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Lilaonitkul M, Zacharia A, Law TJ, Yusuf N, Saria P, Moore J. Evaluation of practice change following SAFE obstetric courses in Tanzania: a prospective cohort study. Anaesthesia 2023; 78:1354-1364. [PMID: 37431149 DOI: 10.1111/anae.16091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/12/2023]
Abstract
Anaesthesia has been shown to contribute disproportionately to maternal mortality in low-resource settings. This figure exceeds 500 per 100,000 live births in Tanzania, where anaesthesia is mainly provided by non-physician anaesthetists, many of whom are working as independent practitioners in rural areas without any support or opportunity for continuous medical education. The three-day Safer Anaesthesia from Education (SAFE) course was developed to address this gap by providing in-service training in obstetric anaesthesia to improve patient safety. Two obstetric SAFE courses with refresher training were delivered to 75 non-physician anaesthetists in the Mbeya region of Tanzania between August 2019 and July 2020. To evaluate translation of knowledge into practice, we conducted direct observation of the SAFE obstetric participants at their workplace in five facilities using a binary checklist of expected behaviours, to assess the peri-operative management of patients undergoing caesarean deliveries. The observations were conducted over a 2-week period at pre, immediately post, 6-month and 12-month post-SAFE obstetric training. A total of 320 cases completed by 35 participants were observed. Significant improvements in behaviours, sustained at 12 months after training included: pre-operative assessment of patients (32% (pre-training) to 88% (12 months after training), p < 0.001); checking for functioning suction (73% to 85%, p = 0.003); using aseptic spinal technique (67% to 100%, p < 0.001); timely administration of prophylactic antibiotics (66% to 95%, p < 0.001); and checking spinal block adequacy (32% to 71%, p < 0.001). Our study has demonstrated positive sustained changes in the clinical practice amongst non-physician anaesthetists as a result of SAFE obstetric training. The findings can be used to guide development of a checklist specific for anaesthesia for caesarean section to improve the quality of care for patients in low-resource settings.
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Affiliation(s)
- M Lilaonitkul
- Department of Anesthesia and Peri-operative Care, University of California San Francisco, California, USA
| | - A Zacharia
- Mbeya Zonal Referral Hospital, University of Dar es Salaam, Mbeya College of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - T J Law
- Department of Anesthesia and Peri-Operative Care, University of California San Francisco, California, USA
| | - N Yusuf
- Department of Anaesthesia, Tanga Regional Referral Hospital, Tanzania
| | - P Saria
- Department of Anesthesia, CCBRT Hospital, Dar es Salaam, Tanzania
| | - J Moore
- Department of Anaesthesia, NHS Grampian, Aberdeen, UK
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Fernandes NL, Lilaonitkul M, Subedi A, Owen MD. Global obstetric anaesthesia: bridging the gap in maternal health care inequities through partnership in education. Int J Obstet Anesth 2023; 55:103646. [PMID: 37211512 DOI: 10.1016/j.ijoa.2023.103646] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/20/2023] [Indexed: 05/23/2023]
Abstract
Maternal mortality rates are unacceptably high globally. Low- and middle-income countries (LMICs) face challenges of an inadequate anaesthesia workforce, under-resourced healthcare systems and sub-optimal access to labour and delivery care, all of which negatively impact maternal and neonatal outcomes. In order to effect the changes in surgical-obstetric-anaesthesia workforce numbers advocated by the Lancet Commission on Global Surgery to support the UN sustainable development goals, mass training and upskilling of both physician and non-physician anaesthetists is imperative. The implementation of outreach programmes and partnerships across organisations and countries has already been shown to improve the provision of safe care to mothers and their babies, and these efforts should be continued. Short subspecialty courses and simulation training are two cornerstones of modern obstetric anaesthesia training in poorly resourced environments. This review discusses the challenges to accessing quality maternal healthcare in LMICs and the use of education, outreach, partnership and research to protect the most vulnerable women from coming to harm in the peripartum period.
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Affiliation(s)
- N L Fernandes
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
| | - M Lilaonitkul
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - A Subedi
- Department of Anesthesiology and Critical Care, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - M D Owen
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Guasch E, Brogly N, Gilsanz F. Teaching and Learning Obstetric Anaesthesia in Low- and Middle-Income Countries: Current Situation and Perspectives. CURRENT ANESTHESIOLOGY REPORTS 2023; 13:76-82. [PMID: 37168832 PMCID: PMC10113969 DOI: 10.1007/s40140-023-00557-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 05/13/2023]
Abstract
Purpose of Review Our goal in this review is to describe the current context and peculiarities of obstetric anaesthesia in low- and middle-income countries (LMIC) and the ongoing actions and perspectives in terms of teaching and learning, focusing on improving maternal outcomes. Recent Findings Correct identification of barriers and lack of infrastructures and anaesthesia providers are still major problems despite efforts of different stakeholders. International consensus and commitment for 2030 goals are trying to be achieved. Summary Structured training courses look a good option as short- and long-term evaluations show a positive impact. Future efforts will have to be also focused on indicators that may help to decrease the high mortality and morbidity ratios in LMIC.
