Miriam Mannak

CAPE TOWN, Mar 7 2008 (IPS) – A discussion about anaesthesiology and anaesthesiologists is something that could bring on drowsiness, even sleep Until, that is, the talk turns to shortages of anaesthesiologists in Africa and how this can increase surgical mortality. Statistics on this matter are frightening enough to keep anyone awake.
The lack of these specialists was one of the issues that came under discussion this week during the 14th World Congress of Anaesthesiologists, which took place in Cape Town, South Africa. The Mar. 2-7 event was organised by the World Federation of Societies of Anaesthesiologists (WFSA), which focuses in part on improving the level of anaesthesiology in developing countries.

According to the WFSA Manpower Taskforce, which evaluates the number of anaesthesiologists in countries worldwide, Africa is hardest hit by shortages of the specialists.

Zambia, for instance, has one registered anaesthesiologist per three million people, said Peter Kempthorne, chairman of the taskforce. Malawi has four specialists for its entire population of 12.5 million.

In developed countries matters are very different: the United Kingdom, for instance, has a ratio of one anaesthesiologist to 2,500 people.

As a result, many people in Africa go under the knife without a qualified anaesthesiologist present, substantially increasing the risks of their operations. In certain parts of sub-Saharan Africa, surgical mortality linked to problems associated with anaesthesia is 2,000 percent higher than the world average.
Kempthorne said the absence of specialists in most parts of Africa meant that anaesthesiology had become the task of non-physicians.

In Malawi, most of the work is done by 77 non-physicians who had no proper training. The situation is worse in Liberia where there is no specialist at all. Sedating patients is done by nurses as well (in Liberia) 37 in total.

The problem is compounded by lack of training for those who step into the gap.

According to our figures, only a few anaesthesia workers have had some form of training. Many of them have learnt what they know from physicians who ve had no formal anaesthesiology training themselves, Kempthorne told IPS.

In Mozambique, 80 percent of the work is done by non-specialists with no formal training. For Kenya and Malawi, the figures come down to respectively 71 percent and 93 percent.

This lack of training heightens the prospects of surgical mortality related to anaesthesia.

Notes David Morrell, managing director of the WFSA, The chance of a patient in Africa dying while being in the hands of a specialist is between one in 80,000 and one in 160,000. Are you sedated by a non-specialist, a nurse for instance? Then your chance of not making it is one in 3,500.

Statistics put forward by Kempthorne tell a similar story.

Worldwide, one in every 300,000 surgical procedures ends in death as a result of anaesthesia-related problems. In Zimbabwe, however, this figure is close to one in 3,000, he said. In Malawi, the chance of a patient dying on the operation table as a result of anaesthesia-related errors is one in 500, and in Togo this figure comes down to one in 150.

The brain drain accounts for part of the desperate shortage of anaesthesiologists. According to the WFSA, a significant percentage of qualified African anaesthesiologists move abroad.

To give you an idea, South Africa produces about 60 anaesthesiologists a year and we see half of them moving overseas, says Morrell, who works in a hospital near Port Elisabeth, on South Africa s coast. Reasons are better salaries, better equipment and less work stress.

The problem is that South Africa needs all the specialists it can get. We only have 1,000 anaesthesiologists, which comes down to one per 450,000 people. This is nothing compared to the situation in other African countries, yet we too struggle with a shortage.

But, other factors also feed into the shortage.

Anaesthesia is not seen as a popular specialisation, said Angela Enright, president of the WSFA. It is not regarded as (being as) glamorous as, for instance, heart surgery; salaries are not as high as specialised surgeons, and the chances of having a private practice are slim.

Kempthorne confirms these observations. The field of anaesthesia is not held in the same esteem and it is not paid as well as, for instance, specialised surgery. That is why medical students who want to specialise tend to choose heart or neurosurgery.

In addition, the sedation and resuscitation of patients is seen as the task of nurses, in many parts of the world.

Many students do not see a reason to study another four years for something that, in their eyes, a nurse is capable of doing. They unfortunately do not realise that the nurse is doing what a specialist is supposed to do, said Enright, who also has harsh words for certain non-governmental organisations (NGOs).

We have seen many cases of NGOs snatching medical students who are in the middle of their anaesthesiology training (and) offering them a bigger salary than they would get in, for instance, a state hospital.

* So, is the situation in Africa without hope as regards anaesthesiologists? Not quite. On Saturday (Mar. 8) IPS will publish an article that examines efforts to address the shortage of these specialists on the continent.