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Braz LG, Braz JRC, Tiradentes TAA, Soares JVA, Corrente JE, Modolo NSP, do Nascimento Junior P, Braz MG. Global neonatal perioperative mortality: A systematic review and meta-analysis. J Clin Anesth 2024; 94:111407. [PMID: 38325248 DOI: 10.1016/j.jclinane.2024.111407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/05/2023] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
STUDY OBJECTIVE There are large differences in health care among countries. A higher perioperative mortality rate (POMR) in neonates than in older children and adults has been recognized worldwide. The aim of this study was to provide a systematic review of published 24-h and 30-day POMRs in neonates from 2011 to 2022 in countries with different Human Development Index (HDI) levels. DESIGN AND SETTING A systematic review with a meta-analysis of studies that reported 24-h and 30-day POMRs in neonates was performed. We searched the databases from January 2011 to July 30, 2022. MEASUREMENTS The POMRs (per 10,000 procedures under anesthesia) were analyzed according to country HDI. The HDI levels ranged from 0 to 1, representing the lowest and highest levels, respectively (very-high-HDI: ≥ 0.800, high-HDI: 0.700-0.799, medium-HDI: 0.550-0.699, and low-HDI: < 0.550). The magnitude of the POMRs by country HDI was studied using meta-analysis. MAIN RESULTS Eighteen studies from 45 countries were included. The 24-h (n = 96 deaths) and 30-day (n = 459 deaths) POMRs were analyzed from 33,729 anesthetic procedures. The odds ratios (ORs) of the 24-h POMR in low-HDI countries were higher than those in very-high- (OR 8.4, 95% CI 1.7-40.4; p = 0.008), high- (OR 7.3, 95% CI 2.2-24.4; p = 0.001) and medium-HDI countries (OR 7.7, 95% CI 3.1-18.7; p < 0.0001) but with no odds differences between very-high- and high-HDI countries (p = 0.879), very-high- and medium-HDI countries (p = 0.915) and high- and medium-HDI countries (p = 0.689). The odds of a 30-day POMR in low-HDI countries were higher than those in very-high-HDI countries (OR 6.9, 95% CI 1.9-24.6; p = 0.002) but not in high-HDI countries (OR 1.4, 95% CI 0.6-3.0; p = 0.396). CONCLUSIONS The review demonstrated very high global POMRs in a surgical population of neonates independent of the country HDI level. We identified differences in 24-h and 30-day POMRs between low-HDI countries and other countries with higher HDI levels.
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Affiliation(s)
- Leandro G Braz
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil.
| | - Jose Reinaldo C Braz
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Teofilo Augusto A Tiradentes
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Joao Vitor A Soares
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Jose E Corrente
- Department of Biostatistics, Institute of Biosciences, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Norma Sueli P Modolo
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Paulo do Nascimento Junior
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Mariana G Braz
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
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Tiradentes TAA, Einav S, Braz JRC, Nunes-Nogueira VS, Betini M, Corrente JE, Braz MG, Braz LG. Global anaesthesia-related cardiac arrest rates in children: a systematic review and meta-analysis. Br J Anaesth 2023; 131:901-913. [PMID: 37743151 DOI: 10.1016/j.bja.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Neonates and infants have a higher perioperative risk of cardiac arrest and mortality than adults. The Human Development Index (HDI) ranges from 0 to 1, representing the lowest and highest levels of development, respectively. The relation between anaesthesia safety and country HDI has been described previously. We examined the relationship among the anaesthesia-related cardiac arrest rate (ARCAR), country HDI, and time in a mixed paediatric patient population. METHODS Electronic databases were searched up to July 2022 for studies reporting 24-h postoperative ARCARs in children. ARCARs (per 10,000 anaesthetic procedures) were analysed in low-HDI (HDI<0.8) vs high-HDI countries (HDI≥0.8) and over time (pre-2001 vs 2001-22). The magnitude of these associations was studied using systematic review methods with meta-regression analysis and meta-analysis. RESULTS We included 38 studies with 5,493,489 anaesthetic procedures and 1001 anaesthesia-related cardiac arrests. ARCARs were inversely correlated with country HDI (P<0.0001) but were not correlated with time (P=0.82). ARCARs did not change between the periods in either high-HDI or low-HDI countries (P=0.71 and P=0.62, respectively), but were higher in low-HDI countries than in high-HDI countries (9.6 vs 2.0; P<0.0001) in 2001-22. ARCARs were higher in children aged <1 yr than in those ≥1 yr in high-HDI (10.69 vs 1.48; odds ratio [OR] 8.03, 95% confidence interval [CI] 5.96-10.81; P<0.0001) and low-HDI countries (36.02 vs 2.86; OR 7.32, 95% CI 3.48-15.39; P<0.0001) in 2001-22. CONCLUSIONS The high and alarming anaesthesia-related cardiac arrest rates among children younger than 1 yr of age in high-HDI and low-HDI countries, respectively, reflect an ongoing challenge for anaesthesiologists. SYSTEMATIC REVIEW PROTOCOL PROSPERO CRD42021229919.
