Transcript Dr. Sampson`s Presentation (PowerPoint)

Partnerships & Processes: Training
Practitioners in Low-Resource Countries.
Safe Anesthesia & Surgery in Sierra Leone Initiative (SASSL)
John B. Sampson, M.D.
Executive Director
Johns Hopkins School of Medicine
Austere Anesthesia Health Outcomes Research Group
Past 15 Years of Partnerships
• 1. Society of Critical Care Medicine
• 2. Health Volunteers Overseas
• 3. Physicians for Peace
• 4. ProHealth International
• 5. George Washington University Global Health
• 6. Johns Hopkins Hospital
• 7. Doctors for United Medical Missions
• 8. Greater Washington Society of Anesthesiology
• 9. United Nations
• 10. Eritrea Ministry of Health
• 11. Burkina Faso Ministry of Health
• 12. Sierra Leone Ministry of Health
• 13. ASA Overseas Training Program
Challenges to Anesthesia Training
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Infrastructure
Instructors
Anesthesia Equipment
Anesthesia Medications
Learning Material
Poor Internet Bandwidth
Retention & Distribution
Challenges to Anesthesia Training
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Infrastructure - UN
Instructors - HVO
Anesthesia Equipment - UAM research
Anesthesia Medications - ?
Learning Material - HVO
Poor Internet Bandwidth - ?
Retention & Distribution - WHO
HVO MISSION
•
Dedicated to improving the
availability and quality of health care in
developing countries through the training
and education of local health care
providers.
Uniqueness of the
Sierra Leone HVO Program
• The Sierra Leone HVO program is a
collaborative between HVO and the
Johns Hopkins Austere Anesthesia
Group.
• This is the only HVO collaboration with
Johns Hopkins. The strengths of both
organizations will be leveraged.
Johns Hopkins Austere
Anesthesia Health Outcomes
Research Group
Safe Anesthesia & Surgery in
Sierra Leone Initiative
1.Creation of an education package to accompany
the new equipment.
•2.
Evaluation of the ability of the equipment
meet the demands of the austere environment.
•3. Evaluation of the equipment to endure the
austere environment.
•4. Evaluation of the health impact of appropriate
new equipment upon the austere environment.
Use of Computer Simulation to Reproduce
Critical Austere Anesthesia Events.
Challenges to Anesthesia Training
•
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Infrastructure - UN
Instructors - HVO
Anesthesia Equipment - UAM research
Anesthesia Medications - ?
Learning Material - HVO
Poor Internet Bandwidth - ?
Retention & Distribution - WHO
Current Anesthesia Physician Situation
in Africa
• Typical Examples
• Eritrea - zero
• Sierra Leone one full-time and a few
temporary and part time.
• Burkina Faso < dozen
• Liberia - none full-time
• Less than one anesthesiologist per million in
most Sub-Saharan countries
The Issue of Task Shifting
• Per the WHO Task Shifting: Global
Recommendations and Guidelines
Manual.
• Defined as the use of non-physician
healthcare providers for the provision of
medical care.
The Current State of Anesthesia Care.
Is Task Shifting the Answer?
• Nurse anesthesia already task-shifting.
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- do we want another level of taskshifting?
• Anesthesia-associated death 100-1,000
times that in developed countries.
• As many as 50% of anesthesiaassociated deaths may take place in
obstetric patients.
• 18-week
medical
officers
3-month
nurse
anesthesia
assistants
Master's
degree nurse
anesthetists.
Can Anesthesia Practice in Low-resource
Environments Afford to have Less Trained Providers?
• The consequences of error can be sudden
death.
• What are the limits of anesthesia task-shifting?
• Is there adequate research within the field of
anesthesia to make the case?
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2009 study in South Asia
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ICRC and MSF in DRC and Somalia
IV Fluid Chosen to Treat Patient "Hunger" after
Multiple Presentations on IV Fluid over the Years.
World Health Organization
• Global Code of Practice on the
International Recruitment of Health
Personnel.
Recruiting, Training & Retaining
Nurse Anaesthetists in Sierra
Leone: A Case Study
Prof Yaw Adu-Gyamfi MB, ChB, FFARCS,
FRCA, FWACS, FGCPS
United Nations Anaesthesia Consultant to
the Sierra Leone Ministry of Health