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January 1, 2013 Volume 77, Number 1
Evolving Expectations of Providing Anesthesia in Humanitarian Settings K. A. Kelly McQueen, M.D., M.P.H., Chair Committee on Global Humanitarian Outreach

Thomas J. Coonan, M.D.



Austere environments (post-disasters, areas of conflict and chronic humanitarian crises) are not intuitive. Even the most experienced volunteer can meet unexpected challenges in places in the world where water is limited, electricity unavailable and security is not certain. Historically, volunteers have found themselves unprepared and at personal risk of becoming a casualty or not being able to give the aid they arrived to deliver.

Increasingly, international organizations are aligning to better prepare volunteers for these difficult settings. But well before these guidelines were available, a visionary group of individuals were preparing courses and teaching anesthesiologists for providing anesthesia with limited resources, as well as educating them on personal safety and physical and mental health in these settings. Originating in Great Britain, Dr. Mike Dobson started a course specifically organized to prepare volunteers for using draw-over vaporizers.

At Oxford in 1981, Dr. Dobson, with the support of Sir Robert Macintosh, initiated a course to assist volunteer anesthetists who wished to travel to austere environments, often alone, and taking little with them. The course offered training in adaptation to unusual equipment, techniques, drugs and pathology, as well as facing the wider issues of aid, sustainability and development. In particular, delegates were afforded the opportunity to learn how to use draw-over anesthetic systems that don’t need compressed gases, electricity and, in a pinch, oxygen. They were also taught how to repair and maintain their own equipment. The original course was called “Anaesthesia for Developing Countries and Difficult Locations.” It is now “Anaesthesia for Developing Countries.” Dr. Dobson directed the course at Oxford for 25 years and moved the course to Kampala, Uganda in 2007 (as a one- week residential course) to better allow delegates to fully experience anesthesia at teaching and mission hospitals in a developing country. While Dr. Dobson remains heavily involved in the course, it is now under the direction of Dr. Hilary Edgecombe and Dr. Jeanne Frossard – and it remains immensely popular.

While training in the U.K., Dr. Haydn Perndt attended Dr. Dobson’s course at Oxford. Inspired, he initiated a similar course in Hobart, Tasmania, with Dr. George Merridew in 1999. Since 1999, there have been 20 courses, some directly targeted for the Australian Defense Force. These courses are also immensely popular and have the unique feature of allowing registrants to use draw-over anesthesia in the operating theater. While Dr. Perndt and Dr. Merridew remain very much involved in every course, the course now includes New Zealand and rotates between Darwin, Frankston and Christchurch, with Drs. Chris Bowden, Phil Blum and Wayne Morriss as co-chairs. It is now called the “Real World Anaesthesia Course.”

With the enthusiastic and constant support of Dr. Dobson, Dr.Perndt, the faculty of the Kampala Course, and the faculty of the Australia/New Zealand course, a North American Course was initiated in 2008 at Dalhousie University in Nova Scotia, Canada, under the direction of Dr. Tom Coonan. Five courses have been run, all tremendously successful, with faculty and registrants from the U.S. and Canada.

This was intended from the start to be a North American course, not allied to a single university or country. And so, with the encouragement of both ASA and the Canadian Anesthesiologists’ Society, we are launching our first course outside Canada this year, in Seattle, hosted by the University of Washington. The site director for the course is Dr. Tony Roche, and the co-directors are Dr. Roche, Dr. Gerald Dubowitz, Dr. Fay Evans and Dr. Holly Muir from the U.S.; and Dr. Alison Froese and Dr. Coonan from Canada.

Following on Great Britain’s lead, Dr. Perndt began the comprehensive and weeklong “Real World Anesthesia Course” in Australia. In the past three years, Dalhousie University has provided the “Global Outreach Course” annually. Each of these courses has been met with unbridled enthusiasm and has routinely been oversold each year.

The “American Global Outreach Course,” hosted by the University of Washington, will be offered in May 2013 and is reported to already be over-subscribed. The hope is that this the Global Outreach Course and the American Global Outreach Course will meet every other year in their respective countries. There will undoubtedly be great interest in these principles and these courses within the ASA membership. With this in mind, the Committee on Global Humanitarian Outreach is also proposing that a brief version of this course be offered as a workshop during the ASA’s annual meeting. If you have interest in these courses, please see the ASA GHO website www.asahq.org/gho.



K.A. Kelly McQueen, M.D., M.P.H. is an Associate Professor of Anesthesiology, Affiliate Faculty, Vanderbilt Institute for Global Health; Director, Vanderbilt Anesthesia Global Health and Development, Vanderbilt University and Medical Center, Nashville.

Thomas J. Coonan, M.D. is Professor, Anesthesia and Surgery, Dalhousie University – Halifax Nova Scotia, Canada.



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