February 1999
Volume 63 |
Number 2
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| ASA Overseas Teaching
Program: A Decade of Progress in African Anesthesia |
Stanley I. Samuels,
M.B.
Alice A. Edler, M.D.
Over the last decade, the vision of Nicholas M. Greene, M.D.,
"to increase the quality and availability of anesthesia care in
countries unable to recognize their full educational potential
due to economic constraints,"1 has
resulted in measurable success and not just in the absolute number
of anesthesia care providers in these countries. Dr. Greene's
vision of service included being a teacher in the best sense of
the word, instructing not only students but also fellow faculty
members to be self-sufficient and open to advancement.
The unique strength of the ASA Overseas Teaching Program (OTP)
lies in its contribution to building an infrastructure of anesthesia
education in the countries most underserved in the world. Dr.
Greene surveyed 50 countries listed as underdeveloped with a view
to seeking our health colleagues' interests in running such a
program. Of the respondents, Dr. Greene then chose participants
on the basis of 1) established educational facilities, 2) whether
or not there was a cadre of local teachers in need of assistance
to accomplish self determined curriculum plans, 3) a safe environment
for volunteers and 4) locations in which all ASA members could
make unique and valuable contributions.
With this in mind, two programs were contacted and, after much
discussion, volunteer teaching began in 1991 at University Hospital,
Lusaka, Zambia, and at the Kilimanjaro Christian Medical Center
(KCMC), Moshi, Tanzania. In the subsequent years, uninterrupted
teaching has continued at KCMC. In 1995, the program was discontinued
at the University Hospital in Lusaka when changes at the university
made it impossible to continue Dr. Greene's program philosophy
of working in concert with local teachers.
The OTP continues to flourish at KCMC with an adequate supply
of volunteers, new approaches to joint curriculum formation and
plans for assisted self-reliance in anesthesia practice. Since
1992, in Tanzania alone, the OTP has contributed to:
- 100 percent increase in the physician anesthesia providers.2
- 900 percent increase in paraprofessional anesthesia providers.2
- Introduction of anesthesia as a required rotation in KCMC.
- Placement of OTP-trained anesthesia providers in more than
40 district hospitals in Tanzania (where often there were no
trained practitioners).3
- Independent departments of anesthesia in 14 other Tanzanian
district hospitals.3
- addition to these quantitative increases in anesthesia care
in East Africa, the OTP measured its successes in several individual
accomplishments:
- A recent KCMC OTP graduate became the first World Health
Organization-sponsored New York State Society of Anesthesiologists
Postgraduate Assembly International Scholarship recipient.
- ASA OTP has begun an anesthetic record and statistics project
(the first anesthetic record-keeping of its kind in Tanzania
under the guidance of a local anesthesiologist.)
- More than 90 ASA volunteers have participated in this program;
volunteers have come from all walks of life and types of anesthesia
practices.
The ASA OTP has made measurable increases in both the quality
and availability of anesthesia care in East Africa over the last
decade. It has also made great strides in the long road to recognition
of anesthesiology as an independent, professional medical specialty.
While it is far from realistic to think that all anesthesia providers
in developing countries could be at the level of physicians in
this short time, the OTP is now using this model to introduce
anesthesia teaching methods to other medical schools of East Africa.
It is also establishing a model physician-supervision program
in areas where an all-physician staff is pragmatically impossible.
An exciting new development is the proposed collaboration between
the World Federation of Societies of Anaesthesiologists (WFSA),
ASA and the University of Ghana Medical School's Department of
Anaesthesia (UGMS).
"New" is somewhat a misnomer as the project has been in the
pipeline since 1992. In that year, the Department of Anaesthesia
at UGMS contacted Dr. Greene for assistance in training its students.
Following lengthy discussions with the Ministry of Health of Ghana,
WFSA and ASA representatives, this program is ready to begin following
final approval from ASA. At the time of this writing, ASA has
granted approval for a one-year preliminary period. It is to be
hoped that the program will continue well after this one-year
period.
These ASA OTP programs are unique in many respects from other
volunteer programs. What makes this particular program unparalleled
is that the government of Ghana has entered into a cost-sharing
arrangement with WFSA and ASA. Unlike the other ASA OTP programs,
this one will train only physician anesthesiologists and will
be for a five-year period. The program will have well-defined
goals and methods available to measure the strengths and weaknesses
of the program. The responsibilities of the Ministry of Health
of Ghana include the recruitment of at least five anesthesia students
and design of a course of study (basic science and clinical) in
line with requirements of the West African College of Surgeons
and Anaesthetists. They also will prepare and administer the Diploma
in Anaesthesia examination.
WFSA will provide 75 percent of the financial support for the
student body and faculty. This should cost about $20,000 per year.
The educational goals for the proposed ASA OTP project in West
Africa will be individualized to meet the specific need for more
patients to be served by the graduates. The program will concentrate
on major areas detailed by local educators and distinct to anesthetic
care in this part of the world.
The core curriculum will cover both the basics of clinical science
and fundamental scientific knowledge in anesthesia as well as
topics that will emphasize skill and learn
ing that need to be used on a daily basis by the graduates.
In most districts, these graduates are usually the only physicians
who have had any anesthesia training. The specialized topics will
include the management of routine and emergency obstetrical anesthesia,
neonatal resuscitation, emergency triage and trauma management,
and administrative skills necessary for the organization of departments
of anesthesia as well as the continuing education of nurses and
other paraprofessional anesthesia providers in the regions.
Measurement criteria of these goals will be formulated by local
faculties and in accord with standards of practice of the West
African Societies of Anaesthesia.
Finally, the ASA OTP will provide volunteers who will teach
the curriculum for the UGMS Diploma of Anaesthesia program in
basic and clinical sciences as well as providing financial assistance
with housing and travel.
The ASA OTP is currently accepting applications and invites
any questions. The ASA OTP welcomes all active members and offers
them a chance to change the world. Please contact: Ronald A. Bruns,
ASA Executive Office, 520 N. Northwest Highway, Park Ridge, IL
60068-2573.
References:
- Greene NM. Overseas Teaching Program update.
American Society of Anesthesiologists NEWSLETTER, April
1992; 56(4):24-27.
- Egan E. Beyond Intubation: A Journal Told
and a New Beginning. All-Africa Conference Abstract, 1997.
- Nyagwa WG. The Functions of American Society
of Anesthesiologists Overseas Teaching Program in Tanzania.
New York State Society of Anesthesiologists Postgraduate Assembly
International Scholars Address, 1997.
Stanley I. Samuels, M.B., is Professor
of Anesthesia, Stanford University School of Medicine, Stanford,
California.
Alice A. Edler, M.D., is an Instructor
in Anesthesiology, Division of Pediatric Anesthesiology, Washington
University School of Medicine, St. Louis, Missouri.Alice A. Edler,
M.D., is
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