Bringing Anesthesia Training to Sierra Leone
“Surgery is the stepchild of public health,” says Dr. Adaora Chima of the Johns Hopkins School of Medicine, speaking from Sierra Leone, one of the world’s poorest countries.
“However, the World Health Organization (WHO) now realizes that surgical diseases take a huge toll on families and societies in low income countries. Good anesthesia care is an integral part of successful surgery—and that means more effective training.”
Training for Safe Anesthesia in Rugged Environments
Drs. Eric Jackson, John Sampson and Ben Lee of Johns Hopkins Department of Anesthesiology and Critical Care Medicine (ACCM) are leading a project to study the introduction of Gradian’s Universal Anesthesia Machine in Sierra Leone. IngMar Medical is partnering with Johns Hopkins to provide training in this country where critical resources such as personnel, supplies, equipment, and reliable electricity are scarce. The company’s RespiTrainer® —a multi-skill ventilation and airway trainer—and its QuickLung® Breather —a test lung capable of active breathing—have already proved invaluable in the rugged environment of Sierra Leone.
“For respiratory training, we need devices that teach without posing risks to patients,” says Dr. Chima, Senior Research Study Coordinator for Johns Hopkins’ Austere Anesthesia Health Outcomes Research Group. “The RespiTrainer gives us the ability to train personnel, including nurses and anesthesiologist technicians, with different levels of experience—both those who need training in general procedures, like intubation, and those who need training in procedures that occur only rarely [treating allergic reactions to anesthetic agents is one example]. The RespiTrainer can simulate so many types of realistic patient scenarios.”
The Johns Hopkins team is using IngMar Medical products in conjunction with Gradian’s Universal Anesthesia Machine (UAM). The UAM is a self-powered unit developed for austere conditions that has contributed to over 2,000 successful surgeries in other African countries such as Liberia, Ghana, Malawi, and South Africa. The UAM can work with or without electricity; doesn’t require expensive or difficult to source bottled oxygen; is designed to be simple to operate, maintain and repair; and is significantly less expensive than anesthesia machines used in the developed world.
Permission to Fail
Nick Coniglio, IngMar Medical’s Director of Clinical Development, is enthusiastic about the company’s latest collaboration with Johns Hopkins. “Simulation is a benefit to people at every level of expertise. We give you permission to fail, so that you can gain the tools and confidence for success. Our work with Johns Hopkins in Sierra Leone shows you can do substantive respiratory training anywhere in the world.”
While Dr. Chima has seen “good results” from the simulation training done so far in Sierra Leone with the RespiTrainer and QuickLung Breather, evaluation surveys conducted by her team indicate a need for further training. This is why Johns Hopkins is considering bringing IngMar Medical’s high fidelity ASL 5000 Breathing Simulator to Sierra Leone.
“The ASL 5000—for medical personnel ready to work with it—will provide more sophisticated simulation for training. So we’ll start trainees with the RespiTrainer and QuickLung Breather, and then work up to the ASL 5000.”Dr. Adaora Chima, Johns Hopkins’ Austere Anesthesia Health Outcomes Research
The Future: Expanded Maternal Health Care
The UAM training project addresses a key medical issue in Sierra Leone—a recent extension of free health care to women of reproductive age. This is a sea change in a country with a high maternal mortality rate. As Caesarean sections are one of the most common major surgeries in sub-Saharan Africa, the ability to deliver safe and effective anesthesia is critical.
“We’ve had a huge increase in patient caseload because of this extension of care to women in Sierra Leone,” Dr. Chima says, “and access to hospital infrastructure is still being built—but despite the difficulties, we’re optimistic.