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Affiliation(s)
- Teofilo Augusto A Tiradentes
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, Sao Paulo, Brazil
| | - Sharon Einav
- General Intensive Care Unit of the Shaare Zedek Medical Centre, Jerusalem, Israel; Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Jose R C Braz
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, Sao Paulo, Brazil
| | - Vania S Nunes-Nogueira
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, Sao Paulo, Brazil
| | - Marluci Betini
- Technical Division of Library and Documentation, Sao Paulo State University - UNESP, Botucatu, Sao Paulo, Brazil
| | - Jose E Corrente
- Department of Biostatistics, Institute of Biosciences, Sao Paulo State University - UNESP, Botucatu, Sao Paulo, Brazil
| | - Mariana G Braz
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, Sao Paulo, Brazil
| | - Leandro G Braz
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, Sao Paulo, Brazil.
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Chibane S, Ryan T, Nizeyimana F, Gill O, Abate A, Hamstra J, Crawford A, Barnbrook J, Bould MD. An audit of the carbon footprint of travel for the Canadian Anesthesiologists' Society International Education Foundation partnerships. Can J Anaesth 2023; 70:327-334. [PMID: 36670316 PMCID: PMC9859664 DOI: 10.1007/s12630-022-02388-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 01/21/2023] Open
Abstract
PURPOSE International partnerships have an important role in capacity building in global health, but frequently involve travel and its associated carbon footprint. The environmental impact of global health partnerships has not previously been quantified. METHODS We conducted a retrospective internal audit of the environmental impact of air travel for the international education programs of the Canadian Anesthesiology Society's International Education Fund (CASIEF). We compiled a comprehensive list of volunteer travel routes and used the International Civil Aviation Organization Carbon Emissions Calculator, which considers travel distance, passenger numbers, and average operational data for optimized estimates. Comparisons were made with average Canadian household emissions and disability adjusted life years (DALYs) lost from climate change consequences. RESULTS The total carbon dioxide emitted (CO2-e) for the Rwanda, Ethiopia, and Guyana CASIEF partnerships were 268.2, 60.7, and 52.0 tons, respectively. The DALYs cost of these programs combined is estimated to be as high as 1.1 years of life lost due to the effects of CO2-e. The mean daily carbon cost of the average Rwanda partnership was equivalent to daily emissions of 2.2 Canadians (or 383 Rwandans), for the Guyana partnership was equivalent to 1.6 Canadians (or 7.6 Guyanese people), and for the Ethiopia partnership was equivalent to 2.4 Canadians (or 252 Ethiopian people). CONCLUSIONS Air travel from these CASIEF partnerships resulted in 380.9 tons CO2-e but also enabled 5,601 volunteer days-in-country since 2014. The estimated environmental cost needs to be balanced against the impact of the programs. Regardless, carbon-reduction remains a priority, whether by discouraging premium class travel, organizing longer trips to reduce daily emissions, prioritizing remote support and virtual education, or developing partnerships closer to home.
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Affiliation(s)
- Sarah Chibane
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Talia Ryan
- Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Francoise Nizeyimana
- Department of Anesthesiology and Critical Care, University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda
| | - Onica Gill
- Department of Anaesthesia and Intensive Care, Georgetown Public Hospital Corporation, Georgetown, Guyana
| | - Ananya Abate
- Department of Anesthesiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Joel Hamstra
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Ana Crawford
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA
| | - Julian Barnbrook
- Department of Anesthesiology, University Hospital of Northern British Columbia, Prince George, BC, Canada
| | - M Dylan Bould
- Department of Anesthesiology and Pain Medicine, The Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
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Dohlman LE, Thakkar N, Jivanelli B, Pakala S, Brouillette MA. Regional anesthesia global health collaborations- a scoping review of current intervention methods. Curr Opin Anaesthesiol 2022; 35:647-653. [PMID: 35942724 DOI: 10.1097/aco.0000000000001178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW Perioperative anesthesia-related mortality is significantly higher in low-resource compared to high-resource countries. Regional anesthesia techniques can provide safety, cost, and access benefits when compared to general anesthesia in these settings but is underutilized primarily due to a lack of experienced educators and training opportunities. Academic institutions and international organizations are attempting to fill this educational gap through collaborations, but these efforts need examination for best practices going forward. RECENT FINDINGS Most collaborative anesthesia interactions between high and low resource areas have occurred between North America or Europe, and Africa or Asia and a majority have involved an educational intervention. Only 7% of the studies used a recognized framework to evaluate the intervention used in their research, such as the Kirkpatrick, REAIM or CFIR method. All recent studies reviewed reported a positive impact from educational collaborations. Only 7% of interventions have had a primary focus on regional anesthesia and most were reported between 2016 and 2022. SUMMARY Robust reports on international collaborations providing capacity enhancing educational interventions in regional anesthesia have increased in recent years but are still rare and should be encouraged going forward. Short courses supported by high-resource countries can be effective in low-resource areas when partnerships produce curricula that are well designed.
