he SS HOPE, the world’s first peacetime hospital ship, voyaged outside the United States eight times between 1960 and 1973. Retired in 1974, the SS HOPE survives as the model for the ASA Overseas Teaching Program (OTP).

William Walsh, M.D., founded Project HOPE in 1958 and acquired the mothballed World War II hospital ship, USNS Consolation. Refitted, the ship embarked in 1960 as the SS HOPE. It contained three operating rooms. Although the SS HOPE was much smaller than current naval hospital ships, it fit the core mission of Project HOPE well — to teach and assist local doctors and nurses.¹ Project HOPE characterized this as “helping people to help themselves,” which differed from most overseas medical services that emphasized patient care. Project HOPE leaders often quoted the Chinese proverb, “To feed a person for a day, give him a fish. To feed him for a lifetime, teach him to fish.”

The SS HOPE last voyaged in 1973 to Maceio, Brazil, a sugar port [Figure 1]. A senior resident then, I flew to Maceio with Brett B. Gutsche, M.D., a faculty anesthesiologist, and joined 29 other physicians and dentists aboard the docked ship. We followed the HOPE plan for Maceio: “One anesthesiologist would be expected to work on shore. He should be primarily responsible for setting up a functioning anesthesia department and supervising the development of a recovery room, ICU and inhalation therapy department. The ship-based anesthesiologist should be responsible for teaching resident physicians while on the ship, using modern techniques.”²

Figure 1. SS HOPE docked in the sugar port of Maceio, Brazil, in 1973.

Dr. Gutsche and I alternated these duties. Aboard the ship we supervised nurse anesthetists and taught Brazilian medical students, surgeons and anesthesiologists. Frequent surgical procedures included splenectomies for shistosomiasis and intestinal resections for Chaga’s disease (trypanisomiasis). We induced anesthesia with thiopental, maintained it with halothane and administered tubocurare for muscle relaxation. We monitored patients with precordial stethoscopes and electrocardiography.

In town we worked side by side with 14 Brazilian anesthesiologists. Most were self-taught and had admirable practical skills. We learned to use the sparse equipment effectively. There were tanks of oxygen but no nitrous oxide. Venturi devices attached to the oxygen lines provided suction. We administered methoxyflurane by bubbling oxygen through a small vaporizer and connecting the outflow to a bag, valve and mask or endotracheal tube [Figure 2]. Other drugs included thiopental, methohexital, Innovar (a fentanyl-droperidol combination), succinylcholine and curare. For regional anesthesia, we administered dibucaine and lidocaine, using glass syringes and reusable needles.

Figure 2. Anesthesia in a surgical office in Maceio, Brazil, in 1973. The hose from the oxygen tank connects to a methoxyflurane vaporizer and a small mechanical ventilator.

After Project HOPE abandoned the ship due to its high expense, some alumni anesthesiologists founded the OTP within ASA. Nicholas M. Greene, M.D., (1922-2004) the first chair of the OTP and the anesthesiologist most responsible for its founding, had served on the 1969 voyage of the SS HOPE to Tunisia. The philosophy of the OTP, as described by Dr. Greene, echoes that of Project HOPE: “While there are several outstanding volunteer medical programs based in the Western World, including the United States, that supply anesthesia coverage in underdeveloped countries … the ASA/FAER-sponsored OTP is unique in several ways, including: 1) OTP emphasizes teaching, not the takeover of clinical care (and) 2) OTP is designed to support only pre-existing, structured anesthesia training programs headed by an anesthetist as director.”³

Mark P. Colip, M.D., OTP chair in 1996, described the philosophy as “to promote self-reliance through on-site teaching assistance.”4 Phillip O. Bridenbaugh, M.D., current OTP chair, served for two months on the 1969 voyage of the SS HOPE. He writes, “The goals and mission of the ASA OTP were patterned after HOPE. The best example is the HOPE motto of ‘teach teachers,’ or now they say, ‘TOT,’ trainers of trainers.” Anesthesiologists interested in the OTP can find more information on the ASA Web site at <www.ASAhq.org/OTP/homepage.html>.


References:
1. Morrow RC. Medical education on the SS Hope. JAMA. 1970; 211:257-260.
2. Archival documents, Project HOPE, Millwood, VA.
3. Greene NM. Overseas teaching program to make its debut in Africa. ASA Newsl. 1990; 54(10): 8-11.
4. Colip MK. Overseas teaching program update: Encouraging indigenous leadership abroad. ASA Newsl. 1996; 60(11):6-8.

Robert E. Johnstone, M.D., is Professor, Department of Anesthesiology, West Virginia University, Morgantown, West Virginia. He is the Director from West Virginia.