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Affiliation(s)
- Emilia Guasch
- Anaesthesia and Reanimation Department, Hospital Universitario La Paz, Servicio Anestesia Y Reanimación, Paseo Castellana, 261, 28046 Madrid, Spain
- WFSA Obstetric Anaesthesia Committee and WFSA Council Member, London, UK
| | - Nicolas Brogly
- Anesthesia and Reanimation Department, European Society of Anaesthesia and Intensive Care (ESAIC), Hospital Universitario La Paz, Madrid, Spain
| | - Fernando Gilsanz
- European Society of Anaesthesia and Intensive Care (ESAIC), Spanish Royal Academy of Medicine (RANME), Universidad Autónoma de Madrid, Madrid, Spain
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MacLennan K, Minehart RD, Vasco M, Eley VA. Simulation-based training in obstetric anesthesia: an update. Int J Obstet Anesth 2023; 54:103643. [PMID: 36933323 DOI: 10.1016/j.ijoa.2023.103643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 01/24/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023]
Abstract
In this update we explore the current applications of simulation in obstetric anesthesia, describe what is known regarding its impacts on care and consider the different settings in which simulation programs are required. We will introduce practical strategies, such as cognitive aids and communication tools, that can be applied in the obstetric setting and share ways in which a program might apply these tools. Finally, we provide a list of common obstetric emergencies essential for a program's curriculum and common teamwork pitfalls to address within a comprehensive obstetric anesthesia simulation program.
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Affiliation(s)
| | - R D Minehart
- Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA
| | - M Vasco
- Universidad CES, Medellín, Colombia
| | - V A Eley
- Royal Brisbane and Women's Hospital, Brisbane, Australia; The University of Queensland, Brisbane, Australia.
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Dharni N, Byrne-Davis LMT, Sanga E, Hart J, Shrestha AB, Gurung T, Shrestha RR, Vaidya PR, Hossain A, Lilaonitkul M, Snell D, Barrett-Chapman A, Walker I, Bull ER. Using behavioural science to explore impact and implementation of obstetric anaesthesia training in Tanzania, Nepal and Bangladesh: a qualitative evaluation study with obstetric anaesthesia providers. Psychol Health 2023:1-15. [PMID: 36622305 DOI: 10.1080/08870446.2022.2160472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/14/2022] [Accepted: 12/15/2022] [Indexed: 01/10/2023]
Abstract
Objective: High quality obstetric anaesthetic care is integral to reducing preventable maternal deaths in Low-and-Middle-Income-Countries (LMICs). We applied behavioural science to evaluate SAFE Obstetrics, a 3-day Continuing Professional Development (CPD) course, on physician and non-physician anaesthetists' practice behaviours across 3 LMICs.Methods: Seven anaesthetist Fellows from Bangladesh, Nepal and Tanzania were trained in qualitative methods and behavioural science. Structured interviews were undertaken by Fellows and two UK behavioural scientists with course participants. Interviews were based on the Theoretical Domains Framework: a comprehensive framework of influences on behaviour change. Interviews were recorded, transcribed and analysed using content and thematic analysis.Results: 78 physician and non-physician anaesthetists participated (n = 26 Bangladesh, n = 24 Nepal and n = 28 Tanzania). Participants reported positive improvements in patient-centered working, safety, teamwork and confidence. Across countries, we found similar barriers and facilitators: environmental resources, a strong professional identity and positive social influences were key facilitators of change.Conclusion: This multi-country theory-based evaluation highlighted the impact of SAFE Obstetrics on participants' clinical practice. A supportive work environment was crucial for implementing learning following training; CPD courses in LMICs must furnish participants with skills and equipment to address training implementation challenges. Building local behavioural science capacity can strengthen LMIC health intervention evaluations.
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Affiliation(s)
- Nimarta Dharni
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Lucie M T Byrne-Davis
- Faculty of Biology Medicine and Health, Division of Medical Education, University of Manchester, Manchester, UK
| | - Evans Sanga
- Department of Anaesthesia, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Jo Hart
- Faculty of Biology Medicine and Health, Division of Medical Education, University of Manchester, Manchester, UK
| | - Amir Babu Shrestha
- Department of Anaesthesia, Paropakar Maternity and Women's Hospital, Kathmandu, Nepal
| | - Tara Gurung
- Department of Anaesthesia, Paropakar Maternity and Women's Hospital, Kathmandu, Nepal
| | - Ravi R Shrestha
- Department of Anaesthesia, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Pradip R Vaidya
- Department of Anaesthesia, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Amir Hossain
- Department of Anaesthesia, Shaheed Tajuddin Ahmad Medical College, Gazipur, Bangladesh
| | - Maytinee Lilaonitkul
- Department of Anaesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA
| | - David Snell
- Department of Anaesthesia, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | | | | | - Eleanor R Bull
- Faculty of Biology Medicine and Health, Division of Medical Education, University of Manchester, Manchester, UK
- Department of Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
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Uwisanze S, Ngabonzima A, Bazirete O, Hategeka C, Kenyon C, Asingizwe D, Kanazayire C, Cechetto D. Mentors' perspectives on strengths and weaknesses of a novel clinical mentorship programme in Rwanda: a qualitative study. BMJ Open 2021; 11:e042523. [PMID: 33741662 PMCID: PMC7986684 DOI: 10.1136/bmjopen-2020-042523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To identify mentors' perspectives on strengths and weaknesses of the Training, Support and Access Model for Maternal, Newborn and Child Health (TSAM-MNCH) clinical mentorship programme in Rwandan district hospitals. Understanding the perspectives of mentors involved in this programme can aid in the improvement of its implementation. DESIGN The study used a qualitative approach with in-depth interviews. SETTING Mentors of TSAM-MNCH clinical mentorship programme mentoring health professionals at district hospitals of Rwanda. PARTICIPANTS 14 TSAM mentors who had at least completed six mentorship visits on a regular basis in three selected district hospitals. RESULTS Mentors' accounts demonstrated an appreciation of the two mentoring structures which are interprofessional collaboration and training. These structures are highlighted as the strengths of the mentoring programme and they play a significant role in the successful implementation of the mentorship model. Inconsistency of mentoring activities and lack of resources emerged as major weaknesses of the clinical mentorship programme which could hinder the effectiveness of the mentoring scheme. CONCLUSION The findings of this study highlight the strengths and weaknesses perceived by mentors of the TSAM-MNCH clinical mentorship programme, providing insights that can be used to improve its implementation. The study represents unique TSAM-MNCH structural settings, but its findings shed light on Rwandan health system issues that need to be further addressed to ensure better quality of care for mothers, newborns and children.
