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The Road to Tanzania

Anesthesia Department joins outreach to Africa 
by Dawn Brazell
Public Relations
Carlee Clark, M.D., left Tanzania surprised by the nurses who were asking if they could keep her tennis shoes and operating garb. She gladly agreed, but what she got in return was well worth it, she said.
Dr. Carlee Clark, recently visited Tanzania as part of a medical mission trip to see ways MUSC's Department of Anesthesiology can help improve the training of the region's anesthetists. She enjoyed seeing the wildlife while she was there.

Clark, who went to Africa for two weeks in February as a representative of MUSC’s Anesthesia & Perioperative Medicine Department, worked with staff to assess and find ways to improve the way anesthesia is being done. The trip is part of the Madaktari program started by Dilantha B. Ellegala, M.D., in MUSC’s Department of Neurosciences. The non-profit program works with the country’s Ministry of Health and regional hospitals to create sustainable health care in East Africa. For information on the Madaktari program, visit
Neurosurgeons volunteering in the country realized that the anesthesia being provided wasn’t very good, she said. Ellegala decided to seek help from MUSC anesthesiologists who could provide the training to allow them to take better care of patients.
Clark decided she’d love to go.
Her goal was to observe, assess weaknesses and strengths, and find the best ways to train the anesthetists there. This was her first trip to Africa and her first mission trip. She had no idea what to expect at Bugando Medical Center, but she went with an open mind. She was pleased to get a warm, friendly welcome, she said.
Anesthetist students at Bugando Medical Center gather for morning report.

“What I found was a group of amazing people trying to practice good anesthesia with limited resources and a mentality towards patient care that was inconsistent. I spent the majority of my time observing, asking questions and commending them when they did something well.”
Her strategy worked well, allowing her to quickly gain their trust, she said. She met with the one anesthesiologist, and then the nine senior anesthetists, who were students. Since they get little supervision in the operating room, the senior anesthetists were excited to have her with them to answer questions, she said.
“What I learned was both fascinating and frightening at the same time.”
The senior anesthetists, who get paid salaries at a nursing level, are responsible for the 24/7 coordination, administration and education that happens in the six operating rooms at Bugando Medical Center. Two of them also share the responsibility for scheduling, ordering and maintaining of equipment and the ordering of medications.
There currently are 23 anesthetist students, with their training program being only 12 months long, she said. A nurse who “monitors” the patients runs the Post Anesthesia Care Unit (PACU). The patients are suctioned, extubated and then watched only five to 15 minutes before being shipped back to the floor.
Clark supervises and teaches one of the anesthetist students in the operating room.

About 200 cases are done a week in six operating rooms, with 50 to 60 cases in general surgery and orthopaedics being scheduled on Mondays, Wednesdays and Fridays. The wait list for surgery is almost three months long. Patients have to pay up front or their cases are cancelled. If they can pay more, their cases are pushed up on the schedule. The anesthetists try to keep the patient’s costs down by limiting medications or using local or regional whenever possible, she said.
“They try to make things as cheap as possible. Some patients get no pain medicine at all. The patients are great. They’re very stoic.”
Clark said she found sometimes the staff was more concerned about speed than safety. Abnormal laboratory results were not repeated, for example. The range of education also varied greatly among the staff, with some having a very poor level of basic anatomical knowledge. Medical staff members also can be stretched thin because they’re serving multiple roles. For example, there’s no circulatory nurse so the anesthesiologist has to perform a dual role, she said.
“On the slower days, the operating rooms get cleaned more and the patients get more time in the PACU. On busy days, it is impressive how well everyone works together to get things done as quickly as possible, but it is obvious that patient care suffers on these days.”
Clark said staff members are aware that they’re not practicing up to the standards in the United States, but that she was impressed by how well they did with often limited resources. She spent much of her time assessing their needs and providing training, since the project is to help them be self-sustaining.
“It’s a very interesting situation because it’s a training center. It’s a place we can effect change. It was a welcoming environment and one in which residents, CRNAs and attendings could all go and bring about change. I think this will be a great opportunity for the department of anesthesia, and I’m excited to be a part of it.”
Scott T. Reeves, M.D., and chairman of MUSC’s Department of Anesthesia & Perioperative Medicine Department, left May 2 for 10 days to visit various sites to determine where training will be most effective. Clark said she definitely will be going back at some point. She would like to get more students there interested in anesthesia and encourage them to apply for postgraduate training. She also wants to encourage them to spend more time with patients and examine how they handle their case loads to create a safer environment.
“I enjoyed working with them. They’re great. They want so badly to be doing better.”

Friday, May 7, 2010

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