Thursday, March 30, 2017

Moving Anesthesia and Critical Care Forward in Botswana

Devan Bartels, MD, MPH
Resident in the Department of Anesthesiology, Critical Care and Pain Medicine at Massachusetts General Hospital

Moving Anesthesia and Critical Care Forward in Botswana
Our trip to Botswana is winding down, and we return to the United States this week. It has been an incredible month of new experiences, constant learning, and meeting inspiring people. David and I have many people to thank for helping make this experience possible, including, but we are sure not limited to, the Department of Anesthesiology, Critical Care and Pain Medicine at MGH (especially Drs. Paul Firth and Lena Dohlman), the University of Botswana Department of Anaesthesia and Critical Care (especially Dr. Neguisse Bekele), the wonderful staff at Princess Marina Hospital, the Partners COE program, and MGH Global Health.

Drs. David Bartels, Lena Dohlman, and Devan Bartels in front of the new teaching hospital.
After a month of striving to achieve our mission of education and capacity assessment, we are heartened that we were able to provide significant supplementary medical student and staff anesthetist education, and we are encouraged by the potential we see for developing anesthesia and critical care capacity in Botswana. A major goal of ours was to convey our enthusiasm for the field of anesthesia and the unique skillset it provides the healthcare system. We have been happy to hear several students express to us that they are now considering becoming anesthesiologists! This is great news and is exactly what is needed. Anesthesia and critical care are vital aspects to a health system, and capacity for anesthesia and critical care is needed in Botswana.

During this last week, we have continued to help teach medical students in the operating rooms and during tutorials. A major theme for our teaching has been safety in obstetric anesthesia, and topics have included postpartum hemorrhage, airway management in the parturient, and appropriate selection of anesthetic technique. In the tutorial sessions, we have discussed monitoring, acid/base status, and vasoactive medications. We have also participated in several case presentations. These sessions are a lot of fun and are perhaps good oral board exam preparation! A student will present a case (e.g. 25 yo female for emergent ex lap…) and then the staff UBSOM anesthesiologist will ask the presenter and her colleagues about appropriate management of the patient. Most often, this discussion starts with the question, “How would you anesthetize this patient?” From this starting point, an organic conversation emerges with students and staff asking questions, offering opinions, and arriving at management consensus. Finally, in addition to our educational work, we have had the chance to learn more about the Botswana-Harvard Partnership and the University of Botswana School of Medicine. This has been invaluable as we learn how to improve future efforts and coordinate with existing programs.

As our time in Botswana draws to a close (for now!), the major question that we now ask ourselves is: What is the path forward for anesthesia and critical care capacity in this remarkable country, especially as the morbidity and mortality of non-communicable disease (especially preventable surgical disease) increase? We have witnessed firsthand the hard work that is already happening and can see the future potential. We know that future development will likely be slow because it requires development of the most precious asset – human capital. This will require real investments in existing staff, recruitment of new (likely foreign) anesthesiologists, and of course, development of the next generation of Batswana anesthesiologists and critical care specialists. It will not be easy, but whatever the path, we have been honored to help at this stage and hope to participate in the future to help create sustainable Botswana anesthesia and critical care capacity. We are eager to return to Boston and further share our experiences and lessons learned. Ke a leboga and thank you!

A Gaborone morning from the top of Kgale (KAA-ley) Hill. Kgale Hill is south of the city and near where the set for “The No. 1 Ladies’ Detective Agency” TV series, based on the Alexander McCall Smith books, was located. This has earned the area the nickname “Kgalewood."

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