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Affiliation(s)
- Sandrine Uwisanze
- School of Social and Political Science, The University of Edinburgh, Edinburgh, UK
| | | | - Oliva Bazirete
- Midwifery Department, College of Medicine and Health Sciences- University of Rwanda, Kigali, Rwanda
| | - Celestin Hategeka
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Cynthia Kenyon
- Perinatal Medicine, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Domina Asingizwe
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | | | - David Cechetto
- Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
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van Tetering AAC, Segers MHM, Ntuyo P, Namagambe I, van der Hout-van der Jagt MB, Byamugisha JK, Oei SG. Evaluating the Instructional Design and Effect on Knowledge, Teamwork, and Skills of Technology-Enhanced Simulation-Based Training in Obstetrics in Uganda: Stepped-Wedge Cluster Randomized Trial. JMIR MEDICAL EDUCATION 2021; 7:e17277. [PMID: 33544086 PMCID: PMC8081249 DOI: 10.2196/17277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 06/07/2020] [Accepted: 06/13/2020] [Indexed: 05/03/2023]
Abstract
BACKGROUND Simulation-based training is a common strategy for improving the quality of facility-based maternity services and is often evaluated using Kirkpatrick's theoretical model. The results on the Kirkpatrick levels are closely related to the quality of the instructional design of a training program. The instructional design is generally defined as the "set of prescriptions for teaching methods to improve the quality of instruction with a goal of optimizing learning outcomes." OBJECTIVE The aim of this study is to evaluate the instructional design of a technology-enhanced simulation-based training in obstetrics, the reaction of participants, and the effect on knowledge, teamwork, and skills in a low-income country. METHODS A stepped-wedge cluster randomized trial was performed in a university hospital in Kampala, Uganda, with an annual delivery volume of over 31,000. In November 2014, a medical simulation center was installed with a full-body birthing simulator (Noelle S550, Gaumard Scientific), an interactive neonate (Simon S102 Newborn CPR Simulator, Gaumard Scientific), and an audio and video recording system. Twelve local obstetricians were trained and certified as medical simulation trainers. From 2014 to 2016, training was provided to 57 residents in groups of 6 to 9 students. Descriptive statistics were calculated for ten instructional design features of the training course measured by the 42-item ID-SIM (Instructional Design of a Simulation Improved by Monitoring). The Wilcoxon signed rank test was conducted to investigate the differences in scores on knowledge, the Clinical Teamwork Scale, and medical technical skills. RESULTS The mean scores on the ten instructional design features ranged from 54.9 (95% CI 48.5-61.3) to 84.3 (95% CI 80.9-87.6) out of 100. The highest mean score was given on the feature feedback and the lowest scores on repetitive practice and controlled environment. The overall score for the training day was 92.8 out of 100 (95% CI 89.5-96.1). Knowledge improved significantly, with a test score of 63.4% (95% CI 60.7-66.1) before and 78.9% (95% CI 76.8-81.1) after the training (P<.001). The overall score on the 10-point Clinical Teamwork Scale was 6.0 (95% CI 4.4-7.6) before and 5.9 (95% CI 4.5-7.2) after the training (P=.78). Medical technical skills were scored at 55.5% (95% CI 47.2-63.8) before and 65.6% (95% CI 56.5-74.7) after training (P=.08). CONCLUSIONS Most instructional design features of a technology-enhanced simulation-based training in obstetrics in a low-income country were scored high, although intervals were large. The overall score for the training day was high, and knowledge did improve after the training program, but no changes in teamwork and (most) medical technical skills were found. The lowest-scored instructional design features may be improved to achieve further learning aims. TRIAL REGISTRATION ISRCTN Registry ISRCTN98617255; http://www.isrctn.com/ISRCTN98617255. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12884-020-03050-3.
