Wa. Tweed et al., ANESTHESIA SERVICES AND THE EDUCATION OF ANESTHETISTS IN NEPAL - A MODEL FOR SUSTAINABLE DEVELOPMENT, Canadian journal of anaesthesia, 40(10), 1993, pp. 993-999
In 1985 the University of Calgary in Canada and Tribhuvan University i
n Kathmandu, Nepal jointly established the Diploma in Anaesthesiology
(DA) programme in Nepal To evaluate the impact of the DA Programme and
provide a data base for long-term planning we conducted a national su
rvey in 1992. We sought to describe anaesthesia manpower and workloads
, and to make an inventory of facilities, equipment, and supplies in d
ifferent sized hospitals. Twenty-seven hospitals providing surgical se
rvices were included nine inside and 18 outside the Kathmandu valley.
Seventeen of the 21 respondent hospitals had at least one specialist a
naesthetist. The results identify both strengths and weaknesses in Nep
al's anaesthesia services and provide important guidelines for plannin
g When the DA course was launched there were only seven specialist ana
esthetists in Nepal. The shortage of anaesthetists was an important fa
ctor limiting surgical services, and after DA graduates were posted to
zonal (50 bed) and regional (150-200 bed) hospitals the surgical case
loads doubled. There are now about 40 specialist anaesthetists in the
country, of which half are DA graduates, but many hospitals have only
one anaesthetist. That isolation, plus lack of continuing education (
CME), are important factors threatening quality of care Recognizing th
e singular role of the DA programme in alleviating Nepal's shortage of
anaesthetists, we conclude that it should be renewed and strengthened
to meet the needs of the next decade Techniques commonly used at the
zonal level: regional, draw-over, and total IV anaesthesia, should be
stressed. At the same time fresh initiatives are required in CME and h
igher education for the renewal of teaching staff Serious deficiencies
and mal-distribution of equipment, supplies and drugs were found, wit
h considerably poorer inventories in smaller- and intermediate-sized h
ospitals To accommodate better the chronic shortages of anaesthetic ga
ses and scarcity of reliable anaesthetic machines in hospitals of that
size, we conclude that they should not attempt to stock N2O. Using ai
r-O2 for all inhalational anaesthesia would streamline equipment needs
reduce the risks of hypoxia, and simplify training. Since much equipm
ent, even of relatively recent acquisition, was unserviceable, establi
shment of regional repair and maintenance centres and training of serv
ice technicians are urgent needs. Lastly we believe that the community
of professional anaesthetists, through their Society, must play a piv
otal role in determining standards of practice of anaesthetists and de
veloping innovative means to maintain communications and disseminate C
ME.