Anaesthesia training and development in Nepal 1985-1990

Training and development of anesthesia in Nepal — 1985 to 2005

PURPOSE

To describe the self-sustaining anesthesia training and development program in Nepal from 1985 through 2005, and the Canadian contributions.

METHODS

We examined the training program and outcome of the diploma in anesthesia (DA) and MD anesthesiology programs in Nepal over a 20-year period. Issues related to recruitment, funding, specialist training opportunities and professional development were examined and summarized.

RESULTS

In 1985 there were seven Nepalese physician anesthesiologists in Nepal. With Canadian support of faculty members and the Canadian Anesthesiologists' Society International Education Fund, a one-year DA training program began in 1985, and a three-year MD anesthesia program began in 1996. As of 2005, 43 anesthesiologists were trained in the DA program, and 19 Nepalese completed MD anesthesia training. Thirteen (30%) of DA graduates have since left the country, compared to only two (10.5%) physicians from the MD anesthesia training program. Annual anesthesia symposia began in 1986, and the Society of Anesthesiologists of Nepal was formed in 1987. Nepalese anesthesiologists have been attending and presenting papers at international scientific meetings since 1991.

CONCLUSION

The devotion of Nepalese anesthesiologists in teaching and training, strong guidance from Canadian medical faculties, and local government support have contributed to the successful development of Nepalese anesthesia training programs. Establishment of the training programs has assisted recruitment of trained anesthesiologists to different regional hospitals. Finally, the formation of a national society, with an organized annual symposium has improved professional self-esteem, and raised the profile of anesthesiology in Nepal.

[Evolution of the demography of anesthesia practitioners in French speaking Sub-Saharan Africa]

OBJECTIVE

To assess the course of the demography of anaesthesia providers in French-speaking subsaharian countries.

TYPE OF STUDY

Retrospective survey.

PERSONS

Doctors trained in anaesthesia and nurse anaesthetists registered in West African medical societies.

METHODS

Countries, hospitals, anaesthesia manpower, seniority and place of training were analysed.

RESULTS

In the 13 French-speaking subsaharian countries including 97.5-M inhabitants, 122 doctors and 868 nurses were registered as anaesthetists in 1998. Mean ratios were one doctor trained in anaesthesia for 799,180 inhabitants and one nurse anaesthetist for 112,327 inhabitants. From 1980 to 1998, these figures increased by a factor 11 for doctors (+1100%) and by a factor two for nurses (+100%). Most doctors were working in the chief town, in both public and private health care institutions.

CONCLUSIONS

In all French-speaking subsaharian countries, a major shortage of doctors trained in anaesthesia is existing.

General anaesthesia for cleft lip and palate surgery team activities in Cambodia

Cleft lip and palate surgery team activities in Cambodia were launched in 1989 by a Japanese non-governmental organization. The objectives of the project were to provide appropriate surgical treatment and safe general anaesthesia for local patients, and also to teach general anaesthesia and surgery to local medical staff. A surgery team was sent on four occasions between 1991 and 1993 and a total of 130 patients received surgical treatment and general anaesthesia. Anaesthesia techniques employed included total intravenous anaesthesia in 70 patients and intravenous anaesthesia and low dose halothane in 60 patients. There were no major complications, such as airway obstruction or apnoea in the postoperative period. Total intravenous anaesthesia is an appropriate technique for patients in developing countries. The teaching of anaesthesia should be emphasized during the surgery team activities.

Anaesthesia services and the education of anaesthetists in Nepal: a model for sustainable development?

In 1985 the University of Calgary in Canada and Tribhuvan University in Kathmandu, Nepal Jointly established the Diploma in Anaesthesiology (DA) programme in Nepal. To evaluate the impact of the DA Programme and provide a data base for long-term planning we conducted a national survey in 1992. We sought to describe anaesthesia manpower and workloads, and to make an inventory of facilities, equipment, and supplies in different sized hospitals. Twenty-seven hospitals providing surgical services were included, nine inside and 18 outside the Kathmandu valley. Seventeen of the 21 respondent hospitals had at least one specialist anaesthetist. The results identify both strengths and weaknesses in Nepal's anaesthesia services and provide important guidelines for planning. When the DA course was launched there were only seven specialist anaesthetists in Nepal. The shortage of anaesthetists was an important factor limiting surgical services, and after DA graduates were posted to zonal (50 bed) and regional (150-200 bed) hospitals the surgical case loads doubled. There are now about 40 specialist anaesthetists in the country, of which half are DA graduates, but many hospitals have only one anaesthetist. That isolation, plus lack of continuing education (CME), are important factors threatening quality of care. Recognizing the singular role of the DA programme in alleviating Nepal's shortage of anaesthetists, we conclude that it should be renewed and strengthened to meet the needs of the next decade. Techniques commonly used at the zonal level: regional, draw-over, and total IV anaesthesia, should be stressed. At the same time fresh initiatives are required in CME and higher education for the renewal of teaching staff.(ABSTRACT TRUNCATED AT 250 WORDS)