Reflecting on the state of global anesthesia

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

I imagine every physician anesthesiologist has experienced drug or equipment shortages in the last year. How frustrating that even in the world’s largest health care system, basic medications can be unavailable. However, when I step back and look at the big picture, I am reminded of the tremendous luxury we have compared to so many countries around the world. During my fellowship year in obstetric anesthesiology at Wake Forest University in North Carolina, I was invited to participate in a global health trip to Ridge Regional Hospital in Accra, Ghana with Kybele, Inc., a non-profit organization dedicated to promoting safe childbirth around the world through partnerships with local medical organizations. Through a local partnership with Ghana Health Service, Kybele, Inc. had formed a five-year memorandum of understanding with Ridge Regional, a large secondary referral hospital in Ghana’s capital.

I will never forget my initial impressions of that hospital. I walked through a maternity ward that delivered over 12,000 children a year and saw women laboring without any analgesia.  I saw families bring a pregnant patient to the operating room (O.R.) with a standard box of medications and fluids they had to purchase from an outside pharmacy in order for her to receive care. I remember a patient who became severely oxygen deprived in the post-anesthesia care unit (PACU) and subsequently died due to the hospital’s oxygen supply running out and the PACU not having full oxygen tanks available until it was too late. Yet for all the resource problems I encountered during my trip, one of the biggest issues I noticed was not just a lack of equipment or medications, but of providers. A December 2018 Anesthesia and Analgesia article demonstrated how deficient many low- and middle-income countries are when it comes to not just physician anesthesiologists, but nurse anesthetists as well. When I first started going to Ghana in 2011, there was only one physician anesthesiologist training program and two nurse anesthesia schools in the entire country. There were only 20 consultant (physician) level anesthesiologists and approximately 200 nurse anesthetists for a country of more than 24 million people1.

As a fellow, my first task was to help teach a class for nurse anesthesia students at Ridge Hospital School of Nurse Anesthesia. This school had been started by local providers, in partnership with Kybele, Inc., in an attempt to help address the country’s shortage of safe anesthesia providers. I asked the students to describe the home clinical environment they would return to after their training and many did not have access to basic anesthesia equipment such as an anesthesia machine, any difficult airway devices, or access to a physician anesthesiologist. As I began to teach a course on the basics of obstetric anesthesia, including maternal physiology, I realized these students were incredibly bright and gifted and so eager to learn this field to help provide some level of safer anesthesia care to their communities. I have returned every year since 2011 to continue teaching at this school. The school has expanded immensely over the years and even started training physician anesthesiologists with the hope to increase the number of physician anesthesiologists in Ghana. There continues to be a great need for physician educators in this school and I consider my annual trips as some of the best two weeks of my academic year.

As I finish this article, I am reminded again of my First World problems and how they may be perceived as less when compared to the hardships in other countries. Recently, the power went out in my neighborhood due to a snowstorm this past weekend, and I was unable to access email or charge my laptop to finish this article. Of course, the power company was out within the day, and everything was back to normal by the next morning. I thought, what if this was my daily work experience at my hospital or clinic? I know we all have a lot testing our patience this holiday season, from the busy OR keeping us late, to out-of-network billing questions, scope of practice discussions and more, but we also have a lot to be thankful for in our professions and countless blessings that providers in other countries only wish they had.

D. Matthews Hatch is an anesthesiologist.

Image credit: D. Matthews Hatch

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