims with every chance of survival, but no hope of receiving the life-saving surgery they need.

According to a 2010 Lancet article, 2 billion people are without access to emergency and essential surgery worldwide, and 34 million anesthetics are delivered annually in low-income countries without the standard safety equipment needed or a trained provider.

In an effort to reduce anesthesia-related mortality and to impact the global anesthesia crisis, initiatives such as the American Society of Anesthesiologists’ (ASA) Global Humanitarian Outreach (GHO) program and overseas teaching program, help improve patient safety and reduce premature disability and death from surgical causes, including maternal and trauma-related mortality.

Recently, the GHO program partnered with Lifebox, a global not-for-profit organization, to provide life-saving pulse oximeters in operating rooms across the globe. A pulse oximeter is a non-invasive medical device that checks the level of oxygen in a patient’s bloodstream and sounds an alarm as soon as it detects the slightest unsafe change. Recent statistics estimate the number of operating rooms working without pulse oximeters ranges from:

  • 41 percent in Latin America
  • 49 percent in south Asia
  • 70 percent in Sub-Saharan Africa

The partnership with Lifebox has engaged ASA with the goal of providing 50 percent of the global need for pulse oximeters through member donations and contributions from anesthesia societies and their leadership throughout the U.S.  Unsafe surgery leaves millions dead or disabled each year; it is up to the anesthesia community to help address this issue. Pulse oximeters are one small step toward making a huge life-saving difference in the lives of so many patients around the world.

Along with the donation of pulse oximeters, ASA maintains its commitment to anesthesia teaching in low-income settings through programs such as the shared ASA/Canadian Anesthesiologists’ Society International Education Foundation (CAS IEF) teaching program in Kigali, Rwanda. This effort not only reinforces the importance of pulse oximeters for every operative setting, but also educates anesthesiologists for the future.

I was recently able to be present when the first shipment of pulse oximeters from Lifebox arrived in Rwanda. The sole surviving anesthesiologist of the 1994 genocide was there to receive them. This hopeful reality encourages all of us who work to improve anesthesia safety in low-income settings.

For more information, please visit the Global Humanitarian Outreach Program.

Kelly A. McQueen is Chair of the ASA Committee on Global Humanitarian Outreach.

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