Miriam Mannak
CAPE TOWN, Mar 8 2008 (IPS) – The need for a global effort to address the shortage of anaesthesiologists in Africa was highlighted over the past week during the World Congress of Anaesthesiologists which took place in Cape Town, South Africa.
Bisola Najin Obembe of Port Harcourt Teaching Hospital, Nigeria. Credit: Miriam Mannak/IPS
This event, which is held every four years, drew over 7,000 international delegates. It was organised by the World Federation of Societies of Anaesthesiologists (WFSA), an umbrella grouping that comprises 141 organisations dealing with anaesthesia, pain management, resuscitation and related issues.
One of the aims of the WFSA is to improve the practice of anaesthesiology in developing nations something that requires anaesthesiology organisations around the world to join forces.
We need to form partnerships with organisations and anaesthesia associations in Africa, but also abroad, said Bisola Najin Obembe from the Department of Anaesthesia at the Port Harcourt Teaching Hospital in southern Nigeria. This is important to improve both the level of training and research.
At present, sub-Saharan Africa faces a vast shortage of qualified anaesthesiologists. Zambia is a case in point, having only one registered anaesthesiologist for every three million citizens. Ratios are considerably better in wealthy nations; in the United Kingdom, there is an anaesthesiologist for every 2,500 people.
The shortages translate into increased surgical mortality through problems linked to anaesthesia; in certain parts of the continent, this mortality rate is 2,000 percent above the global average.
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The mortality figures are higher when a non-specialised anaesthetist, for instance a general practitioner, practices anaesthesiology, said David Morrell, managing director of the WFSA.
A person has a chance of one in 80,000 to one in 160,000 of dying when he or she is under the care of a qualified anaesthesiologist. When a patient is anaesthetised by a non-specialist a nurse for instance the chance of death is one in 3,500, he added. The problem in large parts of Africa, especially in the rural areas, is that anaesthetisation is often conducted by non-specialised healthcare workers.
To increase the number of anaesthesiologists in African countries and other developing nations, the WFSA through its foundation has established programmes in Angola, Rwanda and other states, said WFSA President Angela Enright.
Up until a couple of years ago, Rwanda had only one qualified local specialist for its entire population of nine million people. Since we started working there, the number has increased to five. That excludes four expatriates. It might not sound an achievement, but it is an increase of over 400 percent.
Apart from training physicians to become qualified anaesthesiologists, the programmes also assist nurses and other medical staff. Many nurses are already practicing basic anaesthesiology as a result of the shortage. They are crucial to the health sector, therefore we need to include them, Enright noted.
However, she emphasises that anaesthesiologists remain essential. Anaesthesiology is a highly specialised field: it takes on average ten years for someone to qualify. You can t do that in few weeks or with basic knowledge.
Teach the Teachers , a joint initiative by the Canadian and American associations of anaesthesiology, takes training a step further by also showing physicians how to become instructors themselves, so that they too can advance local training.
The aim is to teach people in their own country instead of in the United States. Moving them overseas increases the chance of them never returning to their home country, and that is where they are needed the most, said Phillip Bridenbaugh, chairman of the WFSA s foundation.
Teach the Teachers has programmes in various countries, including Rwanda and Tanzania.
It is a full, four-year master s in anaesthesiology which is taught by anaesthesiologists from the U.S. and Canada. They do this on a voluntary basis, and we cover their expenses, noted Bridenbaugh, who has worked as an anaesthesiologist for over 40 years.
We also teach medical staff how to operate, maintain and repair equipment, he said. A while back I was in a hospital in Tanzania where they received five brand new machines from Korea. Unfortunately, they were catching dust as the manuals were written in Korean. This could have been prevented.
Bridenbaugh has volunteered in various hospitals in Tanzania. It was and still is very rewarding, especially because the people we train and thus the knowledge remain in the country, where they are needed the most.
We do not give people the fish, we teach them how to fish. And more importantly, we teach them how to teach others how to fish. That is our success.
* This is the second article in a two-part series examining the shortage of anaesthesiologists in Africa. The first feature, HEALTH-AFRICA: Anaesthesiology on Life Support , was issued Mar. 7.
