ANESTHESIA SERVICES AND THE EDUCATION OF ANESTHETISTS IN NEPAL - A MODEL FOR SUSTAINABLE DEVELOPMENT

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.