The Overseas Teaching Program (OTP) functions in an idealistic yet realistic and economical manner. Central to these ideals is the mandate to promote self-reliance through on-site teaching assistance implicit in the premise "Give a man a fish, and you feed him for a day; teach him to fish, and you feed him for a lifetime." Other fundamental strengths in the design of the OTP acknowledge the goals of ASA -- the long-term needs of training locations in select developing countries and the capability of a wide spectrum of teaching volunteers. Recent changes in leadership personnel and policy at program sites have led to the delineation of goals and requirements as set forth in a Statement of Agreement. Regular review and confirmation of this agreement reiterates the foundations for ASA's commitment toward effective overseas teaching support.

The circumstances in Zambia changed abruptly in late 1993, when it became apparent that the anesthesia program at University Teaching Hospital (UTH) in Lusaka, Zambia, would lose much of its expatriate support, including the acting head of the training program, early in 1994. The OTP attempted to facilitate immediate efforts to recruit a capable indigenous anesthesia leader as a replacement and encouraged the establishment of an independent department of anesthesia. However, from April 1994 until June 1995, OTP volunteers essentially provided the only didactic teaching of anesthesia to both medical and paramedical students in the department of surgery. This was disquieting for most OTP volunteers and was incompatible with the original OTP understanding to assist but not take over the teaching of anesthesia.

Persistent lack of formal leadership essentially led to the disruption of the anesthesia training program with deterioration of practice standards. Despite repeated encouragement by the OTP to recruit long-term indigenous leadership at UTH, it became necessary to institute probationary status. OTP volunteers were withheld from June 1995 through December 1995, pending definitive action toward securing a permanent leader in an independent anesthesia department.

After extensive site re-evaluation and attempts at assisting recruitment this year, the OTP decided to terminate its teaching support at UTH because of the failure to comply with conditions that had been established in 1991. It was felt that extending the probationary period beyond two years would be contrary to the best interests of the Zambians and the OTP. Further consideration toward involvement of the OTP in anesthesia training in Zambia will depend on implementation of the pivotal responsibilities described in the Statement of Agreement.

In five years, the OTP has made substantial contributions to anesthesia teaching in Zambia. From February 1991 until March 1996, 29 OTP volunteers provided between one and seven months assistance in training efforts at UTH. Their teaching example positively influenced the anesthesia education of two postgraduate trainees, more than 50 clinical officer students and approximately 100 medical students. OTP volunteers also participated in three international anesthesia meetings held in Zambia during this time. The beneficial legacy of the OTP will undoubtedly be recognized well into the future by Zambians and most OTP participants.

The OTP has been supporting the anesthesia teaching efforts at Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania, since 1992. (View illustration.) Unlike the situation in Zambia, two Tanzanians assumed the responsibility for heading the new independent department and school (Institute of Anaesthesia Training and Research) after the expatriate leader stepped aside in 1993. Other variables, however, could potentially influence the future involvement of the OTP at KCMC. The ongoing policy changes at the Ministry of Health might lengthen anesthesia officer student educational prerequisites from medical assistant to assistant medical officer. The ramifications of this decision could impact the timing of student matriculation and the composition of future classes.

It must be emphasized that the OTP continues to be deeply appreciated by the Tanzanian students and staff and that its support is felt to be most advantageous during these times of growth. Therefore, continuity of OTP involvement at this program site remains critical in these times as long as structural and leadership changes are made in the best interest of training.

Continued subjective progress at KCMC is reported by returning OTP volunteers, who generally rated their overall experience in 1995 as "good to excellent." Previously reported teaching dependency on OTP volunteers has decreased this year for the first time because of the participation of an additional visiting Tanzanian staff member. Additionally, experienced OTP volunteers corroborate better student aptitudes at KCMC compared to students at similar training centers not supported by the OTP. The OTP remains optimistic, flexible and responsive throughout the evolution of this training program toward autonomy.

The OTP is committed to "help them help themselves..." through utilizing ASA volunteers from diverse backgrounds as teaching support for programs in select developing countries. (View illustration.) Recent changes in anesthesia personnel in both Zambia and Tanzania have provided an opportunity for transition from expatriate leadership to indigenous leadership. The OTP supports programs associated with long-term and focused leadership; it especially encourages local staff involvement in this role. The complexity of securing, funding and maintaining quality anesthesia departments headed by capable indigenous leaders is appreciated; however, tangible progress toward this commitment must occur in order to meet the prerequisites of the OTP.

The OTP is sponsored by ASA and FAER and functions within its budget. The continued success of the OTP requires understanding and appreciation for its laudable foundations. It only supports programs in which anesthesia leaders are dedicated to improving the availability and quality of their own anesthesia care through training. Growth of the OTP depends upon increasing involvement and support donated by participants who desire to aid developing countries in their quest for anesthesia independence.

Mark P. Colip, M.D., is Director of Obstetric Anesthesiology, East Texas Medical Center Hospital, and Staff Anesthesiologist, Trinity Mother Frances Health System, Tyler, Texas.
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1. Generalized Objectives:

1. To advance the practice, quality and availability of anesthesia care by temporarily assisting teaching.
2. To support autonomous and self-determined anesthesia training that eventually will be self-sustained.

2. Goals for Overseas Teaching Program:

1. To promote the development of a department of anesthesia and to support its indigenous leadership through teaching activities.
2. To supply qualified ASA volunteer teachers in a contiguous manner, who:
   1. are as well-oriented and as self-reliant as possible;
   2. assist teaching the basic relevant anesthesia and intensive care unit skills;
   3. assist teaching appropriate anesthesia theory;
   4. assist teaching students assigned by the program;
   5. participate in the continuing medical education of the local staff;
   6. encourage teaching by local staff, thereby minimizing teaching dependence; and
   7. promote the use of appropriate supplies and equipment.

3. Goals for Host Program:

1. To recognize and support a department of anesthesiology.
2. To secure and maintain capable and interested long-term indigenous leadership in the field of anesthesia training and practice.
3. To provide anesthesia students of the highest qualification practicable.
4. To assume a progressively larger proportion of overall teaching responsibility.
5. To make available and maintain secure campus housing for OTP volunteers.

4. Requirements by both OTP and Host Program:

1. To communicate and re-evaluate, on an annual basis, realistic and appropriate expectations for both the OTP and the Host Program.
   1. To re-evaluate and revise the teaching curriculum when needed;
   2. To evaluate the progress toward mutual goals;
   3. To estimate the length of time necessary before local independence is achieved and the OTP's work is completed; and
   4. To satisfy the terms and spirit of this agreement.
2. To accept a period of probation or termination of this Statement of Agreement if its conditions are not met.

5. Agreed upon and signed by:

1. Chair, ASA Committee on Overseas Anesthesia Teaching Programs
2. Head, Department of Anaesthesia

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FEATURES

ASA Overseas Teaching Program

• Overseas Teaching Program Update: Encouraging Indigenous Leadership Abroad
  
  
• A Change in Perspective: Experiences With the OTP in Tanzania
  
  
• Return From Zambia
  
  
• Organizational Biography of the OTP: Using Biographic Methods in Educational Program Evaluation and Curriculum Development
  
  
• Thanks to Our 1995 and 1996 OTP Volunteers!
  
  

ARTICLES

• Occupational Exposure to HIV: Chemoprophylaxis Reconsidered
  
  
• Resources Revisited, Part 1: Recruitment and Residency Size Changes for Anesthesiology, 1996
  
  
• ABA Announces...

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The views expressed herein are those of the authors and do not necessarily represent or reflect the views, policies or actions of the American Society of Anesthesiologists.

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