Q: What was the main goal of this year’s American Board of Anesthesiology-accredited, month-long global health residency rotation in Ghana?

A: The goal of the trip to Ghana was to create a project that could show an incremental measurable gain in the delivery of health care. We arrived in Accra, Ghana at a very interesting time. We were working at Ridge Regional Hospital and there were three separate groups of trainees: first-year nursing anesthesia students, certified anesthetist (nurses) doing continuing medical educations (CME), and house officers who were doing a six-month anesthesia rotation.

It became apparent that there was huge deficit in people who would be qualified to lecture at the nurse anesthesia school associated with Ridge Regional Hospital. My project included providing required lectures to the house officers. Given their initial lack of excitement, I decided to pitch the idea to them of ‘flipping the classroom.’ Each day, a separate house officer would take one of the topics and give a 20-30 minute lecture on the topic. After the lectures, I would fill in the gaps for each topic. The house officers were immediately engaged and in a short time it became easy to see their excitement for the field of anesthesiology.

During the month, we were also charged with providing basic life support training for all trainees. The team provided this training for the SRNAs (40), certified anesthetists (30), and the house officers (7). During this time, I was able to locate the only working defibrillator in the hospital. There was a code earlier in the month and no one associated knew where the defibrillator was located.

This was also a month of growth. I participated in my first intraoperative code. The patient was a mother who was referred from an outside hospital due to sickle cell crisis (Hgb of 4 mg/dl) and fetal distress. The mother was rushed to the operating room but coded shortly after induction. Intraoperative ECG is not commonly used due to lack of disposable stickers and working cables. The patient did have a working pulse oximeter which allowed us to track oxygenation and was helpful for determining return of spontaneous circulation (ROSC). Without getting into the clinical specifics of the case, there was no access to non-invasive blood pressure, no stat labs, no defibrillator, no ECG, no intraoperative fetal monitoring, and no functioning post procedure ICU care.

After work, there were opportunities to debrief and see Ghana. We were invited to meet with a group of Americans living in Ghana, many of whom were just granted dual citizenship. Adam Flowe, Derrick King, and Kent Smith joined us for the last week of the mission trip. They helped with teaching and providing many valuable supplies. Kent was able to tour the hospital with the technical support staff and provide insight about ways to improve efficiency.

Overall the trip was a great success. I have grown so much as a global citizen, a human, and a physician. It is safe to say that quality anesthesia care is one of the largest health care disparities in Africa. Dr. Adeyemi Olufolabi (Duke) and Dr. Medge Owen (Wake Forest) are literally saving the lives of women and children around the world. Their work has forever changed Ghana.

Brian Rogers, MD (CA-3)

Chris KeithQ: What was the main goal of this year’s American Board of Anesthesiology-accredited, month-long global health residency rotation in Ghana?
Read More

Q: Can you provide an example of the learning takeaways that Duke Anesthesiology residents gain from their global health mission trips?

A: In March, we spent a week in Jacmel, Haiti, providing anesthesia care and helping to improve the education of Haitian doctors and nurses caring for patients in the perioperative period.

Some very advanced equipment (stryker lap tower), some very basic equipment (fly paper) and a very tall Duke Anesthesiology faculty member (Dr. Aaron Sandler).

The days were long, mostly pushing 14 hours, but we worked with wonderful folks to take excellent care of very grateful people as they received the surgeries they needed, so time went by quickly.  We found ourselves in a very safe anesthetic environment, with the crucial monitors (including capnography), good availability of necessary medications, and even a videolaryngoscope, but there were a few bells and whistles we have grown used to at Duke that were missing which brought us out of our bubble and challenged us to expand our thinking about delivering a safe anesthetic.

Systems-based process improvement is a central part of Duke Anesthesiology residency training, whether at home or abroad.

Systems-based process improvement is a central part of Duke Anesthesiology residency training, whether at home or abroad.

