About - Author
Donna Spratt, MD, Physician Anesthesiologist
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Since 2010 I have had the opportunity to work with an organization that trains surgeons and now anesthesiologists and other specialists in Africa. This gave me the chance to complete short term missions to training sites, work with local anesthesia providers, and to observe perioperative care. The morbidity and mortality associated with anesthesia and perioperative care in developing countries is massive. This has seemingly changed little despite years of work and significant financial investment.
During these visits, patterns of care that lead to significant morbidity and mortality became evident. These included inadequate preparedness and the absence of essential actions and protocols at points of care. Often providers did not have clearly defined preparedness and action goals. Most definitions of these are in sentences in significant journals in electronic form not in usable checklists at their side. Moreover, the providers were often not empowered to uphold and maintain standards, even when they knew them.
Other patterns emerged as common solutions to common problems. Often these seemed uncoordinated, redundant, and to be more of a knee jerk reaction than the result of a root cause analysis. When the anesthesia machine or other piece of equipment was broken the solution was to get a new one. Equipment with cheap or free upfront costs that performed well in controlled environments despite its fragility when this condition was not met, was often procured. Often the equipment was incomplete. It was not coupled to all of the needed accessories, extra quantities of fragile parts, provider training, equipment care training, preventative maintenance, and more. Solutions also included new training programs perhaps attached to a higher degree to expand the workforce while remediating currently practicing providers and teaching efficiencies and enabling them, was not considered. Comon solutions include a large single financial investment and nothing more despite the fact that the cost of items does not stop with the purchase.
Continued