Ten Years of Experience Training Non‐Physician Anesthesia Providers in Haiti

Abstract

Surgery is increasingly recognized as an effective means of treating a proportion of the global burden of disease, especially in resource‐limited countries. Often non‐physicians, such as nurses, provide the majority of anesthesia; however, their training and formal supervision is often of low priority or even non‐existent. To increase the number of safe anesthesia providers in Haiti, Médecins Sans Frontières has trained nurse anesthetists (NAs) for over 10 years. This article describes the challenges, outcomes, and future directions of this training program. From 1998 to 2008, 24 students graduated. Nineteen (79%) continue to work as NAs in Haiti and 5 (21%) have emigrated. In 2008, NAs were critical in providing anesthesia during a post‐hurricane emergency where they performed 330 procedures. Mortality was 0.3% and not associated with lack of anesthesiologist supervision. The completion rate of this training program was high and the majority of graduates continue to work as nurse anesthetists in Haiti. Successful training requires a setting with a sufficient volume and diversity of operations, appropriate anesthesia equipment, a structured and comprehensive training program, and recognition of the training program by the national ministry of health and relevant professional bodies. Preliminary outcomes support findings elsewhere that NAs can be a safe and effective alternative where anesthesiologists are scarce. Training non‐physician anesthetists is a feasible and important way to scale up surgical services resource limited settings.

Surgical Relief Work in Haiti: A Practical Resident Learning Experience

“…4 On their medical experience in Haiti from 1998 to 2008, Rosseel et al 9 reported that working conditions are suboptimal, with frequent shortage of equipment, oxygen, anesthetics, and other medications. For the last 16 years, the Physicians for Humanity-Haiti team has worked to provide surgical and medical attention to Haitians in need and has played an active role in the development of regional medical infrastructure.…”

A 19-Year Record of Training Haitian Residents in Otorhinolaryngology and Cervicofacial Surgery

“…With only 35 anesthetists practicing in Haiti (of whom few work outside Port-au-Prince), planned surgical interventions were often canceled the same day because of a lack of personnel or anesthesia equipment (and particularly a lack of oxygen). 14 The decision to perform major surgical intervention necessitating tracheotomy was carefully considered because of the lack of an aspiration system in the hospital and the absence of paramedical personnel for patient monitoring. The 6-bed ENT hospital area was common to children and adults, men, and women, and did not have any dedicated paramedical personnel (Fig.…”

Anaesthesia in underdeveloped world: Present scenario and future challenges

“…Study on anaesthesia services in one of the African countries showed that the majority of anaesthesia procedures were administered by non-physicians. Even the anesthesiologist was not involved in pain as well as emergency services 710. The other survey further highlighted that there was serious crunch in the entire anaesthesia services.…”

“…But these services are not available to majority of population because of poverty, growing population, limited resources, cost of treatment, disparity and non-uniformity of available healthcare services, increasing burden of non-communicable diseases along with communicable disease and increasing needs of aging population. The need for non-physician anaesthetists cannot be overlooked particularly in areas where properly trained anaesthesiologists are lacking 10. However, standard training of these non-physicians should be ensured.…”

“…In addition, anaesthesia education curriculum should therefore be developed to generate good anaesthesiologist who would know the cutting edge technology but also could able to utilise and modulate the local available resources. The anaesthesia curriculum should also develop for non-anaesthesia personnel as well so that they can also be utilized in underserved areas or area of need 101920. Basic medical education should comprise of basic life support, advance cardiac life support, ventilation/intubation skills and other emergency treatment of common catastrophic situations.…”