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Affiliation(s)
- Lena E Dohlman
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Niharika Thakkar
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery
| | - Bridget Jivanelli
- Kim Barrett Memorial Library, HSS Education Institute, Hospital for Special Surgery
| | - Swetha Pakala
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery.,Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Mark A Brouillette
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery.,Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
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Holmaas G, Abate A, Woldetsadik A, Hevrøy O. Establishing a sustainable training programme in anaesthesia in Ethiopia. Acta Anaesthesiol Scand 2022; 66:1016-1023. [PMID: 35749233 PMCID: PMC9541354 DOI: 10.1111/aas.14106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
Abstract
Background Lack of qualified staff is a major hindrance for quality and safety improvements in anaesthesia and critical care in many low‐income countries. Support in specialist training may enhance perioperative treatment and have a positive downstream impact on other hospital services, which may improve the overall standard of care. Methods Between 2011 and 2019, consultant anaesthetists from Haukeland University Hospital in Norway supported a postgraduate anaesthesia‐training programme at Addis Ababa University/Tikur Anbessa Specialised Hospital in Ethiopia. The aim of the programme was to build a self‐sustainable work force of anaesthetists across the country who could perform high quality anaesthesia within the confinement of limited local resources. Over the course of 10 years, an almost continuous rotation of experienced anaesthetists and intensivists assisted training of Ethiopian residents in anaesthesia and critical care. Local specialists organised the programme; however, external support was necessary during this period to establish a sustainable training programme. Results Since the programme's commencement at Addis Ababa University in 2011, 159 residents have entered the programme and 71 have graduated. As the number of qualified anaesthetists increased, Ethiopian specialists gradually obtained responsibility for the programme. Candidates are recruited from various regions and from neighbouring countries. Five other Ethiopian training sites have been established. To date (May 2022), 112 residents have completed their training in Ethiopia, and 195 residents expect to graduate within 3 years. Conclusion Nearly 11 years after establishment of the programme, locally trained highly qualified anaesthetists work in Ethiopia's major hospitals throughout the country.
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Affiliation(s)
- Gunhild Holmaas
- Department of Surgical Services, Haukeland University Hospital, Bergen, Norway
| | - Ananya Abate
- Department of Anesthesiology, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | | | - Olav Hevrøy
- Department of Surgical Services, Haukeland University Hospital, Bergen, Norway
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Skelton T, Irakoze A, Bould MD, Przybylak-Brouillard A, Twagirumugabe T, Livingston P. Retention and Migration of Rwandan Anesthesiologists: A Qualitative Study. Anesth Analg 2020; 131:605-612. [PMID: 32304459 DOI: 10.1213/ane.0000000000004794] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Health care professional migration continues to challenge countries where the lack of surgical and anesthesia specialists results in being unable to address the global burden of surgical disease in their populations. Medical migration is particularly damaging to health care systems that are just beginning to scale up capacity building of human resources for health. Anesthesiologists are scarce in low-resource settings. Defining reasons why anesthesiologists leave their country of training through in-depth interviews may provide guidance to policy makers and academic organizations on how to retain valuable health professionals. METHODS There were 24 anesthesiologists eligible to participate in this qualitative interview study, 15 of whom are currently practicing in Rwanda and 9 had left the country. From the eligible group, interviews were conducted with 13 currently practicing in Rwanda and 2 who had left to practice elsewhere. In-depth interviews of approximately 60 minutes were used to define themes influencing retention and migration among anesthesiologists in Rwanda. Interviews were conducted using a semistructured guide and continued until theoretical sufficiency was reached. Thematic analysis was done by 4 members of the research team using open coding to inductively identify themes. RESULTS Interpretation of results used the framework categorizing themes into push, pull, stick, and stay to describe factors that influence migration, or the potential for migration, of anesthesiologists in Rwanda. While adequate salary is essential to retention of anesthesiologists in Rwanda, other factors such as lack of equipment and medication for safe anesthesia, isolation, and demoralization are strong push factors. Conversely, a rich academic life and optimism for the future encourage anesthesiologists to stay. CONCLUSIONS Our study suggests that better clinical resources and equipment, a more supportive community of practice, and advocacy by mentors and academic partners could encourage more staff anesthesiologists to stay and work in Rwanda.
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Affiliation(s)
- Teresa Skelton
- From the Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alain Irakoze
- Department of Anesthesiology, Critical Care and Emergency Medicine, University of Rwanda, Huye (Butare), Rwanda
| | - M Dylan Bould
- Department of Anesthesiology and Pain Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Theogene Twagirumugabe
- Department of Anesthesiology, Critical Care and Emergency Medicine, University of Rwanda, Huye (Butare), Rwanda
| | - Patricia Livingston
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Tuyishime E, Durieux M, Banguti PR. The Rwanda Anesthesia Residency Program: A Model for GME in Low- and Middle-Income Countries. J Grad Med Educ 2019; 11:20-21. [PMID: 31428255 PMCID: PMC6697291 DOI: 10.4300/jgme-d-18-01031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Talib Z. Postgraduate Medical Education in Sub-Saharan Africa: A Scoping Review Spanning 26 Years and Lessons Learned. J Grad Med Educ 2019; 11:34-46. [PMID: 31428258 PMCID: PMC6697307 DOI: 10.4300/jgme-d-19-00170] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/30/2019] [Accepted: 06/04/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Investments in training physician specialists through postgraduate medical education (PGME) are critical for Sub-Saharan Africa, given the increasing burden of non-communicable diseases. OBJECTIVES The objectives of this scoping review were to (1) understand the breadth of publications on PGME from Sub-Saharan Africa, and (2) conduct a thematic analysis of lessons learned by specific training programs. METHODS We conducted a literature search of 7 databases for PGME literature published between January 1991 and December 2016. Two reviewers independently reviewed titles and abstracts for inclusion. Full-text articles were then reviewed, and bibliometric data were extracted to create a profile of PGME-related publications. Two authors coded the manuscripts to identify articles written about specific PGME programs. These were analyzed for lessons learned. RESULTS We identified 813 publications that reported on postgraduate medical education in Sub-Saharan Africa. Most articles were published between 2005 and 2016. Nations leading in publication were South Africa and Nigeria, followed by Ethiopia, Uganda, Kenya, Ghana, and Malawi. The largest number of articles related to general surgery training, followed by family medicine, emergency medicine, and anesthesiology. Thematic analysis revealed advantages of training programs for health facilities, challenges related to teaching, resourcing, and standardizing of training, and lessons learned related to international partnerships, faculty engagement, and research support for trainees. CONCLUSIONS PGME in Sub-Saharan Africa has evolved over the past 26 years. Future growth will require strategic support to scale programs, support new specialties, trainees, and teachers, and leverage best practice models to sustain PGME programs.
