Solving manpower deficiency in anaesthesia

*Lagos strengthens profession with School of Anaesthetic Studies Badagry
The dearth of manpower in the nation’s health sector has been generating a lot of concern, as it continues to record poor health outcomes.Over the years, Nigeria has been faced with many challenges in her healthcare system; of which majority could be solved if there are adequate human capitals at the various tertiary health institutions.

For instance, the cry over the shortage of anaesthetists in the nation’s health sector, which has been responsible for the number of deaths recorded in the process of surgery. Anaesthetist is a specialist who administers an anesthetic (a drug that causes temporary loss of bodily sensation) to a patient before treatment, while Anaesthesia is a specialty of medicine that deals with reversible, controllable and predictable methods of pain relief for operative surgery, with or without loss of consciousness.

According to experts, the importance of anaesthesia in healthcare delivery cannot be overemphasised, as it addresses not just pain management and intensive care, but also for pregnant women in labour billed for caesarean session as well as for injuries sustained during accidents.

Other areas where anesthesia is required include, care of patients with infections, chronic conditions like heart and kidney problems among others.Although, problems identified as fueling the shortage of manpower in anaesthesia include, lack of training institutions, ill-equipped medical schools, lack of theatres and anaesthetic equipment for surgery procedures, which is evident in the upsurge in medical tourism.

Presently, there are about 3000 anaesthetists rendering healthcare services in Nigeria, which is relatively inadequate to the entire population of over 200 million.Further estimate shows the ratio of one anaesthetist to about 200, 000 to 300, 000 people, as against the World Health Organisation’s (WHO) ratio of one anaesthetist to 10,000 patients.

Nigeria also has only 221 consultant anaesthetists and about 660 trainee anaesthetists at various stages of training, according to figures released by experts.However, as government across board have been urged to Institutionalise a long term plan and place priority attention to training of more manpower in anaesthesia in order to breach the vacuum in all tertiary health institutions across the country, the Lagos state government has brought succor as doctors and nurses are further trained in the School of Anaesthetic Studies Badagry, while they are provided the needed knowledge and skills, which is equated to international standards.

Located inside Badagry General Hospital, the School of Anesthetic Studies, Badagry (SASB) Lagos state, was established in 2006 with the sole aim of addressing manpower development in the field of Anaesthesia by the State Health Service Commission, through the Ministry of Health.

The institution, which is accredited to offer various levels of training programmes in Anaesthesia for both doctors and nurses, is structured on the West African College of Surgeons and National Postgraduate Medical College of Nigeria programmes for Diploma in Anaesthesia as well as the Fellowship programme.

The school has trained and produced about 134 certified and qualified anesthetic doctors and 85 nurses and is still training more to be able to meet the anaesthetic manpower requirement for the numerous hospitals in Lagos state.Record has, however, shown that about 60 to 70 per cent of surgical cases are those with no anaesthetic complications, which can however be managed by these skilled qualified manpower anaesthetists.

When The Guardian visited the institution, the learning facilities are up to standard. Coordinator of the school, Dr. Olaniyi Oladapo, who spoke to The Guardian, said prior to the establishment of the institution in 2006, Lagos state had just 12 Consultant Anaesthetists, with only 10 of them available for clinical duties with very old anaesthetic nurses.“As at 2006, Lagos state had 25 general hospitals and they had just 12 physician anaesthetists and equal number of very old anaesthetic nurses, so there was dearth of manpower in providing anaesthesia service for perioperative surgery,” he noted.

Oladapo explained that the concept and proposal to start an in-house anaesthetic school came from the need to urgently train more manpower to fill the gap and provide the needed services for peri-operative surgery, as the healthcare facilities in the state required the services of about 250 qualified anaesthetists.“There was need to train the needed manpower in-house to forestall the grounding of surgical services if doctors are released for postgraduate training outside the Health Service Commission hospitals,” he added.

The institution’s coordinator said the roles of anaesthetists are vital in the medical profession, as they are the denominator to effective surgical practice.“Outside the operating theatre in the radiology department, there are some procedures for restless patients and children that anaesthetists are involved in order to put them to sleep so that they can take the xray they want to do, this is not to talk of the accident and emergency, especially when there is mass disasters, anaesthetists are also involved in that.
“In the wards, critically illed patients with one or two failure in the system, just like the respiratory system, the heart, the brain – when one or two of it is having problem, anaesthetists are called upon to assist in the resuscitation. There are some we can do by blocking nerves without putting the patient to sleep. These are what make us vital for any organised hospital running,” he explained.

Giving figures of anaesthetic manpower in the country, Oladapo said, though, Nigeria is losing her best brains to foreign countries, the number of anaesthetists is inadequate for the population of the country.“As we train they go abroad, we still don’t have a system to really track our diaspora anaesthetists, but I know that they must be very many.

“To be self-sufficient in anaesthesia manpower in Lagos state only, we will be thinking of having at least a minimum of about 250 anaesthetists, because in each theatre, they must be about six or more. We need that number, just for the general hospitals alone, including the private hospitals around, there should be about 300 anaesthetists for Lagos state alone,” he explained.

While the institution offers Post Graduate Medical training, Post Basic Nursing Programme and Anaesthetic Technician Programme, five Health Service Commission hospitals, which include General Hospital Lagos, Lagos Island Maternity Hospital, Gbagada General Hospital, General Hospital Badagry and the Lagos State University Teaching Hospital (LASUTH) were co-opted as skill acquisition centres to broaden the spectrum and experience of the residents and trainees, owing to the narrow spectrum of cases seen at the General Hospital Badagry, according to the institution’s coordinator.

