Investing in Human Resources via Education Is Essential to Improving Access to Surgical and Anesthetic Care Across the Globe

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Anna Budde

Anna Budde

Anna Budde, MD, is currently an anesthesia resident at Beth Israel Deaconess Medical Center starting her third year of residency. She earned her MD at Georgetown University in Washington, DC, where she was able to do some interesting work in health policy. She also spent time in Ecuador working at a renal transplant center in a resource-poor public hospital and in Tanzania working on a pediatric burn unit and a labor and delivery ward.

The Lancet Commission on Global Surgery published a report on the state of global surgery in April 2015 reporting the staggering statistic that “5 billion people in the world lack access to safe, affordable surgical and anesthesia care when needed” [1]. I vividly remember working at a busy public hospital in Arusha, Tanzania where this reality was dismally clear. On the labor and delivery ward, we hoped that every patient would have an uncomplicated vaginal delivery because our options if a woman needed a cesarean section for obstructed labor or a D&C for a postpartum hemorrhage were extremely limited. The problem was access to surgeons and anesthesiologists. The solution was obvious: Train more providers.

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There is no way to solve this problem without investing in human resources. Such an investment will only be successful if there is a clear commitment between surgeons and anesthesiologists who offer training and then continue to be available to provide support. The existing model of mission trips where surgeons and anesthesiologists spend a few weeks providing care and then leave never to be seen again does not provide a sustainable improvement.

In the Tanzanian hospital where I was working, which is representative of countless others, there was one anesthesiologist for a city of 1 million people. Transportation between the hospitals he covered was not straightforward; some days he would be stuck in traffic for hours while trying to get to his next patient. The system devised to help him provide coverage involved each hospital having an assigned day when surgery could take place. Our hospital’s day was Tuesday. We diagnosed a case of acute appendicitis on a Wednesday and were forced to offer the patient a choice of waiting until the following Tuesday (and risking his appendix rupturing in the interim) or gathering funds to go to a private hospital. His family did not have the means to pay for an operation at the private hospital, so he writhed in pain for 6 days and became very ill while waiting for his operation.

This case illustrates what the Lancet report has quantified; surgery and anesthesia are vital services that are inextricably linked. The global health community has made huge progress in providing medical services including treatment of infectious diseases and malnutrition, and a great number of lives have been saved. While we should applaud these successes, the fact remains that no amount of prevention and appropriate medical therapy can eliminate the need for surgery and anesthesia. In fact, the need for these services is increasing. For example, as more vehicles enter the developing world and transportation infrastructure improves, we will see a spike in motor vehicle accidents and traumas necessitating prompt anesthesia and surgical management.

Unfortunately, surgery and anesthesia are specialties that require a skill set which is not easy to teach. While infrastructure like operating theaters and equipment like ventilators is crucial, it takes a larger investment of time and resources to train personnel equipped to provide safe surgery and anesthesia. Sustainable programs to train anesthesiologists and surgeons willing to serve in resource poor settings are extremely rare. This is the next place we need to allocate global health resources. Otherwise, the dire situation of poor access to essential surgical and anesthesia services will not improve for 5 billion patients who desperately need our help.

 

References:

  1. Meara, John G., and Sarah L.M. Greenberg. “The Lancet Commission on Global Surgery Global Surgery 2030: Evidence and Solutions for Achieving Health, Welfare and Economic Development.” Surgery5 (2015): 834-35.