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Kudsk-Iversen S, Shamambo N, Bould MD. Strengthening the Anesthesia Workforce in Low- and Middle-Income Countries. Anesth Analg 2018; 126:1291-1297. [DOI: 10.1213/ane.0000000000002722] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Skelton T, Nshimyumuremyi I, Mukwesi C, Whynot S, Zolpys L, Livingston P. Low-Cost Simulation to Teach Anesthetists' Non-Technical Skills in Rwanda. Anesth Analg 2017; 123:474-80. [PMID: 27331783 DOI: 10.1213/ane.0000000000001434] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Safe anesthesia care is challenging in developing countries where there are shortages of personnel, drugs, equipment, and training. Anesthetists' Non-technical Skills (ANTS)-task management, team working, situation awareness, and decision making-are difficult to practice well in this context. Cesarean delivery is the most common surgical procedure in sub-Saharan Africa. This pilot study investigates whether a low-cost simulation model, with good psychological fidelity, can be used effectively to teach ANTS during cesarean delivery in Rwanda. METHODS Study participants were anesthesia providers working in a tertiary referral hospital in Rwanda. Baseline observations were conducted for 20 anesthesia providers during cesarean delivery using the established ANTS framework. After the first observation set was complete, participants were randomly assigned to either simulation intervention or control groups. The simulation intervention group underwent ANTS training using low-cost high psychological fidelity simulation with debriefing. No training was offered to the control group. Postintervention observations were then conducted in the same manner as the baseline observations. RESULTS The primary outcome was the overall ANTS score (maximum, 16). The median (range) ANTS score of the simulation group was 13.5 (11-16). The ANTS score of the control group was 8 (8-9), with a statistically significant difference (P = .002). Simulation participants showed statistically significant improvement in subcategories and in the overall ANTS score compared with ANTS score before simulation exposure. CONCLUSIONS Rwandan anesthesia providers show improvement in ANTS practice during cesarean delivery after 1 teaching session using a low-cost high psychological fidelity simulation model with debriefing.
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Affiliation(s)
- Teresa Skelton
- From the *Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada; †Department of Anesthesia and Intensive Care, University of Rwanda, Huye (Butare), Rwanda; ‡Department of Anesthesia, Rwanda Military Hospital, Kigali, Rwanda; and §Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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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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Chan DM, Wong R, Runnels S, Muhizi E, McClain CD. Factors Influencing the Choice of Anesthesia as a Career by Undergraduates of the University of Rwanda. Anesth Analg 2016; 123:481-7. [DOI: 10.1213/ane.0000000000001433] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ntakiyiruta G, Wong EG, Rousseau MC, Ruhungande L, Kushner AL, Liberman AS, Khwaja K, Dakermandji M, Wilson M, Razek T, Kyamanywa P, Deckelbaum DL. Trauma care and referral patterns in Rwanda: implications for trauma system development. Can J Surg 2016; 59:35-41. [PMID: 26812407 DOI: 10.1503/cjs.008115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Trauma remains a leading cause of death worldwide. The development of trauma systems in low-resource settings may be of benefit. The objective of this study was to describe operative procedures performed for trauma at a tertiary care facility in Kigali, Rwanda, and to evaluate geographical variations and referral patterns of trauma care. METHODS We retrospectively reviewed all prospectively collected operative cases performed at the largest referral hospital in Rwanda, the Centre Hospitalier Universitaire de Kigali (CHUK), between June 1 and Dec. 1, 2011, for injury-related diagnoses. We used the Pearson χ² and Fisher exact tests to compare cases arising from within Kigali to those transferred from other provinces. Geospatial analyses were also performed to further elucidate transfer patterns. RESULTS Over the 6-month study period, 2758 surgical interventions were performed at the CHUK. Of these, 653 (23.7%) were for trauma. Most patients resided outside of Kigali city, with 337 (58.0%) patients transferred from other provinces and 244 (42.0%) from within Kigali. Most trauma procedures were orthopedic (489 [84.2%]), although general surgery procedures represented a higher proportion of trauma surgeries in patients from other provinces than in patients from within Kigali (28 of 337 [8.3%] v. 10 of 244 [4.1%]). CONCLUSION To our knowledge, this is the first study to highlight geographical variations in access to trauma care in a low-income country and the first description of trauma procedures at a referral centre in Rwanda. Future efforts should focus on maturing prehospital and interfacility transport systems, strengthening district hospitals and further supporting referral institutions.
