The Role of Anesthesiology in Global Health: A Comprehensive Guide

435 Pages·2015·16.88 MB·English

by  Ram Roth

The Role of
Anesthesiology in
Global Health
A Comprehensive Guide
Ram Roth
Elizabeth A.M. Frost
Cliff ord Gevirtz
Editors
Carrie L.H. Atcheson
Associate Editor
123
The Role of Anesthesiology
in Global Health

Ram Roth (cid:129) Elizabeth A.M. Frost

Clifford Gevirtz
Editors
Carrie L.H. Atcheson
Associate Editor
The Role
of Anesthesiology
in Global Health
A Comprehensive Guide
Editors
Ram Roth Elizabeth A.M. Frost
Department of Anesthesiology Department of Anesthesiology
Icahn School of Medicine at Mount Sinai Icahn Medical Center at Mount Sinai
New York , NY , USA New York , NY , USA
Clifford Gevirtz
Department of Anesthesiology
LSU Health Sciences Center
New Orleans , LA , USA
Associate Editor
Carrie L.H. Atcheson
Oregon Anesthesiology Group
Department of Anesthesiology
Adventist Medical Center
Portland , OR , USA
ISBN 978-3-319-09422-9 ISBN 978-3-319-09423-6 (eBook)
DOI 10.1007/978-3-319-09423-6
Springer Cham Heidelberg New York Dordrecht London
Library of Congress Control Number: 2014956567
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To Aren, who encouraged me to go on my fi rst surgical mission
many years ago and inspires me every day. Only two of many
reasons that I love you.
R.R.
To my many friends and colleagues around the world who
continue to amaze and humble me by how much they achieve,
often with much less than I have.
E.A.M.F.
To my beloved wife, Alison, and my sons, Theo and Graham,
who are a constant source of inspiration; to Elizabeth Frost,
a teacher, colleague, and friend who has always given me
brilliant perspective and wisdom; and to my patients who teach
me every day, meliora.
C.G.
To my husband, Eric, whose love of the written word
and commitment to service make him my constant companion
and inspiration.
C.L.H.A.

Foreword
Ram Roth and his coeditors have created a unique book. Anesthesiology is
focussed on the relief of acute and chronic pain and the preservation and
enhancement of life in all aspects of medical care. Despite this, many people,
both medical and lay, would not realize this wide spectrum of care and would
consider those who practice in our specialty as physicians who merely remain
in the operating theatre. Medical knowledge has developed in different civili-
zations at different times. While many currently affl uent societies were
rigidly blaming illnesses on personal sin and treating with complex herbal
mixtures and prayer, other currently less affl uent areas had sophisticated
therapeutics and surgery based on sound physiological knowledge.
This persistent inequality in access to medical care has changed from
country to country as civilizations come and go, but in today’s world, appalling
inequality still exists. If the mortality purely from anesthesia in, say, London
is around 1:200,000, that in parts of West Africa right now is 1:150. This is
not acceptable and has to be changed.
Humanity has always had individuals who want to make a difference.
Initially, these might have been medical missionaries who combined teachings
about their faith with simple improvements in healthcare. Soon this was associ-
ated with travelling surgeons and nurses; with the advent of modern anesthesia,
this, too, would be added into the travelling mix. In the early days, this provision
of pain relief would be part of the surgical remit, but as anesthesia developed
and became specialized, slowly, anesthetists started to travel and teach.
Early medical missions went to areas and built hospitals, taught locally,
and stayed for the rest of their lives. Often, however, their deaths resulted in
a loss of service and a return to “the old ways.” As time passed, all countries
started medical schools and local doctors emerged, but anesthesiology has
always been regarded by many as a “low-quality” speciality. This is now
changing, but not fast enough.
Nowadays, there is a very confusing picture of humanitarian aid through-
out the less affl uent world. Some NGOs have found it diffi cult to demonstrate
that donated funds reach those most in need. Many “aid workers” go into an
area and do tremendous surgical or medical interventions but then depart
without any thought of leaving a legacy beyond those individual lives they
have changed. There is almost a sense of medical tourism for some, with the
collecting of photographs of terrible pathology and beautiful landscapes for
what almost seems like the “entertainment” of people back home.
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viii Foreword
I t is now obvious what needs to be done to improve essential surgical and
anesthesia care around the world. Governments can see what could be done
and they need to allocate appropriate resources to make this happen. Those
who travel to teach need to “teach the teachers” and leave a legacy on which
further developments can be built. At this time, the WHO realizes that death
from infectious diseases is falling, while death from essential surgery and
anesthesia is rising. They, too, will seek to infl uence governments. The WFSA
will seek to assist them in this work.
This book describes many sound ways forward. It is a great start, but the
fi nish will come when inequality in care is abolished.
David J. Wilkinson, L.R.C.P., M.R.C.S., M.B., B.S.
World Federation of Societies
of Anaesthesiologists (WFSA)
London , UK May 2014
Pref ace
No man is an island entire of itself … any man ’ s death diminishes me , because I am
involved in mankind.
John Donne, Devotions upon Emergent Occasions, 1624 .
Anesthesiologists provide acute and critical medical care to patients as well as
the necessary infrastructure to enable surgeons to implement dramatic, life-
changing interventions around the world. In and around any operating room
anesthesiologists are the professionals who provide preoperative evaluation,
consult with the surgical team, and create a plan tailored to each individual
patient—including airway management, intraoperative life support, pain con-
trol, and postoperative management. It is in this capacity as perioperative physi-
cians that anesthesiologists improve the safety and effi cacy of surgical
interventions for underserved patients in low- and middle- income countries.
When we fi rst embarked on this project to identify the role of anesthesiol-
ogy in global health, we knew that many organizations around the world were
already involved in medical missions. We came to this task with different
perspectives, from resident to senior practitioner, and diverse experiences,
gained over the years from travels, consultations, and basic care in many
countries. We suspected that anesthetic care providers would identify com-
mon areas of concern and similar diffi culties. What we have learned from
writing this book is so much more. Through reports from so many mission
providers, we learned that many of the problems are the same … lack of basic
supplies, education, infrastructure, and communication. A need to understand
that more can indeed be done with less is a recurring theme. The diffi culties
have all been identifi ed succinctly and on many occasions, but no common
solutions have been determined. Moreover, in diverse corners of the world
anesthesiologists have developed programs that they individually believe to
be unique but in fact are mirrored to a greater or lesser extent by other practi-
tioners. Thus, the need for a collaborative effort and true development of a
global health strategy is underscored. Can this be done by one entity such as
a government or medical school or international organization? Probably not!
Rather, as some of our authors present, representatives and leaders from
among the ranks of health care professionals should put aside different agen-
das to develop a workable health program that is truly global. The resources
are there: organizing and harnessing those resources is the next step in the
process. If readers fi nd that there is duplication in some chapters, they are
correct. We have deliberately left it that way to underscore the need for closer
ix