Safe anaesthesia in the South Asian Region: Reflections on safety at the SAARC-AA Congress
The 12th SAARC-AA (South Asian Association for Regional Cooperation- Association of Anaesthesiologists) Congress was hosted by the College of Anaesthesiologists & Intensivists of Sri Lanka, from 22nd to 26th February. The session on “Safety Issues in SAARC Region” was chaired by Dr Jannicke Mellin-Olsen, President Elect of the WFSA and opened with a presentation from Dr K. Indraratna, President of College of Anaesthesiologists and Intensivists of Sri Lanka. Interestingly, many of the topics Dr Indraratna raised during his presentation were echoed by the other speakers from Bangladesh, India, Nepal, and Pakistan.
He explained that the key factor affecting anaesthetic patient safety in Sri Lanka was lack of human resources. The College of Anaesthesiologists of Sri Lanka have tried to tackle some of these issues by looking at the staffing needs of the country in future, and developing a plan to have 315 consultants by 2025. Dr BB Mishra, President of the Indian Society of Anaesthesiologists, echoed Dr Indraratna’s comments highlighting the shortage of qualified anaesthesiologists in India, particularly as most providers are working in urban areas, leaving many rural areas without adequate anaesthesia care.
Dr M. Hamid, Associate Professor of Anaesthesiology at Aga Khan University, explained that the trained anaesthetic manpower in Pakistan has not kept pace with surgical manpower. According to the 2012 National Health Facility Assessment Report many District Headquarter Hospitals either have a single anaesthetist catering to the full surgical workload (42%) or no anaesthetists (44%). Only 14% hospitals had two or more anaesthetists.
Similarly, the representatives from India and Bangladesh explained that these workforce shortages are particularly challenging in rural settings, with urban/rural divides existing. Professor D Banik, from Bangabandhu Sheikh Mujeeb Medical University, Dhaka, Bangladesh, touched on the role of Bangladesh government who are trying to increase numbers of providers and to provide anaesthesia services in rural areas by giving training of 6-12 months, which is only an interim solution. A rough estimate given was that 600,000-700,000 surgical procedures annually result in around 300-400 deaths and 6,000-8,000 complications per year. He added that the high workload of anaesthetists, and their low remuneration, was also a problem that must be addressed.
Other issues highlighted at the event were the unavailability of essential equipment and medicines, equipment failures, unavailability of technical support, drug errors, overburdened health care systems, out of hour’s surgery, and a lack of uniform standard guidelines and safety standards.
However, to improve these issues, and issues relating to fatigue due to overwork, Dr M. Hamid emphasized the need to develop a culture of safety. Professor Resham Rana from Nepal also discussed improvements needed in monitoring and supervision, within this culture of safety, as well as improving team communications, improving quality processes, frequent peer reviews, enhancing knowledge and skills, maintaining records and statistics of anaesthesia services and focusing on the training of anaesthesia assistants. Recommendations from other speakers included implementing health policy system changes to tackle issues, encouraging young doctors to choose anaesthesiology as a speciality and better remuneration for physician anaesthesiologists.
The session was followed by a lively discussion which was valuable in highlighting the similar issues faced across South Asia. Many of the problems related anaesthesia safety in this region are common, and apart from learning from each other, these conferences are an opportunity to take things forward. A “Safety Group” was proposed in the Executive Committee meeting of SAARC-AA with the goal of creating common strategies to tackle these issues at regional level, and so safety is at the heart of the work SAARC-AA will be undertaking in the near future.
Photo: WFSA Baxter Scholars and Dr Jannicke Mellin-Olsen, WFSA President-Elect, at the 12th SAARC-AA Conference.