Training local clinicians with regional anesthesia techniques has helped the Vietnamese medical community improve their approach to anesthesia care, results of a survey conducted by the Global Health Initiative at Hospital for Special Surgery (HSS) indicate.

These results have spurred new global partnerships with other hospitals, enabling anesthesiologists at HSS to directly address the shortage of adequately trained physicians in underserved areas and help provide sustainable, long-lasting personnel infrastructure within these medical communities.

Since 2011, physicians from the Department of Anesthesiology, Critical Care and Pain Management have been visiting the Hospital for Traumatology and Orthopedics in Ho Chi Minh City, Vietnam, providing hands-on instruction on the use of ultrasound-guided regional anesthesia techniques. The crux of the program, however, isn’t providing care in the short-term but is focused on empowering local anesthesiologists to master these techniques and pass them on to other providers in the community, explained Swetha Pakala, MD, anesthesiologist, and director of the Global Health Initiative, who has brought anesthesiologists and fellows to Vietnam since 2012. She’s found that returning each year helps develop the relationships with the providers who in turn are building their skills more quickly.

"The Global Health Initiative is centered on the idea of providing a self-sustaining model of education," explained Dr. Pakala. "While many mission trips provide much-needed care, once the providers leaves that level of care leaves, too. We wanted to adjust that methodology to not only help patients but instill confidence in providers to perform these techniques so they can continue to utilize them once we leave."

Ultrasound-guided regional anesthesia is associated with lower infection rates, a faster return to function, and requires less medication compared to general anesthesia, making it a worthwhile skill for anesthesiologists to use to combat the large percentage of easily-treatable musculoskeletal conditions that may have otherwise gone untreated in resource-scarce settings like Vietnam.

"More than five billion people do not have access to quality surgical care – that’s more than two-thirds of the global population," explained Mark Brouillette, MD, regional anesthesiology and acute pain management fellow. Dr. Brouillette, who is joining the staff as a full-time attending in the fall of 2018, will help Dr. Pakala lead the Global Health Initiative.

"To improve global health equity, we need more qualified physicians practicing in limited-resource areas, and we need them to feel confident in these skills so they can train others – whether we’re there or not," said Dr. Brouillette.

Dr. Pakala and others measured the program by surveying its participants before and after their five-year curriculum. Overall, each participant surveyed felt confident or very comfortable in using ultrasound-guided blocks; before the Global Health Initiative, not one anesthesiologist expressed this level of comfort.

On average, each participant started using these techniques up to ten-fold more than they used to before the curriculum began, according to the researchers. Additionally, every clinician surveyed indicated they had a high-level of confidence in teaching their local colleagues these blocks in the future, a core tenant of the Global Health Initiative’s mission to provide sustainable education that increases the number of trained physicians in local communities.

After learning the results of the curriculum program in Vietnam, the Global Health Initiative has launched a new partnership with the Department of Anesthesiology and Intensive Care at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. This partnership is affiliated with the hospital’s Global Academic Partnerships.

"The humanitarian work done by Dr. Pakala and colleagues in the Department of Anesthesiology, Critical Care and Pain Medicine is in perfect alignment with HSS on global reach," said Laura Robbins, DSW, senior vice president of Global at HSS.

"HSS and its outstanding clinicians, working together, can have a profound impact on these patients around the world with little or no access to quality musculoskeletal care."

Throughout their time in Ghana, members of the Global Health Initiative will be evaluating their curriculum using the Global Regional Anesthesia Curriculum Engagement (GRACE) protocol. This tool helps by standardizing the design, administration, and measurement associated with implementing a curriculum tailored to meet the needs of local Ghanaian community. Already, members of the KATH department have seen changes in their practice.

"Our regional anesthesia skills were lacking before HSS anesthesiologists came to KATH," said Akwasi Antwi-Kusi, MD, head of the Anesthesia and Intensive Care Department at KATH. "We have much more confidence in performing these techniques and caring for our patients."

The Department of Anesthesiology, Critical Care and Pain Management at HSS hopes to expand their global health offerings and have established a fellowship track dedicated to improving the impact of the Global Health Initiative.