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Affiliation(s)
- Georges Ntakiyiruta
- From the Department of Surgery, University of Rwanda, Kigali, Rwanda (Ntakiyiruta, Ruhungande, Kyamanywa); the Department of Surgery, McGill University, Montreal, Que. (Wong, Rousseau, Liberman, Khwaja, Dakermandji, Wilson, Razek, Deckelbaum); the Centre for Global Surgery, McGill University Health Centre, Montreal, Que. (Wong, Rousseau, Razek, Deckelbaum); the Surgeons Overseas, New York, NY (Wong, Kushner); the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Kushner); and the Department of Surgery, Columbia University, New York, NY (Kushner)
| | - Evan G Wong
- From the Department of Surgery, University of Rwanda, Kigali, Rwanda (Ntakiyiruta, Ruhungande, Kyamanywa); the Department of Surgery, McGill University, Montreal, Que. (Wong, Rousseau, Liberman, Khwaja, Dakermandji, Wilson, Razek, Deckelbaum); the Centre for Global Surgery, McGill University Health Centre, Montreal, Que. (Wong, Rousseau, Razek, Deckelbaum); the Surgeons Overseas, New York, NY (Wong, Kushner); the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Kushner); and the Department of Surgery, Columbia University, New York, NY (Kushner)
| | - Mathieu C Rousseau
- From the Department of Surgery, University of Rwanda, Kigali, Rwanda (Ntakiyiruta, Ruhungande, Kyamanywa); the Department of Surgery, McGill University, Montreal, Que. (Wong, Rousseau, Liberman, Khwaja, Dakermandji, Wilson, Razek, Deckelbaum); the Centre for Global Surgery, McGill University Health Centre, Montreal, Que. (Wong, Rousseau, Razek, Deckelbaum); the Surgeons Overseas, New York, NY (Wong, Kushner); the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Kushner); and the Department of Surgery, Columbia University, New York, NY (Kushner)
| | - Landouald Ruhungande
- From the Department of Surgery, University of Rwanda, Kigali, Rwanda (Ntakiyiruta, Ruhungande, Kyamanywa); the Department of Surgery, McGill University, Montreal, Que. (Wong, Rousseau, Liberman, Khwaja, Dakermandji, Wilson, Razek, Deckelbaum); the Centre for Global Surgery, McGill University Health Centre, Montreal, Que. (Wong, Rousseau, Razek, Deckelbaum); the Surgeons Overseas, New York, NY (Wong, Kushner); the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Kushner); and the Department of Surgery, Columbia University, New York, NY (Kushner)
| | - Adam L Kushner
- From the Department of Surgery, University of Rwanda, Kigali, Rwanda (Ntakiyiruta, Ruhungande, Kyamanywa); the Department of Surgery, McGill University, Montreal, Que. (Wong, Rousseau, Liberman, Khwaja, Dakermandji, Wilson, Razek, Deckelbaum); the Centre for Global Surgery, McGill University Health Centre, Montreal, Que. (Wong, Rousseau, Razek, Deckelbaum); the Surgeons Overseas, New York, NY (Wong, Kushner); the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Kushner); and the Department of Surgery, Columbia University, New York, NY (Kushner)
| | - Alexander S Liberman
- From the Department of Surgery, University of Rwanda, Kigali, Rwanda (Ntakiyiruta, Ruhungande, Kyamanywa); the Department of Surgery, McGill University, Montreal, Que. (Wong, Rousseau, Liberman, Khwaja, Dakermandji, Wilson, Razek, Deckelbaum); the Centre for Global Surgery, McGill University Health Centre, Montreal, Que. (Wong, Rousseau, Razek, Deckelbaum); the Surgeons Overseas, New York, NY (Wong, Kushner); the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Kushner); and the Department of Surgery, Columbia University, New York, NY (Kushner)
| | - Kosar Khwaja
- From the Department of Surgery, University of Rwanda, Kigali, Rwanda (Ntakiyiruta, Ruhungande, Kyamanywa); the Department of Surgery, McGill University, Montreal, Que. (Wong, Rousseau, Liberman, Khwaja, Dakermandji, Wilson, Razek, Deckelbaum); the Centre for Global Surgery, McGill University Health Centre, Montreal, Que. (Wong, Rousseau, Razek, Deckelbaum); the Surgeons Overseas, New York, NY (Wong, Kushner); the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Kushner); and the Department of Surgery, Columbia University, New York, NY (Kushner)
| | - Marc Dakermandji
- From the Department of Surgery, University of Rwanda, Kigali, Rwanda (Ntakiyiruta, Ruhungande, Kyamanywa); the Department of Surgery, McGill University, Montreal, Que. (Wong, Rousseau, Liberman, Khwaja, Dakermandji, Wilson, Razek, Deckelbaum); the Centre for Global Surgery, McGill University Health Centre, Montreal, Que. (Wong, Rousseau, Razek, Deckelbaum); the Surgeons Overseas, New York, NY (Wong, Kushner); the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Kushner); and the Department of Surgery, Columbia University, New York, NY (Kushner)
| | - Marnie Wilson
- From the Department of Surgery, University of Rwanda, Kigali, Rwanda (Ntakiyiruta, Ruhungande, Kyamanywa); the Department of Surgery, McGill University, Montreal, Que. (Wong, Rousseau, Liberman, Khwaja, Dakermandji, Wilson, Razek, Deckelbaum); the Centre for Global Surgery, McGill University Health Centre, Montreal, Que. (Wong, Rousseau, Razek, Deckelbaum); the Surgeons Overseas, New York, NY (Wong, Kushner); the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Kushner); and the Department of Surgery, Columbia University, New York, NY (Kushner)