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Affiliation(s)
| | | | - Peter Ntuyo
- Department of Obstetrics and Gynecology, Mulago Hospital, Makerere University College of Health Sciences, Kampala, Uganda
| | - Imelda Namagambe
- Department of Obstetrics and Gynecology, Mulago Hospital, Makerere University College of Health Sciences, Kampala, Uganda
| | - M Beatrijs van der Hout-van der Jagt
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Josaphat K Byamugisha
- Department of Obstetrics and Gynecology, Mulago Hospital, Makerere University College of Health Sciences, Kampala, Uganda
| | - S Guid Oei
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
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Moore JN, Morriss WW, Asfaw G, Tesfaye G, Ahmed AR, Walker IA. The impact of the Safer Anaesthesia from Education (SAFE) Obstetric Anaesthesia training course in Ethiopia: A mixed methods longitudinal cohort study. Anaesth Intensive Care 2020; 48:297-305. [PMID: 32830542 DOI: 10.1177/0310057x20940330] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
SummaryReducing maternal mortality remains a global priority, particularly in low- and middle-income countries (LMICs). The Safer Anaesthesia from Education (SAFE) Obstetric Anaesthesia (OB) course is a three-day refresher course for trained anaesthesia providers addressing common causes of maternal mortality in LMICs. This aim of this study was to investigate the impact of SAFE training for a cohort of anaesthesia providers in Ethiopia.We conducted a mixed methods longitudinal cohort study incorporating a behavioural questionnaire, multiple-choice questionnaires (MCQs), structured observational skills tests and structured interviews for anaesthesia providers who attended one of four SAFE-OB courses conducted in two regions of Ethiopia from October 2017 to May 2018.Some 149 participants from 60 facilities attended training. Behavioural questionnaires were completed at baseline (n = 101, 69% response rate). Pre- and post-course MCQs (n = 121, n = 123 respectively) and pre- and post-course skills tests (n = 123, n = 105 respectively) were completed, with repeat MCQ and skills tests, and semi-structured interviews completed at follow-up (n = 88, n = 76, n = 49 respectively). The mean MCQ scores for all participants improved from 80.3% prior to training to 85.4% following training (P < 0.0001) and skills test scores improved from 56.5% to 83.2% (P < 0.0001). Improvements in MCQs and skills were maintained at follow-up 3-11 months post-training compared to baseline (P = 0.0006, < 0.0001 respectively). Participants reported improved confidence, teamwork and communication at follow-up.This study suggests that the SAFE-OB course can have a sustained impact on knowledge and skills and can improve the confidence of anaesthesia providers and communication within surgical teams.
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Affiliation(s)
- Jolene N Moore
- Department of Anaesthesia, NHS Grampian, Aberdeen, UK.,School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Wayne W Morriss
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.,Department of Anaesthesia, University of Otago, Otago, New Zealand
| | | | - Gosa Tesfaye
- World Federation of Societies of Anaesthesiologists, London, UK
| | - Aaliya R Ahmed
- Department of Anaesthesia, University of Otago, Otago, New Zealand
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Lilaonitkul M, Mishra S, Pritchard N, Andhoga J, Olang' P, Kibet EB, Walker IA, Hart J, Byrne-Davis L. Mixed methods analysis of factors influencing change in clinical behaviours of non-physician anaesthetists in Kenya following obstetric anaesthesia training. Anaesthesia 2020; 75:1331-1339. [PMID: 32436211 DOI: 10.1111/anae.15091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 11/30/2022]
Abstract
Maternal mortality rates in low-middle income countries remain high, with sub-Saharan Africa accounting for two-thirds of global maternal deaths. Inadequate staff training is one of the main contributors to anaesthesia-related deaths and the Association of Anaesthetists developed the Safe Anaesthesia from Education course in collaboration with the World Federation of Societies of Anaesthesiologists to address this training gap. We aimed to evaluate the impact of this course among Kenyan participants. Mixed methodologies and secondary analyses of anonymised data were used to study translation of learning into practice. In total, 103 participants from 66 facilities who attended courses between 2016 and 2017 were analysed. Ninety (87%) participants who were followed up completed knowledge tests. Baseline median (IQR [range]) knowledge test score was 41 (37-43 [21-46]). There was a significant improvement in median (IQR [range]) knowledge test score immediately post-course (43 (41-45 [33-48]); p < 0.001) which was sustained at 3-6 month follow-up (43 (41-45 [32-50]); p < 0.001 compared with baseline). Eighty-four of the 103 participants were observed in their workplace and capability, opportunity and motivation-behaviour framework was used to study the barriers and facilitators to practice change. Psychological capability and reflective motivation were the main factors enabling positive behaviour change such as team communication and pre-operative assessment, whereas physical and social opportunity accounted for the main barriers to behaviours such as performing the surgical safety checklist. Our study demonstrates that the Safe Anaesthesia from Education obstetric course is relevant in the low-resource setting and may lead to knowledge translation in clinical practice.