He added that the Lagos State Health Service Commission hospitals have been accredited as anaesthetic training centres, with the institution as the academic centre, noting that a Memorandum of Understanding (MoU) between the LASUTH Anaesthesia department and the institution has been enclosed.

The institution’s focus of training include: Obstetrics and Gynecology, General Surgery and Specialties, Neuro/ Cardiothoracic, Main Laboratory, Main Blood Bank, Radiology, Accident and Emergency, Intensive Care Management and Trauma, which takes place at the various skill acquisition centres. They include, General Hospital Badagry, Lagos Island Maternity Hospital, Isolo General Hospital, General Hospital Lagos, Lagos State University Teaching Hospital, Gbagada General Hospital, National Orthopedic Hospital Igbobi and the Lagos State Emergency Service (LASEMS).

Oladapo explained that the doctor’s training programme is coordinated by Physician Anaesthetist, while the nursing training programme is coordinated by Anaesthetic Nurse tutor and the for Anaesthetic technician course, a B.Sc. Anaesthetic Nurse tutor is in charge.He said Consultant Lecturers of the school are free to move around other Health Service Commission hospitals to run lists and supervise the residents on postings there, adding that they also have a visiting consultant appointment with LASUTH based on the MoU.

Speaking on the capacity of the institution, Oladpo said: “Right now, we have the Diploma in Anaesthesia Programme, the Master, and the Fellowship. But for the Diploma programme, we were given the capacity to train 30 doctors, and for the Fellowship training programme, we are restricted to 16 doctors because it is the ratio of 1:4 doctors.

He explained that the duration for the Diploma Programme in Anaesthesia is 12 months, Master programme is 18 months, while the Fellowship Programme is a minimum of five years from the day the practitioners joins the institution for the training programme. Oladapo noted that the demand and availability of the eligible residents for further fellowship training puts the Health Service Commission under pressure, adding that the continued services of the doctors are needed consequently, which was the primary reason for the request for the accreditation for full fellowship training in anaesthesia.

He said the preparation for full fellowship training will include, Neuro-Anaesthesia and Cardiothoracic Anaesthesia as well as posting in medicine which will be arranged in the accredited hospitals in the county.He added that training centres with senior residents is on weekly basis, which include journal review, case study and analysis, research methodology and other needed areas as the curriculum directs.

Others include the school library, which will be upgraded and connected to the e-health system of Lagos State Hospitals.He said 10 Fellow Consultants would be in charge of the Fellowship and Diploma training. Oladapo said they would be assisted by eight Diplomate Consultants with two visiting Consultants, which would ensure the residents get the best skills and knowledge for the profession.

The school coordinator noted that those qualified to enroll and undergo the training include, qualified doctors that have done their National Youth Service Corp (NYSC), housemanship, while for nurses, they must be register and for anaesthetic technician, they must have a qualified school certificate with English, mathematics and one science subject.

Explaining the preparation process, Oladapo said, after passing the prescribed entrance examination, the students are given two weeks of intensive introductory course in anaesthesia, which comprises of basic sciences, pharmacology, anatomy and physiology.He said the aim is to impart in them some basic knowledge of anaesthesia before the beginning of the clinical skill acquisition, after which they are posted on a rotation of two months to the respective skill acquisition centres for further training on the profession.

On the facilities meeting up with international standards and practices, the institution’s coordinator said the state government has equipped the school and the theatres in all the accredited hospitals, which is the learning area for the training.
“Every student is posted out to the accredited hospitals for two to three months, where we rotate them round the hospitals. That gives them a lot of varieties of situations and in each of these hospitals there are qualified consultants to train them.

He continued: “The training is to international standards, because we use the syllabus of the West Africa College of Surgeons, as well as National Post-Graduate Medical College and from the performance evaluation, you can see the number of our students that have really passed these exams. That is an attestation to the fact that the training programme at the School of Anaesthetic Study Badagry is of International standards.

“Furthermore, at least I can count about 10 of our graduates that are working in the United Kingdom, America and about three in the United Arab Emirates and there is no adverse reports because they often send for their transcripts before they are employed.”Oladapo said the school has also trained manpower outside the state’s hospitals with its external accredited programme, such that the medical programmes are exposed to the public, while it trained personnel for the armed forces and private hospitals

He lamented that the problem facing anaesthesia as a profession is multifactorial, as an average young graduate in Nigeria wants to go for a lucrative profession that can earn him quick money.“Although, there is money in anaesthesia, just like pain management in labour and intensive care, which are capital intensive, unlike when a surgeon graduates, he can readily open a clinic, but that is not helping the situation.

“What we are now doing is to increase the advocacy in the medical schools. During our own time, we just did about two weeks of anaesthesia, but they are now requesting that the number of exposure at that early stage be up to six weeks. It is a lot of effort retaining them to specialise in anaesthesia. The beauty of it is that just this April, 2019, this school produced the first two fellows in Anaesthesia for the state,” he added.

He noted that the benefit of the anaesthetic training programmes, include being recognised as a specialist in Anaesthesia, with the diploma certificate, a Senior Specialist in Anaesthesia with the Master’s programme certificate and a Consultant in Anaesthesia with the Fellowship programme certificate.

Speaking on the progress made by the institution, Oladapo said presently, there has been 500 percent increase in the doctor anaesthetic manpower to the 25 hospitals of the state, adding that all the hospitals now have coverage of qualified anaesthetic manpower of both doctors and nurses.

The school coordinator, however, requested that the training billet approved for the school should be upwardly reviewed, especially for the fellowship and diploma programme in anaesthetics to accommodate the increasing number of residents joining the programme.He further said once the manpower is trained to administer safe anaesthesia in the country, which is the aim of the programme, there should be at least one physician anaesthetist in a primary or secondary health facility where surgery is performed so that the expected degree of safety can be guaranteed.