| | - Tarek Razek
- From the Department of Surgery, University of Rwanda, Kigali, Rwanda (Ntakiyiruta, Ruhungande, Kyamanywa); the Department of Surgery, McGill University, Montreal, Que. (Wong, Rousseau, Liberman, Khwaja, Dakermandji, Wilson, Razek, Deckelbaum); the Centre for Global Surgery, McGill University Health Centre, Montreal, Que. (Wong, Rousseau, Razek, Deckelbaum); the Surgeons Overseas, New York, NY (Wong, Kushner); the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Kushner); and the Department of Surgery, Columbia University, New York, NY (Kushner)
| | - Patrick Kyamanywa
- From the Department of Surgery, University of Rwanda, Kigali, Rwanda (Ntakiyiruta, Ruhungande, Kyamanywa); the Department of Surgery, McGill University, Montreal, Que. (Wong, Rousseau, Liberman, Khwaja, Dakermandji, Wilson, Razek, Deckelbaum); the Centre for Global Surgery, McGill University Health Centre, Montreal, Que. (Wong, Rousseau, Razek, Deckelbaum); the Surgeons Overseas, New York, NY (Wong, Kushner); the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Kushner); and the Department of Surgery, Columbia University, New York, NY (Kushner)
| | - Dan L Deckelbaum
- From the Department of Surgery, University of Rwanda, Kigali, Rwanda (Ntakiyiruta, Ruhungande, Kyamanywa); the Department of Surgery, McGill University, Montreal, Que. (Wong, Rousseau, Liberman, Khwaja, Dakermandji, Wilson, Razek, Deckelbaum); the Centre for Global Surgery, McGill University Health Centre, Montreal, Que. (Wong, Rousseau, Razek, Deckelbaum); the Surgeons Overseas, New York, NY (Wong, Kushner); the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Kushner); and the Department of Surgery, Columbia University, New York, NY (Kushner)
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Yassi A, Zungu M, Spiegel JM, Kistnasamy B, Lockhart K, Jones D, O’Hara LM, Nophale L, Bryce EA, Darwin L. Protecting health workers from infectious disease transmission: an exploration of a Canadian-South African partnership of partnerships. Global Health 2016; 12:10. [PMID: 27036516 PMCID: PMC4818531 DOI: 10.1186/s12992-016-0145-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 03/09/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Health workers are at high risk of acquiring infectious diseases at work, especially in low and middle-income countries (LMIC) with critical health human resource deficiencies and limited implementation of occupational health and infection control measures. Amidst increasing interest in international partnerships to address such issues, how best to develop such collaborations is being actively debated. In 2006, a partnership developed between occupational health and infection control experts in Canada and institutions in South Africa (including an institute with a national mandate to conduct research and provide guidance to protect health workers from infectious diseases and promote improved working conditions). This article describes the collaboration, analyzes the determinants of success and shares lessons learned. METHODS Synthesizing participant-observer experience from over 9 years of collaboration and 10 studies already published from this work, we applied a realist review analysis to describe the various achievements at global, national, provincial and hospital levels. Expectations of the various parties on developing new insights, providing training, and addressing service needs were examined through a micro-meso-macro lens, focusing on how each main partner organization contributed to and benefitted from working together. RESULTS A state-of-the-art occupational health and safety surveillance program was established in South Africa following successful technology transfer from a similar undertaking in Canada and training was conducted that synergistically benefitted Northern as well as Southern trainees. Integrated policies combining infection control and occupational health to prevent and control infectious disease transmission among health workers were also launched. Having a national (South-South) network reinforced by the international (North-south) partnership was pivotal in mitigating the challenges that emerged. CONCLUSIONS High-income country partnerships with experience in health system strengthening - particularly in much needed areas such as occupational health and infection control - can effectively work through strong collaborators in the Global South to build capacity. Partnerships are particularly well positioned to sustainably reinforce efforts at national and sub-national LMIC levels when they adopt a "communities of practice" model, characterized by multi-directional learning. The principles of effective collaboration learned in this "partnership of partnerships" to improve working conditions for health workers can be applied to other areas where health system strengthening is needed.