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Affiliation(s)
- M Lilaonitkul
- Department of Anesthesia and Peri-operative Care, University of California San Francisco, San Francisco, CA, USA
| | - S Mishra
- Department of Internal Medicine, Lincoln Medicine Center, New York, NY, USA
| | - N Pritchard
- Department of Anaesthesia, St George's University Hospitals NHS Foundation Trust, London, UK
| | - J Andhoga
- Department of Anaesthesia, Jomo Kenyatta University of Agriculture and Technology, Kiambu, Kenya
| | - P Olang'
- Department of Anaesthesia, University of Nairobi, Nairobi, Kenya
| | - E B Kibet
- Department of Anaesthesia, Kenyatta National Hospital, Nairobi, Kenya
| | - I A Walker
- University College London Institute of Child Health, London, UK
| | - J Hart
- Division of Medical Education, University of Manchester, Manchester, UK
| | - L Byrne-Davis
- Division of Medical Education, University of Manchester, UK
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11
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Mossenson AI, Tuyishime E, Rawson D, Mukwesi C, Whynot S, Mackinnon SP, Livingston P. Promoting anaesthesia providers' non-technical skills through the Vital Anaesthesia Simulation Training (VAST) course in a low-resource setting. Br J Anaesth 2020; 124:206-213. [DOI: 10.1016/j.bja.2019.10.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/05/2019] [Accepted: 10/18/2019] [Indexed: 11/27/2022] Open
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White MC, Rakotoarisoa T, Cox NH, Close KL, Kotze J, Watrous A. A Mixed-Method Design Evaluation of the SAFE Obstetric Anaesthesia Course at 4 and 12-18 Months After Training in the Republic of Congo and Madagascar. Anesth Analg 2019; 129:1707-1714. [PMID: 31743192 PMCID: PMC6844653 DOI: 10.1213/ane.0000000000004329] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Maternal mortality in low- and middle-income countries (LMICs) is higher than in high-income countries (HICs), and poor anesthesia care is a contributing factor. Many anesthesia complications are considered preventable with adequate training. The Safer Anaesthesia From Education Obstetric Anaesthesia (SAFE-OB) course was designed as a refresher course to upgrade the skills of anesthesia providers in low-income countries, but little is known about the long-term impact of the course on changes in practice. We report changes in practice at 4 and 12-18 months after SAFE-OB courses in Madagascar and the Republic of Congo. METHODS We used a concurrent embedded mixed-methods design based on the Kirkpatrick model for evaluating educational training courses. The primary outcome was qualitative determination of personal and organizational change at 4 months and 12-18 months. Secondary outcomes were quantitative evaluations of knowledge and skill retention over time. From 2014 to 2016, 213 participants participated in 5 SAFE-OB courses in 2 countries. Semistructured interviews were conducted at 4 and 12-18 months using purposive sampling and analyzed using thematic content analysis. Participants underwent baseline knowledge and skill assessment, with 1 cohort reevaluated using repeat knowledge and skills tests at 4 months and another at 12-18 months. RESULTS At 4 months, 2 themes of practice change (Kirkpatrick level 3) emerged that were not present at 12-18 months: neonatal resuscitation and airway management. At 12-18 months, 4 themes emerged: management of obstetric hemorrhage, management of eclampsia, using a structured approach to assessing a pregnant woman, and management of spinal anesthesia. With respect to organizational culture change (Kirkpatrick level 4), the same 3 themes emerged at both 4 and 12-18 months: improved teamwork, communication, and preparation. Resistance from peers, lack of senior support, and lack of resources were cited as barriers to change at 4 months, but at 12-18 months, very few interviewees mentioned lack of resources. Identified catalysts for change were self-motivation, credibility, peer support, and senior support. Knowledge and skills tests both showed an immediate improvement after the course that was sustained. This supports the qualitative responses suggesting personal and organizational change. CONCLUSIONS Participation at a SAFE-OB course in the Republic of Congo and in Madagascar was associated with personal and organizational changes in practice and sustained improvements in knowledge and skill at 12-18 months.
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Affiliation(s)
- Michelle C. White
- From the Department of Pediatric Anesthesia, Great Ormond Street Hospital, London, United Kingdom
- Department of Medical Capacity Building, Africa Bureau, Africa Mercy Hospital, Mercy Ships, Cotonou, Benin
| | - Tsiferana Rakotoarisoa
- From the Department of Pediatric Anesthesia, Great Ormond Street Hospital, London, United Kingdom
- Department of Medical Capacity Building, Africa Bureau, Africa Mercy Hospital, Mercy Ships, Cotonou, Benin
| | - Nicola H. Cox
- From the Department of Pediatric Anesthesia, Great Ormond Street Hospital, London, United Kingdom
- Department of Medical Capacity Building, Africa Bureau, Africa Mercy Hospital, Mercy Ships, Cotonou, Benin
| | - Kristin L. Close
- From the Department of Pediatric Anesthesia, Great Ormond Street Hospital, London, United Kingdom
- Department of Medical Capacity Building, Africa Bureau, Africa Mercy Hospital, Mercy Ships, Cotonou, Benin
| | - Joan Kotze
- From the Department of Pediatric Anesthesia, Great Ormond Street Hospital, London, United Kingdom
- Department of Medical Capacity Building, Africa Bureau, Africa Mercy Hospital, Mercy Ships, Cotonou, Benin
| | - Abigail Watrous
- From the Department of Pediatric Anesthesia, Great Ormond Street Hospital, London, United Kingdom
- Department of Medical Capacity Building, Africa Bureau, Africa Mercy Hospital, Mercy Ships, Cotonou, Benin
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Boyd N, Sharkey E, Nabukenya M, Tumukunde J, Sipuka N, Zyambo M, Walker I, Hart J, Byrne-Davis L. The Safer Anaesthesia from Education (SAFE) ® paediatric anaesthesia course: educational impact in five countries in East and Central Africa. Anaesthesia 2019; 74:1290-1297. [PMID: 31350856 DOI: 10.1111/anae.14778] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2019] [Indexed: 11/28/2022]
Abstract
There is an urgent need to improve access to safe surgical and anaesthetic care for children living in many low- and middle-income countries. Providing quality training for healthcare workers is a key component of achieving this. The 3-day Safer Anaesthesia from Education (SAFE)® paediatric anaesthesia course was developed to address the specific skills and knowledge required in this field. We undertook a project to expand this course across five East and Central African countries (Ethiopia, Kenya, Malawi, Uganda and Zambia) and train local faculty. This study reports the outcomes from course evaluation data, exploring the impact on knowledge, skills and behaviour change in participants. Eleven courses were conducted in a 15-month period, with 381 participants attending. Fifty-nine new faculty members were trained. Knowledge scores (0-50 scale) increased significantly from mean (SD) 37.5 (4.7) pre-course to 43.2 (3.5) post-course (p < 0.0001). Skills scores (0-10 scale) increased significantly from 5.7 (2.0) pre-course to 8.0 (1.5) post-course (p < 0.0001). One hundred and twenty-six participants in Malawi, Uganda and Zambia were visited in their workplace 3-6 months later. Knowledge and skills were maintained at follow-up, with scores of 41.5 (5.0) and 8.3 (1.4), respectively (p < 0.0001 compared with pre-course scores). Content analysis from interviews with these participants highlighted positive behaviour changes in the areas of preparation, peri-operative care, resuscitation, management of the sick child, communication and teaching. This study indicates that the SAFE paediatric anaesthesia course is an effective way to deliver training, and could be used to help strengthen emergency and essential surgical care for children as a component of universal health coverage.
