1 / 69

PROVIDING ANESTHESIA BEYOND USA BORDERS

PROVIDING ANESTHESIA BEYOND USA BORDERS. KATUBIYA BENJAMIN BAKATUBIA SRNA ,RN , BS, MBA ALLEGHENY VALLEY HOSPITAL /LA ROCHE COLLEGE SCHOOL OF ANESTHESIA 2011 SPRING ANESTHESIA CONFERENCE APRIL 02,2011. METHODS OF PROVIDING ANESTHESIA SERVICES BEYOND THE USA.

lew
Download Presentation

PROVIDING ANESTHESIA BEYOND USA BORDERS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. PROVIDING ANESTHESIA BEYOND USA BORDERS KATUBIYA BENJAMIN BAKATUBIA SRNA ,RN , BS, MBA ALLEGHENY VALLEY HOSPITAL /LA ROCHE COLLEGE SCHOOL OF ANESTHESIA 2011 SPRING ANESTHESIA CONFERENCE APRIL 02,2011

  2. METHODS OF PROVIDING ANESTHESIA SERVICES BEYOND THE USA • Currently they are two main methods a Certified Registered Nurse Anesthetists from the USA can provide anesthesia service to other countries. • Legally working • In certain parts of the world • Any country if working for a USA agency • Volunteerism • Technology may introduce new choices

  3. LEGALLY WORKING FOR NON-USA AGENCIES ABROAD • Nurse Anesthetists are practicing all over the world , generally. • However , mobility for nurse anesthetists to practicing in other countries is affected by • Rules and regulations defining conditions for being authorized as a foreigner for practicing. • Economics

  4. COUNTRIES WHERE NURSE ANESTHETIST CAN WORK LEGALLY • North AmericaUSAJamaica • AfricaCongo Democratic R Ghana Tunisia • EuropeDenmark FranceUnited Kingdom Switzerland Sweden • AsiaCambodia IndonesiaTaiwan

  5. COUNTRY ANNUAL SALARIES (€) COMPARED

  6. 1 euro = 1.4234 US dollars EXCHANGE RATE 1 euro = 1.4234 US dollars

  7. WHO IS A NURSE ANESTHETIST VOLUNTEER? • A Nurse Anesthetist volunteer is someone ,qualified ,who performs a nursing and anesthesia service for free. • The community, organizations and individuals receive a vital benefit, that otherwise , could not have existed without the assistance of volunteers.

  8. BENEFITS OF VOLUNTEERING • Perhaps the first and biggest benefits are the satisfaction of serving and making a difference in the community and country. • The Pride, satisfaction and a sense of accomplishment alone are worthwhile intangible beneficial reason to serve, share time and talents. • CRNA volunteers also: • Transform their own lives • Solve problems • Strengthen communities • Improve lives • Connect to others

  9. "Everybody can be great because everybody can serve.“ - Martin Luther King, Jr.

  10. VOLUNTEERING AND HEALTH • A review of recent researches, has established a strong relationship between volunteering and health. Those who volunteer have • lower mortality rates • greater functional ability • lower rates of depression later in life than those who do not • Comparisons of the health benefits of volunteering for different age groups have also shown that older volunteers are the most likely to receive greater benefits because • volunteering provides them with physical and social activity • They obtain a sense of purpose at a time when their social roles are changing. • 100 hours in volunteer time per year are most likely to exhibit positive health outcomes

  11. GLOBAL HEALTH CRISIS • The above is made up of a populations in crisis of: • longevity • maternal mortality • compromised survival from trauma and other emergencies. • A predicament triad manifests itself as follows : • Limited higher education • Compromised level of care • Lack of expertise and technical anesthesia providers • No availability of safe anesthesia for surgery, labor and delivery and other procedures. • No provision of acute and chronic pain relief strategies. • No existence of highest level of intensive care. • Lack of equipment / technology

  12. THE DEGREE OF CRISIS • Anesthesia crisis exist in low-income countries • In the USA, there are 35 anesthesiologists for 300 thousand people • In Cambodia, there 25 anesthesiologist for 13 million people • In Ethiopia, there are 12 practicing anesthesiologists for 85 million people. • In Sierra Leone there is 1 anesthesiologist for 5 million people

  13. Ratio Nurse Anesthetist / 100 000 Hbts

  14. RATIO OF ANESTHESIA CASES NOT REALIZED BY ANESTHESIOLOGIST

  15. LENGTH OF VOLUNTEERING • Two types of time period exist • Short term ( 1 week to three months) • Maybe planned or unplanned • Unplanned Includes : • response to world disasters such as Katrina Hurricane , Earth Quakes in Haiti and Japan, etc • Planned ones marches : • Personal fulfillment • Professional Credits • School programs • Vacation • Long term (6 months to a number of years) • Usually planned • Establishing and running an anesthesia school • Supporting local government with anesthesia policy making • Establishing a hospital

  16. SELECTING A VOLUNTEERING ORGANIZATION • Depends on • Personal goals • Locations in crisis • Organizational goals • Quality of information • Internet • Websites • Seminars • Meeting other volunteers • Current affairs and news

  17. PLANNING • Passport • Not all countries require U.S citizens to carry a passport to enter • A passport or birth certificate may be needed to return to the United States. • Leave a copy of the face sheet of your passport at home in case of emergencies • Visa • A visa overlooked maybe a denial of entry into a foreign country. • Check this requirement and start procurement process at least several weeks early • Check in with the U.S. Embassy or Consulate on arrival. • Contact you in an emergency. • License • Your licenses e.g nursing , etc must be valid and current

  18. PLANNING • Financial and expenses • Plan before you leave • Expenses varies with the sponsoring group • Be ready to spend • Remember to arrange for payment of your own bills at home • Taxes • Direct and documentable expenses can be deducted from individual income tax. • Even for volunteer expenses claimed on tax returns can be audited by the U.S. Internal Revenue Service