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Affiliation(s)
- Annalee Yassi
- />Global Health Research Program (GHRP), The University of British Columbia (UBC), Rm. 430, 2206 East Mall, V6T 1Z3 Vancouver, BC Canada
| | - Muzimkhulu Zungu
- />National Institute for Occupational Health (NIOH), a division of National Health Laboratory Service (NHLS), Johannesburg, South Africa
- />University of Pretoria, School of Health Systems and Public Health, Pretoria, South Africa
| | - Jerry M. Spiegel
- />Global Health Research Program (GHRP), The University of British Columbia (UBC), Rm. 430, 2206 East Mall, V6T 1Z3 Vancouver, BC Canada
| | - Barry Kistnasamy
- />Department of Health, Compensation Commissioner, Johannesburg, South Africa
| | - Karen Lockhart
- />Global Health Research Program (GHRP), The University of British Columbia (UBC), Rm. 430, 2206 East Mall, V6T 1Z3 Vancouver, BC Canada
| | - David Jones
- />National Institute for Occupational Health (NIOH), a division of National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - Lyndsay M. O’Hara
- />Global Health Research Program (GHRP), The University of British Columbia (UBC), Rm. 430, 2206 East Mall, V6T 1Z3 Vancouver, BC Canada
| | - Letshego Nophale
- />Provincial Occupational Health Unit and Centre for Health Systems Research & Development, University of the Free State (UFS), Bloemfontein, South Africa
| | - Elizabeth A. Bryce
- />Vancouver General Hospital (VGH), Vancouver Coastal Health, Vancouver, BC Canada
| | - Lincoln Darwin
- />National Institute for Occupational Health (NIOH), a division of National Health Laboratory Service (NHLS), Johannesburg, South Africa
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Dumbarton TC, Bould MD. Thinking globally, training locally. Can J Anaesth 2016; 63:652-7. [PMID: 27030129 DOI: 10.1007/s12630-016-0630-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 02/12/2016] [Accepted: 03/11/2016] [Indexed: 10/22/2022] Open
Affiliation(s)
- Tristan C Dumbarton
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Dalhousie University, Halifax, NS, Canada
| | - M Dylan Bould
- Department of Pediatric Anesthesia, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada.
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Johnson AP, Mahaffey R, Egan R, Twagirumugabe T, Parlow JL. Perspectives, perceptions and experiences in postoperative pain management in developing countries: A focus group study conducted in Rwanda. Pain Res Manag 2015; 20:255-60. [PMID: 26448971 PMCID: PMC4596633 DOI: 10.1155/2015/297384] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Access to postoperative acute pain treatment is an important component of perioperative care and is frequently managed by a multidisciplinary team of anesthesiologists, surgeons, pharmacists, technicians and nurses. In some developing countries, treatment modalities are often not performed due to scarce health care resources, knowledge deficiencies and cultural attitudes. OBJECTIVES In advance of a comprehensive knowledge translation initiative, the present study aimed to determine the perspectives, perceptions and experiences of anesthesia residents regarding postoperative pain management strategies. METHODS The present study was conducted using a qualitative assessment strategy in a large teaching hospital in Rwanda. During two sessions separated by seven days, a 10-participant semistructured focus group needs analysis was conducted with anesthesia residents at the Centre Hospitalier Universitaire de Kigali (Kigali, Rwanda). Field notes were analyzed using interpretative and descriptive phenomenological approaches. Participants were questioned regarding their perspectives, perceptions and experiences in pain management. RESULTS The responses from the focus groups were related to five general areas: general patient and medical practice management; knowledge base regarding postoperative pain management; pain evaluation; institutional/system issues related to protocol implementation; and perceptions about resource allocation. Within these areas, challenges (eg, communication among stakeholders and with patients) and opportunities (eg, on-the-job training, use of protocols, routine pain assessment, participation in resource allocation decisions) were identified. CONCLUSIONS The present study revealed the prevalent challenges residents perceive in implementing postoperative pain management strategies, and offers practical suggestions to overcoming them, primarily through training and the implementation of practice recommendations.
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Affiliation(s)
- Ana P Johnson
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario
| | - Ryan Mahaffey
- Department of Anesthesiology and Perioperative Medicine, Queen’s University, Kingston, Ontario
| | - Rylan Egan
- Centre for Teaching and Learning, Queen’s University, Kingston, Ontario
| | - Theogene Twagirumugabe
- Department of Anesthesiology, Critical Care and Emergencies, University of Rwanda, Butare, Rwanda
| | - Joel L Parlow
- Department of Anesthesiology and Perioperative Medicine, Queen’s University, Kingston, Ontario
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McQueen K, Coonan T, Ottaway A, Hendel S, Bagutifils PR, Froese A, Neighbor R, Perndt H. The Bare Minimum: The Reality of Global Anaesthesia and Patient Safety. World J Surg 2015; 39:2153-60. [DOI: 10.1007/s00268-015-3101-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Faculty experiences regarding a global partnership for anesthesia postgraduate training: a qualitative study. Can J Anaesth 2014; 62:11-21. [DOI: 10.1007/s12630-014-0252-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/14/2014] [Indexed: 10/24/2022] Open
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Livingston P, Zolpys L, Mukwesi C, Twagirumugabe T, Whynot S, MacLeod A. Non-technical skills of anaesthesia providers in Rwanda: an ethnography. Pan Afr Med J 2014; 19:97. [PMID: 25722770 PMCID: PMC4337347 DOI: 10.11604/pamj.2014.19.97.5205] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 08/20/2014] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Patient safety depends on excellent practice of anaesthetists' non-technical skills (ANTS). The ANTS framework has been validated in developed countries but there is no literature on the practice of ANTS in low-income countries. This study examines ANTS in this unexplored context. METHODS This qualitative ethnographic study used observations of Rwandan anaesthesia providers and in-depth interviews with both North American and Rwandan anaesthesia providers to understand practice of ANTS in Rwanda. RESULTS Communication is central to the practice of ANTS. Cultural factors in Rwanda, such as lack of assertiveness and discomfort taking leadership, and the strains of working in a resource-limited environment hinder the unfettered and focused communication needed for excellent anaesthesia practice. CONCLUSION Despite the challenges, anaesthesia providers are able to coordinate activities when good communication is actively encouraged. Future teaching interventions should address leadership and communication skills through encouraging both role definition and speaking up for patient safety.