Anu learned a lot and saw pathology she’d only read about such as thyroid storm, acute hypocalcemia, and the emergency airway management of an expanding neck hematoma!  She also adjusted to using an unfamiliar machine in an unfamiliar environment and relying on spontaneous respiration in our intubated patients (in order to avoid wasting expensive oxygen on driving the ventilator) during some long surgeries for huge parotid tumors, impressive goiters, and the laparoscopic (mostly) removal of the largest gall bladder either of us had ever seen.  The proudest moment of Aaron’s week might have been when Anu, after a ten-hour sevoflurane anesthetic with spontaneous respiration and no end-tidal agent monitor, managed a two-minute wakeup!

There was also the opportunity for improving the education of the Haitian providers, starting with nurses and nursing students, some of whom were caring for postoperative patients for the first time in their careers, and continuing with the Haitian surgeon who will be managing the facility’s two ICU/ventilator beds when they open in June.  He was especially hungry for practical advice on using arterial blood gas measurements to manage ventilator settings, a topic we were happy to talk about.

We both returned to Durham exhausted (as well as desperate for hot showers and a day without bug spray), but also remarkably refreshed.  We felt that we had a made a direct difference in some folks’ lives, both the patients undergoing surgery and the nurses and doctors who ended the week a little bit better educated than they were before.  And, on a personal level, we had been reminded of why we originally wanted to go into medicine.  Overall, not a bad outcome for our week in Haiti.

Aaron Sandler, MD, PhD, and Anushree Doshi, MD (CA-2)

Chris KeithQ: Can you provide an example of the learning takeaways that Duke Anesthesiology residents gain from their global health mission trips?
Read More

Q: What role does the Duke Anesthesiology Residency Program play in global health?

Global Health - DARE BlogA: Dr. Brad Taicher takes us on his journey abroad to provide a snapshot of how our department and residency program make a real difference in the lives of others.

It’s March 11th and we’ve safely arrived in Guatemala City, Guatemala for the sixth time in as many years to help evaluate and care for a group children undergoing general and urologic surgeries. This year’s anesthesia team is comprised of Stephanie Jones (CA-3 resident), Dayna Seguin (CRNA) and Becky Motykiewicz (CRNA), as well as three local anesthesia residents who will anesthetize with us throughout the week (Drs. Miguel Gonzales, Amilkar Garcia and Yolanda Castaneda). On our first day, we saw 80 plus children come through the clinic to be evaluated by our surgical team for appropriateness, and by our anesthesia teams to ensure they are medically optimized, and plan for the week ahead.

Why Guatemala? It’s the poorest country in Central America, and one of the poorest in the world. The public health system in Guatemala is well developed, but bankrupt. It lacks sufficient resources to provide care for all in need, creating an enormous backlog of patients, many of whom have no chance of ever receiving the surgeries they need through the public health system. There are about 4.5 million people in and around Guatemala City; more than 90 percent of whom rely on the public system and only two significant public hospitals to handle major surgeries. These two hospitals are only provided enough funding to purchase supplies to do elective operations in the mornings for about half of the year. When they run out of supplies, it’s emergency surgery only. There is no pediatric fellowship training here for those who are interested, so when I’m here, I’m usually the only pediatric anesthesiologist in the country. Pediatrics is an interest for many here, but a job for few. And for perspective, Guatemala is a country of children with greater than 50 percent of the population less than 18 years old.

In the United States, we may encounter patients who lack the skills to cope with the stress of their surgical encounter. In Guatemala, it is the opposite; patients have overdeveloped coping skills secondary to the conditions of their upbringing and the ubiquitous violence. It is often said that Guatemalan children don’t cry because they have long ago run out of tears. Our mission brings hope to these individuals and families while simultaneously seeking a sustainable model by supplementing pediatric training for local providers and collaborating on research and quality improvement endeavors with local institutions.

In addition to Guatemala, Duke teams have traveled to Ghana, Haiti, Philippines, India, and countless other countries. We are grateful for the phenomenal support provided by our department, hospital, and university over the past six years and the opportunity to include our own trainees and CRNAs on our mission trips. We are excited to continue our collaboration here in Guatemala, and look forward to another successful trip!

Brad Taicher, DO, MBA

Guest BloggerQ: What role does the Duke Anesthesiology Residency Program play in global health?
Read More