Fig. 6.1
Anesthesia machine used for storage
Anesthesia Resources
Michael Dobson in his book Anaesthesia at the District Hospital says “good anaesthesia depends much more on the skills, training and standards of the anaesthetist than on the availability of expensive and complicated equipment.” [1] All anesthesia providers wish to give safe anesthesia to their patients. However basic infrastructure, taken for granted in wealthy environments, is often not available in economically challenged areas. This means that special consideration has to be given to the suitability of anesthesia equipment for such regions.
In 2007, Hodges and colleagues studied the resources available in Uganda using a specially designed questionnaire given to 97 participants at a Ugandan anesthesia conference [2]. The response rate was 100 %. The survey requested information on equipment and drugs considered necessary to administer anesthesia to an adult for a laparotomy, to a child under 5 years for an appendectomy, and to a pregnant mother requiring anesthesia for cesarean section. Only the most basic equipment was included such as oxygen, suction, pulse oximeter, blood pressure cuff, laryngoscope, endotracheal tube, and essential drugs. Twenty three (23 %) of the respondents had what they required to give safe anesthesia to an adult; 13 % could give safe anesthesia to the child and only 6 % could safely give general or spinal anesthesia for the cesarean section. This situation is not unique to Uganda but is reflected in studies from many other countries [3–6].
Looking at a basic element such as a reliable electricity supply, the World Bank developed some key performance indicators for Sub-Saharan Africa [7]. Factors such as number of outages per year and capacity of the system were included. Eastern and Southern Africa were doing better than Central and Western Africa in terms of capacity but the number of outages was highly variable from a low of 6 per annum in South Africa to a high of 407 in Guinea. These figures are borne out by information from published studies [3, 8] and particularly by a study done by Michael Dobson for the World Federation of Societies of Anaesthesiologists (personal communication). He contacted anesthesia providers in 122 countries requesting information on electrical supply and oxygen availability. Responses were obtained from 23 low- and middle-income countries (LMICs) which contained information from 52 hospitals. The results are contained in Tables 6.1 and 6.2.
Table 6.1
Availability of electricity and oxygen in Africa
Country | Mains electricity | Oxygen piped | Oxygen cylinder | ||||||
|---|---|---|---|---|---|---|---|---|---|
TH | RH | DH | TH | RH | DH | TH | DH | RH | |
Botswana | F | – | – | G | – | – | G | – | – |
Cameroon | F | F | O | F | O | O | P | P | O |
Egypt | F | F | P | G | G | O | G | G | G |
Kenya | P | – | – | G | – | – | G | – | – |
G | P | P | G | O | O | G | F | P | |
– | G | – | – | G | – | – | – | – | |
F | F | P | G | – | – | G | G | F | |
G | – | – | G | – | – | G | – | – | |
G | – | – | G | – | – | G | – | – | |
Nigeria | F | – | – | F | – | – | F | – | – |
F | P | P | G | O | O | G | O | O | |
P | – | – | O | – | – | G | – | – | |
– | F | – | – | G | – | – | G | – | |
P | – | – | G | – | – | – | – | – | |
Rwanda | F | – | – | O | – | – | G | – | – |
South Africa | G | G | G | G | G | G | G | G | G |
G | G | F | G | G | F | – | – | G | |
G | F | P | G | G | F | G | G | G | |
G | – | – | G | – | – | – | – | – | |
– | F | – | – | G | – | – | G | – | |
Tanzania | F | F | O | – | – | – | – | – | – |
Tunisia | G | F | F | G | O | O | G | G | P |
Uganda | F | – | – | – | – | – | – | – | – |
F | P | – | O | O | O | G | P | P | |
Table 6.2
Availability of electricity and oxygen in Asia
