This week Anaesthetists from all over Nigeria are gathered in Owerri for their annual conference. For a start the word ” anaesthesia ” itself is a mouthful, not only for patients, but for other doctors as well. What does it mean? In simplest terms, anaesthesia means……no sensation. This is not the same as analgesia…which means “no pain”. During anaesthesia, all sensation, including pain, is (supposed to be) lost.
History records that an early Anaesthetist, whilst giving a new gas for a dental extraction, ended up putting both the patient and the dentist to sleep. He then pulled out the tooth himself and quietly left the room, leaving the two people there to wake up and wonder what had happened. Some go back to Biblical times to observe many times where a supposedly “deep sleep” was induced in certain people. You can even go back right to the beginning of creation, according to the Bible, where “Adam was put into a deep sleep and a rib taken to create Eve”.
What do they do?
In many parts of the developed world the role and importance of Anaesthetists has been long recognised and the specialty is highly respected. Developments in anaesthesia has facilitated the ingenuity and success of today’s highly complex surgical procedures.
Sensation, that is used to be rendered to zero using gases, can now be totally suppressed using intravenous methods alone. Nerves of the body can be located and injected with medications that block their activity and block pain. It is now even possible to visualise these nerves by bouncing sound waves off them, thereby increasing accuracy and reducing complications.
I owe my entire career to the great teachers I had at the University of Ibadan thirty years ago. These were skilled and dedicated men and women who imbibed a clinical and professional dignity to a fledgling specialty which, at that time, commanded little accolades. In the technology of the developed world, it was a surprise to them in the UK that my ‘basic” Nigerian training could shine. What I find, see and experience on my return home now is a bit different.
The decay in health infrastructure has dealt Anaesthesia a devastating blow. Residency training as a whole is, according to the residents themselves, in disarray. I am befuddled to see a junior doctor, coming out of NYSC, being pushed into a career of (perceived) need, rather than one of personal choice. I see hitech anaesthesia machines, dispensing anaesthetic gases long been condemned in other countries, still being administered to Nigerians, because of cheap cost.
All this has impacted on surgical services. It has affected morale and effectiveness of Anaesthetists. It has affected delivery of care to Nigerian patients. This group of doctors meeting in Owerri, working silently, without many of the drugs and facilities I had abroad, without applause, deserve a little, just a little, more support from all stakeholders.
Perinatal and maternal mortality in Nigeria remains among the highest in the world. People die from complications of basic surgery; complications like bleeding and infection. If material and human resources were to be directed at our peri-operative services, Nigeria’s health indices will improve immediately and significantly.
The WHO published recommendations in 2009 to curb the rising incidence of death and mishaps in surgeries around the world. Over half of their ten suggestions is under the control of anaesthesia.“Anaesthetists have great expertise in peri-operative services…..ie before, during and after the actual operation.
Anaesthetists were the original, and still remain, the pioneers of Intensive Care. Over 75 percent of doctors who specialise in Pain Medicine in the USA, and nearly all of them in the UK, are Anaesthetists.
As the Anaesthetists gather this week in Owerri, they need to look inwards too. The NSA needs to, not only reevaluate the training of its residents and the retraining (CPD) of Consultants, they must also regulate and monitor ethics and standards within the specialty.
The role of this small, seemingly unglamorous (I disagree), but vital medical specialty, cannot be underestimated in any healthcare system. Your (physical) life is truly in their hands.