On October 16, 1846, in Massachusetts hospital Boston USA, anaesthesia was administered for the first time. “World Anaesthesia Day” is observed on October 16 all over the world.
The day was also observed in various hospitals of Punjab. Clinical meetings were held and the provision of safe anaesthesia was discussed. Since its inception, the speciality has progressed to the extent that it has become an integral part of the health care system.
Gone are the days when anaesthetists were confined to operation theatres where they would anaesthetise patients to carry out operations. Todays’ anaesthetists are involved in operation theaters, intensive care units, pain clinics, pain relief in labour, gastrointestinal endoscopies, cardiac angiographies, neuro angiographies, ECT for psychiatric patients, cardiac arrest team, trauma and bomb blast. team, resuscitation, transfer of critically ill patients.
The speciality plays a vital role in any hospital and more than 70 per cent health care service in any hospital requires anaesthetists’ involvement. The intensive care units are managed by anaesthesia doctors. With the increasing number of qualified anaesthetists and care of patients in ICU after surgery, the death rate has declined from 1: 10000 in 1960 to 1: 100000 now.
Complex and complicated operations like liver transplant, kidney transplants are possible only because of progress in anaesthesia services.
The involvement of anaesthetists in multiple areas of care has resulted in a shortage of anaesthetists all over the world. Pakistan is also one of the sufferers of this shortage.
Presently there are about 2800 qualified anaesthetists registered with PMDC; the number extremely deficient for safe and quality anaesthetic care. This includes both major and minor qualifications.
The factors leading to current situation are multiple: there is lesser number of training slots, inadequate number of trainers, increasing demand worldwide, transfer of trainers to new medical colleges, difficulty in getting job after higher qualification, stress of speciality, working hours in DHQ/THQ, retention of trained staff, and finances.
The previous and present government took certain steps to meet the demand. We appreciate their efforts but we are sorry to say that Pakistan Society of Anaesthesiologists Lahore has not been taken in confidence by any Government while taking decisions.
The lack of qualified anaesthesia providers is likely to have a dramatic impact on the quality of health care in this country. Without qualified anesthesiologists, many critical surgical procedures may be delayed or even cancelled.
The anaesthetists are solely responsible for the safety of patients during operations. Anaesthetists are not ordinary doctors, and cannot be replaced as the OPD doctors are replaced. Their job is technical and needs training under supervision.
It takes a minimum of two years to train a doctor, for a diploma, who can administer safe anaesthesia, but to a limited extent. It is not justified to send untrained doctors and technologists to administer anaesthesia to poor patients in DHQ and THQ hospitals.
The world federation of societies of anaesthesiologists is continuously campaigning for safe anaesthesia for everyone.
We need to make concrete efforts to provide safe anaesthetic cover to all surgical patients, whether they are in rural areas or urban areas. Safe anaesthesia is patients’ right and is the responsibility of health care authorities.
The World Health Organization and World Bank expect that by 2026, the burden of diseases requiring surgery and anaesthesia will far exceed that of HIV, tuberculosis and malaria. There will be further demand for qualified anaesthetists in future.
A “task force” or “think tank” is needed to make an estimate of workload and required the number of anaesthetists in future.
There should be close collaboration between Pakistan society of Anaesthesiologists, postgraduate institutions, degree awarding authorities and health department to ensure recruitment of trainees, quality training and supervision.
To conclude, anaesthetists are absolutely essential for the delivery of health care services, and staff shortages in this speciality present a serious risk to patient care.
Anaesthetists are like pillars of a building; stronger the pillar strong will be the building. The health department is requested to take serious steps to meet the crisis; unless serious actions are taken the patients will keep suffering.
Safe anaesthesia is not a luxury, it is patients’ right.
Prof Khalid Bashir is president of Pakistan Society of Anaesthesiologists, Lahore.