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Advancing Anesthesia Care in Sub-Saharan Africa

Operating Room

This is the first of an ongoing series of blog posts from the Global Health Initiative, an international educational program from the Department of Anesthesiology aimed at advancing the practice of regional anesthesiology abroad.

Uganda has only 40 anesthesiologists to care for its 36 million citizens. On a typical day, one nurse may care for as many as 40 patients at a time — these startling statistics have spurred an international effort to help the dedicated medical professionals in Uganda improve surgical care and better serve the Sub-Saharan population.

Over the course of two weeks, Dr. Swetha Pakala and I traveled to Uganda and India as part of the Department of Anesthesiology’s Global Health Initiative. Our goal was to teach regional anesthesia workshops at two national conferences and, perhaps more importantly, to develop future collaborations for the Global Health Initiative.

Our first stop was Entebbe, Uganda. While in Entebbe, we attended a global health conference run by Global Partners in Anesthesia and Surgery (GPAS) which focused on improving perioperative care in Sub-Saharan Africa. Since its inception in 2008, GPAS’ international support has expanded to a number of institutions including Massachusetts General Hospital, Yale, and Hospital for Special Surgery.

It became clear at the conference that a lot needs to change within the Ugandan health care system; mostly in terms of their healthcare workforce crisis. In a country where the average woman gives birth to more than six children, the numbers in obstetrics are astounding. The largest hospital in Uganda has 33,000 births per year — about 100 births per day.  Among these women, on average there is one maternal death per day, and several infant deaths.

Compared to seven years ago, these statistics have greatly improved. In 2008, there were only two anesthesiologist physicians in the country; now there are 40 practicing anesthesiologists and a number of residents joining the workforce in years to come. With the help of global health advocates, conditions are improving within the anesthesia and surgical community.

The most poignant quote I heard was from one of the most senior Ugandan physicians, who said, “it is better to light one candle in the dark than to curse the darkness altogether.” Every little effort counts.

Following the GPAS conference, we drove to the capital of Uganda, Kampala. We did the bulk of our clinical and educational work at Mulago Hospital, the university hospital of Mekerere University. GPAS has worked to strengthen the university’s anesthesia residency program, and by doing so, has improved the quality and quantity of graduating anesthesiologists in Uganda.

Dr. Pakala and I taught and supervised anesthesia residents performing nerve blocks, the anesthetic techniques best-suited for most orthopedic procedures, on patients who had been waiting over a week for surgery. Our creative minds were certainly tested, as much of the supplies such as intravenous (IV) tubing needed to be ‘jerry-rigged’ in order to function the way we need it to for our techniques.

After doing cases in the morning, I gave the residents a series of lectures on the regional anesthesia procedures that we do regularly at HSS. Then, we got everyone together for hands-on ultrasound workshops. The residents were incredibly engaged and extremely motivated to improve their skills. In fact, they expressed great interest in an additional, more thorough regional anesthesia course as an integrated part of their curriculum.

Ultimately, Global Health Initiative aims to teach a cohort of residents who can then serve as the local ‘champions’ who will then teach their colleagues and peers throughout the country. We believe that education is the key to lasting, sustainable development in the Ugandan healthcare system.

In order for the Ugandans to improve their health care, it must come from within and that starts with obtaining skills and increasing the workforce numbers. Given the enthusiasm that we encountered, we are confident that their skills and standards of care will only continue to improve.


Dr. Lee Rasamny is a 2015-2016 Regional Anesthesiology and Acute Pain Medicine Fellow focusing on global outreach.

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