Completeness of Care: Anaesthesia

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Anaesthetist Dr. Ahmed Shorrab of the United Arab Emirates administers anaesthesia to a young patient during an Operation Smile Medical Mission to Amman, Jordan, in 2017. Photo: Manuela Emmer.
 

Editor’s Note: With more than three decades of experience performing safe surgery in resource-limited environments, Operation Smile knows that a single surgical procedure is a small part of a larger process that’s focused on the entire well-being of the patient. Our “Completeness of Care” series highlights each of our volunteer medical specialities and the critical roles these dedicated, selfless volunteers play in our ability to uphold our Global Standards of Care*, which outlines procedures that allow us to provide our patients with outcomes that are consistent with the world’s finest hospitals, no matter where in the world our surgeries are performed.

Over the years, many analogies have been drawn between anaesthesiologists and airline pilots to contextualise the immense responsibilities of their duties.

The most common parallel is assigned to the most dangerous aspect of their work – for pilots, it’s the takeoff and landing of the airliner – for anaesthesiologists, it’s the patient’s induction and emergence during general anaesthesia.

And that’s for good reason: Both have people’s lives in their hands.

That’s why Operation Smile utilises the talents of some of the world’s most highly-skilled and highly-trained anaesthetists and certified nurse anaesthetists to volunteer at our medical programs.

In the most resource-poor areas of the countries where we work, the everyday administration of anaesthesia can pose serious risks to the health and lives of surgical patients, depending on the setting. This can be due to the lack of skilled professionals, adequate infrastructure, facilities and equipment, or any combination of these factors.

The results are alarming. According to the World Health Organization, the risk of dying from anesthesia complications in resource-poor environments is 100 to 1,000 times higher than in high-resource environments. In some parts of sub-Saharan Africa, it’s reported that one in every 150 patients die during general anesthesia.

Acknowledging the life-and-death stakes that come with this territory, Operation Smile’s Global Standards of Care outlines stringent protocol that’s carried out by credentialed, trusted and experienced anaesthesia providers using only the highest-quality anaesthetics.

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Anaesthetist Dr. Clive Duke of the United Kingdom, centre, at work during an Operation Smile medical mission to Accra, Ghana, in December 2011. Photo: Peter Stuckings.

That’s what attracted Dr. Clive Duke, an anaesthetist and educator at West Suffolk Hospital in the United Kingdom, to become an Operation Smile medical volunteer.

“I’d been looking into volunteering for some time but didn't want to lower my clinical standards just because I was working in (resource-poor environments),” said Clive, who’s served on 13 Operation Smile medical missions since 2010. “Operation Smile gave me to opportunity to do what I wanted to do with the appropriate support and kit. That was my original reason for going on my first mission, but since that start, I’ve seen firsthand how life-changing our work is for the children.”

The administration of anaesthesia is only one facet of the anaesthesia provider’s role while volunteering for Operation Smile. They also work closely with nurses, paediatricians, paediatric intensivists and cleft surgeons to conduct our patients’ pre-surgical comprehensive health evaluations – a critical step to determine who will be able to receive surgery during a medical program.

“We make sure that the patient is fit to safely undergo the procedure. This is done through careful screening, examination, lab testing and discussion with the patient, family and surgeon,” said Dr. Ahmed Shorrab, a veteran of four Operation Smile medical missions and the head anaesthetist at University Hospital Sharjah in the United Arab Emirates. “Then we offer the intra-operative management and post-operative care, including adequate alleviation of pain.”

 
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Anaesthetist Dr. Marcelo Teixeira dos Santos of Brazil, left, prepares a young patient for their anaesthesia experience before surgery at an Operation Smile medical mission to Fortaleza, Brazil, November 2016. Photo: Paulo Fabre.

Dr. Marcelo Teixeira dos Santos of Brazil added: “We have many critical situations and we need to act very quickly in a safe way…

“The anaesthetist’s role is fundamental and crucial in situations like bleeding, difficult airways and airway obstruction. Fortunately, those situations aren't very frequent, but they are urgent and our role is crucial for a successful end,” said Marcelo, who’s worked at the Federal University of Rio de Janeiro for 26 years and served on 19 Operation Smile medical missions.

“With Operation Smile missions, I’m always learning how to manage critical situations, especially because we are working in a different environment than our regular work.”

Patients aren’t the only people our volunteer anaesthetist serve on our medical programs. Key agents of Operation Smile’s commitment to building surgical capacity where we work, they also host educational lectures and hands-on training for local medical professionals during medical programs. Anaesthesia training is also incorporated into our surgical training rotations in Ethiopia, Rwanda and Madagascar – places in dire need of surgical workforce development.

Like every member of the Operation Smile medical volunteer community, showing compassion for patients and their families is a close second to safety.

“On every mission, I am able to identify a few kids that face problems greater than the rest,” said Dr. Chris Erkmann, an anaesthetist of 33 years who works at Mercy Hospital in St. Louis. “Perhaps it’s the nature of their disfigurement, their family’s lack of acceptance or the terror they face – all of these are challenges that I accept in trying to relate to them – to show them the love, compassion and acceptance that I’m willing to share.

“With only a few minutes of opportunity, I do my best to work with them pre-operatively to gain their confidence, then guide them through a safe anaesthetic,” added Chris, who’s attended 15 Operation Smile medical missions. “I then visit with them post-operatively and hope that I was able to have a positive impact on them.”

 
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Anaesthetist Dr. Chris Erkmann of the United States, left, prepares a young patient for anaesthesia during an Operation Smile medical mission to Managua, Nicaragua, in November 2016. Photo: Margherita Mirabella.


*Global Standards of Care © 2006, 2015 Operation Smile, Inc. All Rights Reserved.


 
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“Every child that has a facial deformity is our responsibility. If we don’t take care of that child, there’s no guarantee that anyone else will.”

- Kathy Magee, Operation Smile Co-founder and President