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Affiliation(s)
- N Boyd
- Department of Anaesthesia, Bristol Royal Hospital for Children, Bristol, UK
| | - E Sharkey
- Department of Anaesthesia, University College Hospital, London, UK
| | - M Nabukenya
- Department of Anaesthesia, Makerere University College of Health Sciences, Kampala, Uganda
| | - J Tumukunde
- Department of Anaesthesia, Makerere University College of Health Sciences, Kampala, Uganda
| | - N Sipuka
- Department of Anaesthesia and Critical Care, University Teaching Hospital, Lusaka, Zambia
| | - M Zyambo
- Department of Anaesthesia and Critical Care, University Teaching Hospital, Lusaka, Zambia
| | - I Walker
- Department of Anaesthesia, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Department of Anaesthesia, UCL Great Ormond Street Institute of Child Health, London, UK
| | - J Hart
- Department of Education, University of Manchester, Manchester, UK
| | - L Byrne-Davis
- Department of Education, University of Manchester, Manchester, UK
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Ho M, Livingston P, Bould MD, Nyandwi JD, Nizeyimana F, Uwineza JB, Urquart R. Barriers and facilitators to implementing a regional anesthesia service in a low-income country: a qualitative study. Pan Afr Med J 2019; 32:152. [PMID: 31303923 PMCID: PMC6607318 DOI: 10.11604/pamj.2019.32.152.17246] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/29/2019] [Indexed: 01/17/2023] Open
Abstract
Introduction Regional anesthesia is a safe alternative to general anesthesia. Despite benefits for perioperative morbidity and mortality, this technique is underutilized in low-resource settings. In response to an identified need, a regional anesthesia service was established at the University Teaching Hospital of Kigali (CHUK), Rwanda. This qualitative study investigates the factors influencing implementation of this service in a low-resource tertiary-level teaching hospital. Methods Following service establishment, we recruited 18 local staff at CHUK for in-depth interviews informed by the “Consolidated Framework for Implementation Research” (CFIR). Data were coded using an inductive approach to discover emergent themes. Results Four themes emerged during data analysis. Patient experience and outcomes: where equipment failure is frequent and medications unavailable, regional anesthesia offered clear advantages including avoidance of airway intervention, improved analgesia and recovery and cost-effective care. Professional satisfaction: morale among healthcare providers suffers when outcomes are poor. Participants were motivated to learn techniques that they believe improve patient care. Human and material shortages: clinical services are challenged by high workload and human resource shortages. Advocacy is required to solve procurement issues for regional anesthesia equipment. Local engagement for sustainability: participants emphasized the need for a locally run, sustainable service. This requires broad engagement through education of staff and long-term strategic planning to expand regional anesthesia in Rwanda. Conclusion While the establishment of regional anesthesia in Rwanda is challenged by human and resource shortages, collaboration with local stakeholders in an academic institution is pivotal to sustainability.