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Affiliation(s)
- Patricia Livingston
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lauren Zolpys
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christian Mukwesi
- Department of Anaesthesia and Intensive Care Medicine, University of Rwanda, Huye Campus, Butare, Rwanda
| | - Theogene Twagirumugabe
- Department of Anaesthesia and Intensive Care Medicine, University of Rwanda, Huye Campus, Butare, Rwanda
| | - Sara Whynot
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anna MacLeod
- Division of Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
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Livingston P, Evans F, Nsereko E, Nyirigira G, Ruhato P, Sargeant J, Chipp M, Enright A. Safer obstetric anesthesia through education and mentorship: a model for knowledge translation in Rwanda. Can J Anaesth 2014; 61:1028-39. [DOI: 10.1007/s12630-014-0224-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/08/2014] [Indexed: 11/30/2022] Open
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Livingston P, Bailey J, Ntakiyiruta G, Mukwesi C, Whynot S, Brindley P. Development of a simulation and skills centre in East Africa: a Rwandan-Canadian partnership. Pan Afr Med J 2014; 17:315. [PMID: 25328611 PMCID: PMC4198314 DOI: 10.11604/pamj.2014.17.315.4211] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 04/10/2014] [Indexed: 11/11/2022] Open
Abstract
Simulation replicates clinical experiences without patient risk; it remains uncommon in lower-income countries. We outline the creation of Rwanda's first centre for simulation and skills training. We secured funding for renovations, equipment and staff; curricula were developed, tested, and refined; local clinicians were trained to teach. In 13 months the centre provided 2,377 learning-encounters and 822 hours of training to Rwandan health care professionals. Our strategy represents an adaptable model for simulation and skills centre development in low-resources settings
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Affiliation(s)
- Patricia Livingston
- Dalhousie University, Department of Anesthesia, Pain Management and Perioperative Medicine, Halifax, Nova Scotia, Canada
| | - Jonathan Bailey
- Dalhousie University, Department of Surgery, Halifax, Nova Scotia, Canada
| | | | - Christian Mukwesi
- University of Rwanda, Department of Anesthesia and Intensive Care, Kigali, Rwanda
| | - Sara Whynot
- Dalhousie University, Department of Anesthesia, Pain Management and Perioperative Medicine, Halifax, Nova Scotia, Canada
| | - Peter Brindley
- University of Alberta, Critical Care Medicine, Edmonton, Alberta, Canada
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A new partnership for anesthesia training in Zambia: reflections on the first year. Can J Anaesth 2013; 60:484-91. [DOI: 10.1007/s12630-013-9905-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 01/31/2013] [Indexed: 11/26/2022] Open
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Developing a curriculum for anaesthesia training in low- and middle-income countries. Best Pract Res Clin Anaesthesiol 2012; 26:17-21. [DOI: 10.1016/j.bpa.2012.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 02/01/2012] [Indexed: 11/17/2022]
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Abstract
BACKGROUND In low-income countries, unmet surgical needs lead to a high incidence of death. Information on the incidence and safety of current surgical care in low-income countries is limited by the paucity of data in the literature. The aim of this survey was to assess the surgical and anesthesia infrastructure in Rwanda as part of a larger study examining surgical and anesthesia capacity in low-income African countries. METHODS A comprehensive survey tool was developed to assess the physical infrastructure of operative facilities, education and training for surgical and anesthesia providers, and equipment and medications at district-level hospitals in sub-Saharan Africa. The survey was administered at 21 district hospitals in Rwanda using convenience sampling. RESULTS There are only nine Rwandan anesthesiologists and 17 Rwandan surgeons providing surgical care for a population of more than 10 million. The specialty-trained Rwandan surgeons and anesthesiologists are practicing almost exclusively at referral hospitals, leaving surgical care at district hospitals to the general practice physicians and nurses. All of the district hospitals reported some lack of surgical infrastructure including limited access to oxygen, anesthesia equipment and medications, monitoring equipment, and trained personnel. CONCLUSIONS This survey provides strong evidence of the need for continued development of emergency and essential surgical services at district hospitals in Rwanda to improve health care and to comply with World Health Organization recommendations. It has identified serious deficiencies in both financial and human resources-areas where the international community can play a role.
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Colmegna I, Bartlett SJ, Oyoo OG. The ILAR-East Africa initiative: current needs and progress in the globalization of rheumatology. Clin Rheumatol 2010; 30:251-3. [PMID: 20945075 DOI: 10.1007/s10067-010-1594-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 09/29/2010] [Indexed: 10/19/2022]
Abstract
In early 2009, the International League of Associations for Rheumatology (ILAR) funded a program known as the "East Africa Initiative." The long-term goal of this program is to unite the international rheumatology community to aid in enhancing clinical rheumatology services in an area that carries 25% of the world's disease burden but has only 2% of the world's human resources for health. This paper provides an overview of the rationale and progress to date of this collaborative effort toward the globalization of rheumatology.
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Affiliation(s)
- Inés Colmegna
- McGill University, Division of Rheumatology, Royal Victoria Hospital, 687 Pine Avenue W, M11-32, Montreal, QC, H3A 1A1, Canada.
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