  19. PLANNING • Anesthesia equipment • Assume a simplest of anesthesia equipment at your destination. • Ask preceding anesthesia provider • A portable pulse oximeter from Walgreen is a good idea • Owning laryngoscope maybe useful • Think outside the box. • Sanitation • Different standards from the United States. • Carry your own toilet paper and packaged towelets. • Okay to bath with water from the faucets or fountains • Use bottled water for drinking and brushing your teeth • Do not eat uncooked foods , unless cleaned with bottled water

  20. PLANNING • Prescription drugs and medical devices • Appropriate labels and original container • A letter from the sponsoring agency stating • Purpose of your trip • You will be carrying medical supplies • It is hard to bring them back medical supplies and drugs into the United States. • Oxygen • No

  21. PLANNING • Health precautions • You are a tourist but will be working in environment with infection that you are not immune to. • Universal precautions • Malaria prophylaxis recommended if going to endemic to the region. • A gamma globulin shot to protect against infectious hepatitis is recommended in the week before leaving. • Tetanus, polio, and measles boosters • Yellow fever, cholera, and other vaccinations may be required • Consult with a travel clinics and CDC hotline

  22. A LITTLE BACKGROUND OF AFRICA • Consists of • 48 countries on the African continent (if Sudan is officially split into two N. Sudan and S. Sudan) • 6 island nations • Is second largest continent , following Asia • Africa population is around 1 billion • Most African countries have annual population growth rates above 2% • In some African states half or more of the population is under 25 years of age

  23. A LITTLE BACKGROUND OF AFRICA • Life expectancy is below 60 years in most the African Countries • Other mortality rate: • The infant mortality rate is at 9% • Child mortality under five years at 15%

  24. Weather • Tropical: • warm and comparatively dry inland • hot and humid along coast area • Season • Snow is rare during winter • During the rainy season one enjoys both lots of rain and beautiful skies daily.

  25. ANESTHESIA VOLUNTEERING IN AFRICA • How does a typical major city look like ?

  26. ACCOMODATIONS • Accommodations are usually • quite adequate • include : • dormitories • private homes • occasionally hotels • guesthouses

  27. JOURNEY TO AFRICA • How does a providing anesthesia in a typical village looks like ?

  28. TYPES ANESTHESIA SERVICES NEEDED • The types of anesthesia services you can get involved are : • Academics • Training SRNA • Operating a volunteer service • Administering Anesthetics • Knowledge of culture , customs and tropical co-exisiting diseases is important

  29. COMMON CO-EXISTING DISEASES • The most common co-existing diseases are : • Diabetes • HTN • Malaria • Cholera • Yellow Fever • Tuberculosis • Dengue Fever • Typhoid Fever • Sickle cell anemia

  30. DISTRIBUTION OF CO-EXISTING DISEASES • Malaria (Most Common) • Botswana • South Africa • Namibia • Swaziland • Zimbabwe • Dengue Fever • Zimbabwe • South Africa • Swaziland • Typhoid Fever • South African countries. • Most concentrated in the rural areas • Smaller cities. • Yellow Fever • Sudan • Angola • Congo DR. • Cholera • Southern African countries

  31. SICKLE CELL DISEASE • Sickle cell disease is an autosomal recessive inheritance hemoglobinopathy. • Beta chain of HgbA has valine substituted for glutamine at position 6 • Homozygote have symptoms secondary to deoxygenated HgbS which undergoes sickling • RBCs become insoluble, rigid and sickle shaped • Onset likely in hypoxia, acidosis, low temperature or cellular dehydration •  Reversible only before H2O and K are lost

  32. SCD CLINICAL FEATURES • Hematological. • Acute low Hgb secondary to infection induced hemolysis or an acute sequestration syndrome in the spleen . • multiple organ damage through repeated veno-occlusive episodes . Blood transfusion is essential. • Respiratory. • Acute chest syndrome .S/S include dyspnea, cough , hemoptysis and pleuritic chest pain. • pulmonary hypertension and respiratory failure. • Genitourinary. • Relative hypoxia and hyperosmolarity of the renal medulla creates an environment for sickling in the vasa recta. Hematuria and Priapism

  33. SCD CLINICAL FEATURES • Liver. • Jaundice , gallstone and Liver failure • Skeletal. • Sickling and microvascular occlusion causes shortening of the limbs and gross deformity of joints. Osteomyelitis . • Skin. • Leg ulcers • Neurological. • Acute brain syndrome with s/s of confusion with variable neurological defects.

  34. SCD PREOP MANAGEMENT • Full blood count. • Sickledex • Urea and electrolyte. • Liver function tests. • ECG • Chest X-ray

  35. SCD • Local infarction causes: • Chest pain • Musculoskeletal pain • Abdominal pain • Splenic sequestration • Hematuria • CVA /TIA • Problems • Anemia • Prevention of sickling • Surgical procedure • Infection risk

  36. SCD ANESTHETIC MANAGEMENT • Achieve HgbA >40% with total Hgb >10 g/dl via exchange transfusion. Transfuse slowly to avoid an increase in blood viscosity. Aim to achieve HgbA levels of more than 70% to limit sickling crises. • Assess for pre-existing organ damage • Caution with sedation. Anxiolytics are preferable to opiates • Monitor : • SaO2 • Temp • Urine • hydration

  37. SCD ANESTHETIC MGT • Replace fluid loss promptly. A central venous pressure line may help monitor fluid replacement. • Adequate oxygenation • Pre-oxygenation, hyperventilation can shift oxy-Hgb curve to the left and O2 is more readily bound • Maintain cardiac output • Avoid vasoconstrictors • May need antibiotics

More Related