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Partnerships & Processes: Training Practitioners in Low-Resource Countries. Safe Anesthesia & Surgery in Sierra Leone Initiative (SASSL) John B. Sampson, M.D. Executive Director Johns Hopkins School of Medicine Austere Anesthesia Health Outcomes Research Group Past 15 Years of Partnerships • 1. Society of Critical Care Medicine • 2. Health Volunteers Overseas • 3. Physicians for Peace • 4. ProHealth International • 5. George Washington University Global Health • 6. Johns Hopkins Hospital • 7. Doctors for United Medical Missions • 8. Greater Washington Society of Anesthesiology • 9. United Nations • 10. Eritrea Ministry of Health • 11. Burkina Faso Ministry of Health • 12. Sierra Leone Ministry of Health • 13. ASA Overseas Training Program Challenges to Anesthesia Training • • • • • • • Infrastructure Instructors Anesthesia Equipment Anesthesia Medications Learning Material Poor Internet Bandwidth Retention & Distribution Challenges to Anesthesia Training • • • • • • • Infrastructure - UN Instructors - HVO Anesthesia Equipment - UAM research Anesthesia Medications - ? Learning Material - HVO Poor Internet Bandwidth - ? Retention & Distribution - WHO HVO MISSION • Dedicated to improving the availability and quality of health care in developing countries through the training and education of local health care providers. Uniqueness of the Sierra Leone HVO Program • The Sierra Leone HVO program is a collaborative between HVO and the Johns Hopkins Austere Anesthesia Group. • This is the only HVO collaboration with Johns Hopkins. The strengths of both organizations will be leveraged. Johns Hopkins Austere Anesthesia Health Outcomes Research Group Safe Anesthesia & Surgery in Sierra Leone Initiative 1.Creation of an education package to accompany the new equipment. •2. Evaluation of the ability of the equipment meet the demands of the austere environment. •3. Evaluation of the equipment to endure the austere environment. •4. Evaluation of the health impact of appropriate new equipment upon the austere environment. Use of Computer Simulation to Reproduce Critical Austere Anesthesia Events. Challenges to Anesthesia Training • • • • • • • Infrastructure - UN Instructors - HVO Anesthesia Equipment - UAM research Anesthesia Medications - ? Learning Material - HVO Poor Internet Bandwidth - ? Retention & Distribution - WHO Current Anesthesia Physician Situation in Africa • Typical Examples • Eritrea - zero • Sierra Leone one full-time and a few temporary and part time. • Burkina Faso < dozen • Liberia - none full-time • Less than one anesthesiologist per million in most Sub-Saharan countries The Issue of Task Shifting • Per the WHO Task Shifting: Global Recommendations and Guidelines Manual. • Defined as the use of non-physician healthcare providers for the provision of medical care. The Current State of Anesthesia Care. Is Task Shifting the Answer? • Nurse anesthesia already task-shifting. • - do we want another level of taskshifting? • Anesthesia-associated death 100-1,000 times that in developed countries. • As many as 50% of anesthesiaassociated deaths may take place in obstetric patients. • 18-week medical officers 3-month nurse anesthesia assistants Master's degree nurse anesthetists. Can Anesthesia Practice in Low-resource Environments Afford to have Less Trained Providers? • The consequences of error can be sudden death. • What are the limits of anesthesia task-shifting? • Is there adequate research within the field of anesthesia to make the case? • 2009 study in South Asia • ICRC and MSF in DRC and Somalia IV Fluid Chosen to Treat Patient "Hunger" after Multiple Presentations on IV Fluid over the Years. World Health Organization • Global Code of Practice on the International Recruitment of Health Personnel. Recruiting, Training & Retaining Nurse Anaesthetists in Sierra Leone: A Case Study Prof Yaw Adu-Gyamfi MB, ChB, FFARCS, FRCA, FWACS, FGCPS United Nations Anaesthesia Consultant to the Sierra Leone Ministry of Health