Teaching Anesthesia in Ghana: A Thirteen Year Experience
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- Kory Adams
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1 Teaching Anesthesia in Ghana: A Thirteen Year Experience Jeffrey L. Peters PhD, MD Extreme Affordability & InnovaEve SoluEons For Surgical Care March 22,23, 2012 Salt Lake City, Utah
2 Songs &Lining Up Before School
3 Overview Brief history of anesthesia pracece in Ghana. Philosophy and sustainabilty of a collaboraeve anesthesia educaeon program. PoliEcs and problems: What is our role? Goals for 2012.
4 Brief History of Anesthesia PracEce in Ghana U.K. with Dr. s Gabriel Boakye* & Frank Boni restructured OR and started a Nurse Anesthesia School. Currently 590 Nurse AnestheEsts in Ghana, 4 teaching hospitals (2 new- Cape Coast & Tamale) 10 Regional Hospitals, 230 District Hospitals, Military, OrganizaEonal (Church, NGO s) Burden of anesthesia care is by Nurse AnestheEsts (N.A.). CerEficaEon, registraeon and licensing recently placed under the Medical & Dental Council. * Only anesthesiologist at KATH unel ~2009
5 History (cont.) Limited anesthesia resources- machines, venelators, monitors, supplies, medicaeons with some private hospital excepeons. High infant and maternal mortality ( Kybele break through at the Ridge Hospital) Major problems for public health- water (typhoid), non- covered sewers (malaria), transportaeon and roads ( road accidents #1 cause of mortality and morbidity in Ghana)
6 History (cont.) Visionary CEO sent Ghanaian MD s for residency training in anesthesiology and other specialees. 5 anesthesiologists now at the KATH Hospital in Kumasi. Nurse anesthesia school (18 mo. Program) graduates over 50 N.A /class (590 in Ghana). New anesthesia residency program (5 years). Medical student anesthesia interest group.
7 Anesthesia EducaEon Philosophy- under direceon of our Ghanaian colleagues assist in teaching the N.A. & residents basic science and clinical anesthesia. ParEcipate in OR teaching and clinical care. Provide textbooks, lectures and demonstraeons (regional blocks,fiberopec intubaeon, echocardiography). Annual KATH Anesthesia Refresher Course.
8 VisiEng Residents Before Performing U.S. Guided Surgical Block
9 Teaching ECHO for Quick Volume Assessment
10 Program Sustainability Long term collaboraeve relaeonship and friendships with exchanges. in the OR s to see first hand the condieons, surgeries and parecipate in the anesthesia care (preop. to postop.) Yearly visits, biannual visits to 1+ months/year. Year round planning, conenuous communicaeon and interaceon.
11 Annual Anesthesia Refresher Course
12 Professors Gladys Amponsah & Gabriel Boakye
13 Refresher Course: Neonatal ResuscitaEon
14 Refresher Course CerEficate
15 Classroom Teaching
16 Why We Are There!
17 PoliEcs & Problems New eleceon, new party, new hospital CEO & Board Visionary and non- visionary CEO s Affordable resources not available High infant and maternal mortality Unnecessary deaths because of lack of monitors, venelators and consumables. Some medicaeons cost more in Ghana.
18 Problems OR management & efficiency OB paeent overload (weekends) and lack of space, neonatal resuscitaeon, prolonged period of Eme before paeents reach the hospital. No beds available aoer surgery. If paeents can t pay their bill they are kept in the hospital. Delayed care of paeents coming from the ER. Minimal M&M, quality assurance programs.
19 New A&E Recovery Room
20 Main Theatre Recovery Room Over 5000 Surgeries Last Year
21 Too Many PaEents & No Space
22 Is Everything Ready in the PACU?
23 Warming the Newborn aoer Surgery Prior to ExtubaEon
24 Ruptured Giant Omphalocele
25 Post Op
26 Post Op & Pre Op
27 Ghana Nurse AnaestheEsts 2006,2009 QuesEonnaire Anaesthesia Equipment
28 Barery Powered Pulse Oximeter
29 Three Bed ICU 2009
30 New event VenElator
31 Ghana Nurse AnaestheEsts QuesEonnaire 2006,2009 Current MedicaEons
32 OB Pain Management in Ghana Minimal- lack of qualified staff and resources Pethidine unel close to delivery (7 cm) Ridge Hospital (Accra)- single shot spinals, a protocol developed by Dr. Medge Owen of Kybele
33 Is It Time for Epidurals for Labor & Delivery in Ghana? Jeffrey L. Peters PhD, MD 6 th Annual KATH Anesthesia Refresher Course April 14-15, 2009
34 Medical Hospitals in Ghana 230 District Hospitals 9 Regional Hospitals Private Hospitals Military Hospital OrganizaEonal (e.g. Church, NGO s) Hospitals
35 CriEcal Problems Lack of anaesthesia resources* High infant & maternal mortality (neonatal resucitaeon) Staffing & physical faciliees (beds, Emely surgeries, ICU funding) Pain management in L&D * Anaesthesia machines, monitors, drugs, equipment repair
36 What is Our Role? IdenEfy dedicated faculty and support their efforts. Give and take interaceons with all final decisions by our hosts. Maintain discussion of condieons and possible solueons. Provide our standard of care. Promote exchanges of faculty, residents and medical students.
37 Plans for 2012 and Beyond ConsorEum of Departments of Anesthesiology for teaching year around. Obtain 5 year Anesthesia Teaching Grant. To include anesthesia teaching lab and simulator. Country wide District and Regional Hospital educaeon site visits to standardize anesthesia pracece and resources*. * Monitors, anesthesia machines, medicaeons & consumables in conjunceon with the GHS/MOH.
38 Our Goal: Healthy Ghanaians
39 Thank You For Your ArenEon!
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