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Affiliation(s)
- Matthew Ho
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia
| | - Patricia Livingston
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada
| | - M Dylan Bould
- Department of Anesthesiology, University of Ottawa, Ontario, Canada
| | - Jean Damascène Nyandwi
- Department of Anesthesiology and Intensive Care Medicine, University of Rwanda, Kigali, Rwanda
| | - Françoise Nizeyimana
- Department of Anesthesiology and Intensive Care Medicine, University of Rwanda, Kigali, Rwanda
| | | | - Robin Urquart
- Department of Surgery, Dalhousie University, Halifax, Canada
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Turkot O, Banks MC, Lee SW, Dodson A, Duarte S, Kaino M, Nelson-Williams H, Toy S, Sampson J. A Review of Anesthesia Simulation in Low-Income Countries. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00305-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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16
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Enright A. A friend in need: evaluating the impact of Lifebox in Burkina Faso. Can J Anaesth 2019; 66:139-142. [DOI: 10.1007/s12630-018-1264-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 09/26/2018] [Accepted: 09/26/2018] [Indexed: 11/30/2022] Open
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17
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Making a case for national surgery, obstetric, and anesthesia plans. Can J Anaesth 2018; 66:263-271. [DOI: 10.1007/s12630-018-01269-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 11/25/2022] Open
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18
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Enright A, McDougall R. In Response. Anesth Analg 2018; 127:e86-e87. [DOI: 10.1213/ane.0000000000003731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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19
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Leading the World: Perspectives of a Female President of WFSA. Int Anesthesiol Clin 2018; 56:128-140. [PMID: 29889130 DOI: 10.1097/aia.0000000000000194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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20
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Nyirigira G, Wilson RA, VanDenKerkhof EG, Goldstein DH, Twagirumugabe T, Mahaffey R, Parlow J, Johnson AP. Barriers and facilitators to postoperative pain management in Rwanda from the perspective of health care providers: A contextualization of the theory of planned behavior. Can J Pain 2018; 2:87-102. [PMID: 35005369 PMCID: PMC8730569 DOI: 10.1080/24740527.2018.1451251] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/21/2017] [Accepted: 03/08/2018] [Indexed: 11/20/2022]
Abstract
AIMS Identify opportunities to improve knowledge translation for post-operative pain management in Rwanda by exploring clinician and environmental factors affecting this practice. METHODS The theory of planned behavior (TPB) guided development of a questionnaire to measure intent to assess and treat postoperative pain. Focus groups and individual interviews were used to contextualize the final questionnaire and generate questions related to pain management practice. Health care providers from two Rwandan teaching hospitals involved in postoperative pain management completed the TPB questionnaire in May 2015. TPB subscale scores were analyzed to identify demographic and practice characteristics associated with intention to treat pain. The general linear model was used to test effect of attitudes, subjective norms, and perceived control on behavioral intent to treat pain. RESULTS Forty-six percent of participants (N = 131) had training in acute pain management, 56% used a pain protocol, and 74% used pain scales. Tramadol (78%), morphine (79%), and paracetamol (75%) were used most often to treat pain. Drug availability was the most frequently reported barrier to treating pain. Though intention to treat pain was high, only attitudes and perceived control about assessing pain were associated with intention to treat pain. The theme of fear of the adverse effects of pain medications was consistent across focus groups and interviews in both sites. CONCLUSIONS System and knowledge barriers exist: interventions to address these barriers may lead to improved postoperative pain care. Further validation of the TPB questionnaire is required to address cultural and language factors specific to the Rwandan context.
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Affiliation(s)
- Gaston Nyirigira
- Anaesthesia, Critical Care and Pain, Butare University Teaching Hospital, Butare, Rwanda
| | - Rosemary A. Wilson
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
- Department of Anesthesiology and Perioperative Medicine, Queen’s University, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Elizabeth G. VanDenKerkhof
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
- Department of Anesthesiology and Perioperative Medicine, Queen’s University, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - David H. Goldstein
- Department of Anesthesiology and Perioperative Medicine, Queen’s University, Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Department of Anesthesiology, Brockville General Hospital, Brockville, Ontario, Canada
| | | | - Ryan Mahaffey
- Department of Anesthesiology and Perioperative Medicine, Queen’s University, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Joel Parlow
- Department of Anesthesiology and Perioperative Medicine, Queen’s University, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Ana P. Johnson
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
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Barreiro G, Mellin-Olsen J, Gore-Booth J. The Role of the WFSA in Reaching the Goals of the Lancet Commission on Global Surgery. Anesth Analg 2018; 126:1400-1404. [DOI: 10.1213/ane.0000000000002543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Evans FM, Duarte JC, Haylock Loor C, Morriss W. Are Short Subspecialty Courses the Educational Answer? Anesth Analg 2018; 126:1305-1311. [DOI: 10.1213/ane.0000000000002664] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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23
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Hewitt-Smith A, Bulamba F, Ttendo S, Pappenheim K, Walker IA, Smith AF. A mixed-methods evaluation of the Association of Anaesthetists of Great Britain and Ireland Uganda Fellowship Scheme. Anaesthesia 2018; 73:284-294. [DOI: 10.1111/anae.14116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2017] [Indexed: 11/29/2022]
Affiliation(s)
- A. Hewitt-Smith
- Busitema University; Mbale Uganda
- Assocaition of anaesthetists of great Britain and
Ireland (AAGBI); London UK
| | | | - S. Ttendo
- Mbarara University of Science and Technology; Mbarara Uganda
| | - K. Pappenheim
- Assocaition of anaesthetists of great Britain and
Ireland (AAGBI); London UK
| | - I. A. Walker
- Department of Anaesthesia; Great Ormond Street Hospital NHS Foundation Trust; UCL Great Ormond Street Institute of Child Health; London UK
| | - A. F. Smith
- Royal Lancaster Infirmary and Honorary Professor of Clinical Anaesthesia; Lancaster University; Lancaster UK
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25
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Martin RF, Rangira C, d'Arc Uwambazimana J, Desai SP. The History and Evolution of Anesthetic Care in Rwanda. J Anesth Hist 2016; 3:5-11. [PMID: 28160992 DOI: 10.1016/j.janh.2016.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 03/28/2016] [Accepted: 12/18/2016] [Indexed: 10/20/2022]
Abstract
Although the development of anesthesia as a specialty and its practice in Rwanda have occurred postindependence, there are several contributing factors that have had an impact on the current state of the delivery of anesthetic care. European colonization of Africa, in general, and Belgium's control, in particular, are primary factors that have had a significant impact on education. The ripple effect has had a long-lasting impact on health care as well as other facets of present-day Rwandan society. Tertiary education did not start until the latter half of the 20th century and has left this country with the belated development of an educated population in sufficient numbers to handle health care problems and provide sufficient care to its population. This article will examine the history of Rwanda and delineate factors that have led to the current state of anesthetic practice.
