Anesthesia in International Health

by Dr. Swetha Pakala
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The World Health Organization has claimed “health is a human right” and therefore every human should be entitled to a healthy life and adequate healthcare.  Unfortunately, huge disparities in health remain, as low income countries carry a disproportionate burden of disease.

When I chose a career in Anesthesiology, I sought to understand the role of surgery and anesthesia in international health.  Despite robust evidence that surgical burden of disease represents a substantial and rapidly-growing  problem in the global arena, surgical concerns have been marginalized within the grand international and public health agendas.  In fact, Dr. Paul Farmer, co-founder of Partners in Health, a nonprofit that specializes in providing care to the poor worldwide, has coined surgery as the “neglected stepchild of global health.”

There is currently a serious global anesthesia workforce crisis.  A shortage in providers as well as limited anesthesia training leads to high rates of complications and anesthesia-related deaths.  While anesthetic officers are eager to improve their skills, they are severely limited in terms of resources and training.  It is unjust and carries severe consequences. I firmly believe it is our responsibility to use our resources to improve safety in surgical and anesthetic care around the world.

We have several ways to do so.  My experiences in global health have included both short-term surgical missions as well as sustainable health efforts.  During surgical missions such as those with Operation Rainbow, I have traveled with multidisciplinary teams of anesthesiologists, surgeons and other practitioners to perform orthopedic surgery to over 80 patients in a span of one week. While immediately productive and fulfilling, these trips are limited in their sustainability.  In order to make a meaningful and lasting impact, we must also focus our attention on using existing local infrastructures to build local workforce.  Our goal is to “teach teachers to teach” so that improved care continues even in our absence.

To this end, I have been involved in anesthesia teaching programs throughout Ethiopia, Malawi, Kenya, Uganda, and Vietnam.  I have focused on utilizing local resources to improve the safety profile of surgery and anesthesia.  Regional anesthesia has a particularly poignant role in these settings, as it allows for safe surgical procedures and improved pain control in the absence of expensive equipment.  Using my skills as a regional anesthesiologist, I am constantly excited to teach local providers the use of safe regional anesthesia.

As a new member of the Department of Anesthesiology at HSS, I hope to develop lasting collaborations with physicians from HSS and under-resourced communities around the world.  As leaders in our field, our impact both in service and teaching trips will no doubt be profound.  Ultimately, our goal as global health advocates is to close the widening gap in burden of disease disparities around the world.

Dr. Swetha Pakala is an anesthesiologist at Hospital for Special Surgery.Dr. Pakala completed her fellowship in Regional Anesthesiology and Acute Pain Medicine at HSS.

Topics: Anesthesiology, Featured
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