World anaesthesia day 2016

Every year, on 16th October the World Federation of
Societies of Anaesthetists (WFSA) organizes and
encourages activities to sensitise the world community on
the role of anaesthesia in global health. Looking back on a
long and storied history of medical breakthroughs, we’re
inclined to remember the discoveries that take the form of
lifesaving solutions: penicillin, the polio vaccine,
radiotherapy, antiretroviral drugs etc. Our minds turn
almost naturally to the game-changing inventions designed
to cure or prevent diseases: rarely do they conjure up those
that sow the seeds of a whole new playing field. If surgery
was the game-changing solution to save or improve lives,
anaesthesia was the discovery that allowed the game (as
we know it) to be played in the first place. And it’s only
fitting that we remember its role. Such is the story of
modern anaesthesia, first administered on this day in 1846
by William Morton at Massachussets General Hospital,
Boston, USA.
Anaesthesia is the intervention needed to sedate patients
for surgical operations, typically consisting of four
elements: hypnosis (sleep, loss of consciousness),
analgesia (inability to feel pain), and muscle relaxation.
Before that happens, anxiolytics to calm patients in fear or
agitation as well as amnesia (loss of recall of unpleasant
moments) are usually prescribed. Depending on the type
and site of surgery, anaesthesia is most often delivered as
an injection, a topical agent or an inhaled vapour - all of
which are common, safe practices and should be available
to almost everyone.
Tremendous and steady progress have been made in global
health and in particular surgical practice, where the high-
income countries have attained and set standards and safer
and more effective methods of providing surgical care for
their citizens. Sadly, and tragically this progress has not
been uniform. Deaths and disabilities from common
conditions needing surgery have grown in the world’s
poorest regions, both in real terms and relative to other
health gains. At the same time, development of safe,
essential, life-saving surgical and anaesthesia care in low-
income and middle-income countries (LMICs) have
stagnated and regressed. Over 5 billion people do not have
access to safe, affordable surgical and anaesthesia care
when needed. Access is worst in low-income and lower-
middle-income countries, including Nigeria where nine of
10 people cannot access basic surgical care. Of the 313
million procedures undertaken worldwide each year, only
6% occur in the poorest countries, where over a third of the
world’s population lives. This is a catastrophy!
Many factors are responsible for this but prominent barriers
to the provision of surgical and anaesthesia care that is
accessible, safe, timely, and affordable include:
- Acute shortage of skilled manpower
- Lack of appropriate, easy to maintain and affordable
equipment
- Lack of global policy on anaesthesia
The West African College of Surgeons (WACS) and the
National Postgraduate Medical College of Nigeria (NPMCN)
have identified this factor long time ago and have taken
proactive steps by stepping up postgraduate training of
medical doctors in anaesthesia. Of course the number of the
specialists in anaesthesia has increased remarkably but
most have remained in the tertiary health facilities.
Secondly, the number of trained surgeons and surgical
subspecialities have also risen and with it also more health
facilities have been established. There’s also the factor of
emigration of the physician anaesthetists to the developed
countries.
The technology factor has to be tackled head on. The
anaesthesia machines and other equipment essential for the
delivery of anaesthetic services have been rendered non
functional due to unreliable or non availability of
compressed medical gas (oxygen), poor and unreliable
electricity supply, lack of spare parts and shortage of funds
and the trained biomedical technicians/engineers to fix
them. Even when this is done, it will not be sustainable in
most rural facilities in Low and Middle Income Countries.
The solution lies in development of anaesthesia equipments
that can function in the face of these challenges.
The third leading factor affecting global anaesthesia care is
policy - and the lack of data necessary to inform it.
Confronted with the urgent need to battle infectious
diseases like HIV/AIDS, malaria and tuberculosis,
governments in LMICs have traditionally prioritized policies
to target specific epidemics. But, thanks in large part to the
Lancet Commission on Global Surgery and less-disease-
specific trends in funding, that paradigm has changed in
recent years. There is now a growing body of global,
national and sub-national data on anesthesia and surgery
that has begun to quantify the problem and influence
countries to invest in systems to overcome a new
generation of health issues - many of which hinge on better
anaesthesia and surgical care.
If there’s one suture that stitches the above factors
together, it is the recognition that anesthesia does not hold
the revolutionary appeal of penicillin or the immediate
treatment power of antiretroviral drugs: it is as much a
game-changer as it is a game-enabler. More than a century
and a half since it enabled its first surgery, anaesthesia is
as critical a medical discovery as any. Now, it is imperative
that we make it a staple of every health system -
remembering its central role in surgery, even if its patients
can’t. If surgery was the game-changing solution to save or
improve lives, anaesthesia was the discovery that allowed
the game (as we know it) to be played in the first place. And
it’s only fitting that we remember its role.
This year, the WFSA seeks to build on its recent successful
launch of the SAFE-T (Safe Anaesthesia For Everybody -
Today) campaign to raise awareness worldwide as an
important component of safe surgery and the need to
advance access to safe and affordable anaesthesia
worldwide.
Dr. Alhassan Datti Mohammed, FWACS, Senior Lecturer and
Consultant Anaesthetist Bayero University/Aminuj Kano
Teaching Hospital Kano, Nigeria 0806 929 7557