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Affiliation(s)
- Ramon F Martin
- Assistant Professor, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Charles Rangira
- Lecturer, Department of Anesthesiology, College of Medicine and Health Sciences, University of Rwanda
| | - Jeanne d'Arc Uwambazimana
- Senior Lecturer, Department of Anesthesiology, College of Medicine and Health Sciences, University of Rwanda
| | - Sukumar P Desai
- Assistant Professor, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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26
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White MC. Pro: Pure service delivery is still needed in global surgery missions. Can J Anaesth 2016; 64:347-352. [DOI: 10.1007/s12630-016-0807-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022] Open
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27
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White M, Close K. Lasting impact: insights from a surgical mission-based mentoring training programme in the Republic of Congo. BMJ Glob Health 2016; 1:e000102. [PMID: 28588961 PMCID: PMC5321362 DOI: 10.1136/bmjgh-2016-000102] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/05/2016] [Accepted: 09/15/2016] [Indexed: 02/03/2023] Open
Abstract
The global shortage of surgeons, anaesthetists and obstetricians is significant, especially in low and middle income countries (LMICs). A significant amount of LMIC surgical volume is provided by surgical missions and non-governmental organisations (NGOs) who are often well resourced, making them ideal environments for training. However, there are few publications addressing how to train in this setting, or the long-term impact of such training. Mercy Ships operates the largest non-governmental hospital ship in the world, the Africa Mercy, serving LMICs at the invitation of their President by providing free surgery and training for the surgical workforce. Mercy Ships developed and offered a comprehensive training programme across surgical specialties and disciplines in the Republic of Congo, 2013–2014. In this analysis paper, we present our experiences in developing and implementing the training portion of the programme. We also present the findings of an evaluation of the programme, which show a sustained positive impact and lasting change on personal and organisational practice 12–18 months post-training. We also make recommendations to NGOs and surgical mission organisations seeking to augment the impact of surgical missions with effective surgical training programmes.
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Affiliation(s)
- Michelle White
- Department of Medical Capacity Building, Mercy Ships, Port of Cotonou, Benin
| | - Kristin Close
- Department of Medical Capacity Building, Mercy Ships, Port of Cotonou, Benin
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Ulisubisya M, Jörnvall H, Irestedt L, Baker T. Establishing an Anaesthesia and Intensive Care partnership and aiming for national impact in Tanzania. Global Health 2016; 12:7. [PMID: 26993790 PMCID: PMC4799533 DOI: 10.1186/s12992-016-0144-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 03/09/2016] [Indexed: 01/09/2023] Open
Abstract
Anaesthesia and Intensive Care is a neglected specialty in low-income countries. There is an acute shortage of health workers – several low-income countries have less than 1 anaesthesia provider per 100,000 population. Only 1.5 % of hospitals in Africa have the intensive care resources needed for managing patients with sepsis. Health partnerships between institutions in high and low-income countries have been proposed as an effective way to strengthen health systems. The aim of this article is to describe the origin and conduct of a health partnership in Anaesthesia and Intensive Care between institutions in Tanzania and Sweden and how the partnership has expanded to have an impact at regional and national levels. The Muhimbili-Karolinska Anaesthesia and Intensive Care Collaboration was initiated in 2008 on the request of the Executive Director of Muhimbili National Hospital in Dar es Salaam. The partnership has conducted training courses, exchanges, research projects and introduced new equipment, routines and guidelines. The partnership has expanded to include all hospitals in Dar es Salaam. Through the newly formed Life Support Foundation, the partnership has had a national impact assisting the reanimation of the Society of Anaesthesiologists of Tanzania and has seen a marked increase of the number of young doctors choosing a residency in Anaesthesia and Intensive Care.
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Affiliation(s)
- Mpoki Ulisubisya
- Society of Anaesthesiologists of Tanzania, PO Box 65588, Dar es Salaam, Tanzania. .,Mbeya Zonal Referral Hospital, Mbeya, Tanzania.
| | - Henrik Jörnvall
- Department of Anaesthesia, Intensive Care and Surgical Services, Karolinska University Hospital, 171 76, Stockholm, Sweden.,Department of Physiology and Pharmacology, Section for Anaesthesiology and Intensive Care Medicine, Karolinska Institute, Stockholm, Sweden
| | - Lars Irestedt
- Department of Anaesthesia, Intensive Care and Surgical Services, Karolinska University Hospital, 171 76, Stockholm, Sweden.,Department of Physiology and Pharmacology, Section for Anaesthesiology and Intensive Care Medicine, Karolinska Institute, Stockholm, Sweden
| | - Tim Baker
- Department of Anaesthesia, Intensive Care and Surgical Services, Karolinska University Hospital, 171 76, Stockholm, Sweden.,Department of Physiology and Pharmacology, Section for Anaesthesiology and Intensive Care Medicine, Karolinska Institute, Stockholm, Sweden.,Global Health - Health Systems and Policy, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
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A New Approach to Teaching Obstetric Anaesthesia in Low-Resource Areas. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:880-4. [DOI: 10.1016/s1701-2163(16)30021-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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31
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We should do more to train anesthesia technicians in Africa. Can J Anaesth 2014; 62:435-6. [PMID: 25467753 DOI: 10.1007/s12630-014-0281-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022] Open
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32
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Providing quality in anesthesia care in low- and middle-income countries. Can J Anaesth 2014; 61:975-8. [DOI: 10.1007/s12630-014-0225-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 08/08/2014] [Indexed: 12/19/2022] Open
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