Column: Canuck docs making a difference around the world

I have just returned from Halifax, where I attended a four-day course designed to prepare anesthesiologists who wish to volunteer for service in developing countries.

There is a huge unmet need for safe surgical and anesthetic services in many countries. People die too often from easily treatable conditions such as appendicitis, fractures and obstructed labour. There are widespread shortages of skilled professionals, equipment and supplies.

Anesthesia may often be provided by technicians and not by physicians. Drugs may be available one week and not the other. There may be no blood in the hospital for transfusion.

The electrical supply is often episodic. There may be no oxygen. If there is no laboratory in the hospital, the family is asked to take the patient’s blood sample to a lab across town, pay, and return with the results. There is unpredictable availability of supplies. Sending our old equipment over does not help when there is no capacity to repair them. They often gather dust in a corner.

Trained in Canada, we physicians take a lot for granted: oxygen, equipment to monitor the patient’s vital signs; personnel with the skills to maintain our sophisticated equipment; adequate supplies to replace broken parts; a safe place where patients awaken after surgery; a place to send patients who are critically ill. You need to question all your assumptions when you arrive.

There is a very high childhood death rate. Ditto for mothers giving birth. Patients may labour at home for days. Then, when there is no progress, they seek help. They must often travel long distances, often over very bad roads. In the meantime, bad things can happen. There may be prolonged bleeding causing shock. There may be untreated infection that causes organ failure.

A survey of Ugandan anesthesiologists showed that 23 per cent felt that they had the proper facilities to deliver safe anesthesia for adults, 13 per cent felt that way for kids and six per cent for a Caesarian section.

We were shown a photograph that showed a child’s chin stuck down to his chest by scarring following burn injury. People cook over open fires and accidents are common. The scarring was not repaired for a long time. The result was malnutrition. I saw the picture of a man with a grossly swollen face and lips. He had a throat infection. But he had been so slow coming for help that he could no longer swallow. Sometimes such folks arrive in time to be helped. Sometimes they do not.

Volunteer physicians may be severely traumatized by the patients that they are unable to save; who die from conditions they would never die from in Canada.

Then there are cultural differences. The husband must give consent for surgery for his wife. Parents must consent for their teenage children.

If a woman were to have a hysterectomy without the husband’s permission, she may well be shunned at home. Pain is undertreated because the reporting of pain is held to be an expression of weakness.

The Lancet Commission on Global Surgery concluded that five billion people do not have access to safe, affordable surgical and anaesthetic care. Access is worst in low and lower middle-income countries, where nine out of 10 people cannot access basic surgical care. A quarter of the people who have a surgical procedure will incur financial catastrophe as a result of seeking care.

In Zambia, Canadian physicians are helping to set up its first training program. The aim is to achieve self-sufficiency. Ditto for Rwanda. In Halifax, they are teaching anesthesiologists to practice safely in unfamiliar surroundings. Helping where we can, to make a difference.

Dr. Peter Zalan is president of the medical staff at Health Sciences North.