WORLD ANAESTHESIA DAY The game-enabler in modern surgical care
Every year, on 16th October the World Federation of Societies of Anaesthetists (WFSA) organizes and encourages activities to sensitise the world community on the role of anaesthesia in global health. Looking back on a long and storied history of medical breakthroughs, we’re inclined to remember the discoveries that take the form of lifesaving solutions: penicillin, the polio vaccine, radiotherapy, antiretroviral drugs etc. Our minds turn almost naturally to the game-changing inventions designed to cure or prevent diseases: rarely do they conjure up those that sow the seeds of a whole new playing field. If surgery was the game-changing solution to save or improve lives, anaesthesia was the discovery that allowed the game (as we know it) to be played in the first place. And it’s only fitting that we remember its role. Such is the story of modern anaesthesia, first administered on this day in 1846 by William Morton at Massachussets General Hospital, Boston, USA.
Anaesthesia is the intervention needed to sedate patients for surgical operations, typically consisting of four elements: hypnosis (sleep, loss of consciousness), analgesia (inability to feel pain), and muscle relaxation. Before that happens, anxiolytics to calm patients in fear or agitation as well as amnesia (loss of recall of unpleasant moments) are usually prescribed. Depending on the type and site of surgery, anaesthesia is most often delivered as an injection, a topical agent or an inhaled vapour - all of which are common, safe practices and should be available to almost everyone.
Tremendous and steady progress have been made in global health and in particular surgical practice, where the high-income countries have attained and set standards and safer and more effective methods of providing surgical care for their citizens. Sadly, and tragically this progress has not been uniform. Deaths and disabilities from common conditions needing surgery have grown in the world’s poorest regions, both in real terms and relative to other health gains. At the same time, development of safe, essential, life-saving surgical and anaesthesia care in low-income and middleincome countries (LMICs) have stagnated and regressed. Over 5 billion people do not have access to safe, affordable surgical and anaesthesia care when needed. Access is worst in low-income and lower-middleincome countries, including Nigeria where nine of 10 people cannot access basic surgical care. Of the 313 million procedures undertaken worldwide each year, only 6% occur in the poorest countries, where over a third of the world’s population lives. This is a catastrophy!
Many factors are responsible for this but prominent barriers to the provision of surgical and anaesthesia care that is accessible, safe, timely, and affordable include: Acute shortage of skilled manpower - Lack of appropriate, easy to maintain and affordable equipment - Lack of global policy on anaesthesia The West African College of Surgeons (WACS) and the National Postgraduate Medical College of Nigeria (NPMCN) have identified this factor long time ago and have taken proactive steps by stepping up postgraduate training of medical doctors in anaesthesia. Of course the number of the specialists in anaesthesia has increased remarkably but most have remained in the tertiary health facilities. Secondly, the number of trained surgeons and surgical subspecialities have also risen and with it also more health facilities have been established. There’s also the factor of emigration of the physician anaesthetists to the developed countries.
The technology factor has to be tackled head on. The anaesthesia machines and other equipment essential for the delivery of anaesthetic services have been rendered non functional due to unreliable or non availability of compressed medical gas (oxygen), poor and unreliable electricity supply, lack of spare parts and shortage of funds and the trained biomedical technicians/engineers to fix them. Even when this is done, it will not be sustainable in most rural facilities in Low and Middle Income Countries. The solution lies in development of anaesthesia equipments that can function in the face of these challenges.
The third leading factor affecting global anaesthesia care is policy - and the lack of data necessary to inform it. Confronted with the urgent need to battle infectious diseases like HIV/AIDS, malaria and tuberculosis, governments in LMICs have traditionally prioritized policies to target specific epidemics. But, thanks in large part to the Lancet Commission on Global Surgery and less-disease-specific trends in funding, that paradigm has changed in recent years. There is now a growing body of global, national and sub-national data on anesthesia and surgery that has begun to quantify the problem and influence countries to invest in systems to overcome a new generation of health issues - many of which hinge on better anaesthesia and surgical care.
If there’s one suture that stitches the above factors together, it is the recognition that anesthesia does not hold the revolutionary appeal of penicillin or the immediate treatment power of antiretroviral drugs: it is as much a game-changer as it is a gameenabler. More than a century and a half since it enabled its first surgery, anaesthesia is as critical a medical discovery as any. Now, it is imperative that we make it a staple of every health system - remembering its central role in surgery, even if its patients can’t. If surgery was the game-changing solution to save or improve lives, anaesthesia was the discovery that allowed the game (as we know it) to be played in the first place. And it’s only fitting that we remember its role.
This year, the WFSA seeks to build on its recent successful launch of the SAFE-T (Safe Anaesthesia For Everybody - Today) campaign to raise awareness worldwide as an important component of safe surgery and the need to advance access to safe and affordable anaesthesia worldwide.