HSS anesthesia education program sees sustainable results in Vietnam

May 14, 2018, Hospital for Special Surgery

Training local clinicians with regional anesthesia techniques has helped the Vietnamese medical community improve their approach to anesthesia care, results of a survey conducted by the Global Health Initiative at Hospital for Special Surgery (HSS) indicate.

These results have spurred new global partnerships with other hospitals, enabling anesthesiologists at HSS to directly address the shortage of adequately trained physicians in underserved areas and help provide sustainable, long-lasting personnel infrastructure within these medical communities.

Since 2011, physicians from the Department of Anesthesiology, Critical Care and Pain Management have been visiting the Hospital for Traumatology and Orthopedics in Ho Chi Minh City, Vietnam, providing hands-on instruction on the use of ultrasound-guided techniques. The crux of the program, however, isn't providing care in the short-term but is focused on empowering local anesthesiologists to master these techniques and pass them on to other providers in the community, explained Swetha Pakala, MD, anesthesiologist, and director of the Global Health Initiative, who has brought anesthesiologists and fellows to Vietnam since 2012. She's found that returning each year helps develop the relationships with the providers who in turn are building their skills more quickly.

"The Global Health Initiative is centered on the idea of providing a self-sustaining model of education," explained Dr. Pakala. "While many mission trips provide much-needed care, once the providers leave, that level of care leaves, too. We wanted to adjust that methodology to not only help patients but instill confidence in providers to perform these techniques so they can continue to utilize them once we leave."

Ultrasound-guided regional anesthesia is associated with lower infection rates, a faster return to function, and requires less medication compared to general anesthesia, making it a worthwhile skill for anesthesiologists to use to combat the large percentage of easily-treatable musculoskeletal conditions that may have otherwise gone untreated in resource-scarce settings like Vietnam.

"More than five billion people do not have access to quality surgical care—that's more than two-thirds of the global population," explained Mark Brouillette, MD, regional anesthesiology and acute fellow. Dr. Brouillette, who is joining the staff as a full-time attending in the fall of 2018, will help Dr. Pakala lead the Global Health Initiative.

"To improve global health equity, we need more qualified physicians practicing in limited-resource areas, and we need them to feel confident in these skills so they can train others—whether we're there or not," said Dr. Brouillette.

Dr. Pakala and others measured the program by surveying its participants before and after their five-year curriculum. Overall, each participant surveyed felt confident or very comfortable in using ultrasound-guided blocks; before the Global Health Initiative, not one anesthesiologist expressed this level of comfort.

On average, each participant started using these techniques up to ten-fold more than they used to before the curriculum began, according to the researchers. Additionally, every clinician surveyed indicated they had a high-level of confidence in teaching their local colleagues these blocks in the future, a core tenant of the Global Health Initiative's mission to provide sustainable education that increases the number of trained physicians in local communities.

After learning the results of the curriculum program in Vietnam, the Global Health Initiative has launched a new partnership with the Department of Anesthesiology and Intensive Care at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. This partnership is affiliated with the hospital's Global Academic Partnerships.

"The humanitarian work done by Dr. Pakala and colleagues in the Department of Anesthesiology, Critical Care and Pain Medicine is in perfect alignment with HSS on global reach," said Laura Robbins, DSW, senior vice president of Global at HSS.

"HSS and its outstanding clinicians, working together, can have a profound impact on these patients around the world with little or no access to quality musculoskeletal care."

Throughout their time in Ghana, members of the Global Health Initiative will be evaluating their curriculum using the Global Regional Anesthesia Curriculum Engagement (GRACE) protocol. This tool helps by standardizing the design, administration, and measurement associated with implementing a curriculum tailored to meet the needs of local Ghanaian community. Already, members of the KATH department have seen changes in their practice.

"Our regional anesthesia skills were lacking before HSS anesthesiologists came to KATH," said Akwasi Antwi-Kusi, MD, head of the Anesthesia and Intensive Care Department at KATH. "We have much more confidence in performing these techniques and caring for our patients."

The Department of Anesthesiology, Critical Care and Pain Management at HSS hopes to expand their global offerings and have established a fellowship track dedicated to improving the impact of the Global Health Initiative.

Explore further: People tend to overestimate pain from surgery

Related Stories

People tend to overestimate pain from surgery

November 3, 2017
(HealthDay)—Many patients overestimate the amount of pain they'll experience after surgery, resulting in needless anxiety, a new study reports.

Pain management in low-resource settings—anesthesiologists advocate for increased access

March 20, 2018
Increasing the availability of effective pain management in low- to middle-income countries will be an essential part of ongoing efforts to expand global access to safe surgery and anesthesia, according to a special article ...

Physician anesthesiologists oppose VA rule replacing physicians with nurses in anesthesia

May 25, 2016
The American Society of Anesthesiologists (ASA) urges Americans to protect our nation's Veterans by opposing a U.S. Department of Veterans Affairs (VA) proposed policy that removes physician anesthesiologists from surgery ...

ACP issues ethical guidance for individuals participating in volunteer medical trips

March 27, 2018
Physicians who participate in short-term global health experiences such as volunteer medical trips have ethical obligations to the individuals and communities they serve, the American College of Physicians (ACP) advises in ...

Anesthesia safe for kids, doctors' group says

July 15, 2016
(HealthDay)—Anesthesia eases the pain of millions of children who must have surgery every year, but parents who are worried about the safety of these medications should talk to their anesthesiologist about their fears, ...

Chance of falling after knee replacement not increased by regional anesthesia

February 18, 2014
Two types of regional anesthesia do not make patients more prone to falls in the first days after having knee replacement surgery as some have previously suggested, according to a study based on nearly 200,000 patient records ...

Recommended for you

Surprise finding—for very sick elderly, lighter sedation won't drop risk of postoperative delirium, study suggests

August 13, 2018
Johns Hopkins Medicine researchers say a study designed to see if reducing the amount of anesthesia reduces the risk of postoperative delirium in older patients surprisingly found that lighter sedation failed to do so in ...

Kidney transplant chains more effective in saving lives

August 9, 2018
New research from the UBC Sauder School of the Business has found that transplant societies which prioritize kidney transplant chains over kidney exchanges can increase the total number of transplants, thereby saving more ...

Surgical mesh implants may cause autoimmune disorders

July 31, 2018
Surgical mesh implants, often used for hernia or gynecological repair, may be the reason so many patients report symptoms of an autoimmune disorder, according to a University of Alberta rheumatologist.

Surgeons discuss options when the risks of surgery may be too high

July 27, 2018
In an essay published July 26 in the New England Journal of Medicine, Ira Leeds, M.D., research fellow, and David Efron, M.D., professor of surgery, both of the Johns Hopkins University School of Medicine, along with their ...

Blood plasma during emergency air transport saves lives

July 25, 2018
Two units of plasma given in a medical helicopter on the way to the hospital could increase the odds of survival by 10 percent for traumatically injured patients with severe bleeding, according to the results of a national ...

The dark side of antibiotic ciprofloxacin

July 25, 2018
The use of ciprofloxacin and other antibiotics of the class of fluoroquinolones may be associated with disruption of the normal functions of connective tissue, including tendon rupture, tendonitis and retinal detachment. ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.