Marcel E. Durieux
Teaching Neuroanesthesiology in Africa
My focus is the teaching of anesthesiology in developing countries in Africa. I work with several organizations, and in several locations, to accomplish this. Currently, I participate in programs in Tanzania and Rwanda.
Work in Tanzania is being done in conjunction with Madaktari Africa. This program was started by Dilan Ellegala, M.D., (a UVA Neurosurgery trainee) with the purpose of teaching basic neurosurgical techniques to non-physician medical workers – an innovative approach to address the appalling lack of neurosurgical care in Africa. We work with Madaktari to teach basic neuroanesthesia and intensive care skills to local providers. We’ve organized multi-disciplinary trips (neurosurgery, anesthesiology, critical care) where we spent about a month in one or two locations, teaching the local surgeons, anesthetists and postoperative care providers. The two Tanzania locations we work at are Haydom Lutheran Hospital, a large, rural facility, and Bugando Medical Centre in Mwanza, a university setting. Anesthesiology residents (as well as neurosurgery residents) have been actively involved in these efforts.
Haydom facilities are extremely basic. There are no anesthesia machines and essentially no monitoring equipment is available. Bugando is more advanced, with reasonably modern equipment, but severe limitations in available drugs. Teaching neuroanesthesia in these settings requires translating the underlying principles into practices that are different from those we employ in the US, but feasible in the typical setting in Africa.
At Bugando, we also participate in the anesthesiology training program. This is a one-year, mostly hands-on program. Trainees often have very limited medical background, and this one year of training is all they will receive before going into practice. The sole physician anesthesiologist at Bugando runs this program single-handedly, and welcome support is provided by visiting anesthesiologists, organized primarily through the Global Health program of the Medical University of South Carolina. We help by giving lectures and doing in-OR teaching.
In Rwanda, we also participate in several programs. A joint program by the American Society of Anesthesiologists and the Canadian Anesthesiologists’ Society assists the first anesthesiology residency program in Rwanda. US and Canadian faculty members, accompanied by residents, travel there for a month at a time, to assist with lectures and in-OR teaching. The primary goal is to teach the local anesthesiologists the skills to become effective teachers. A short video about this program is available here.
Recently, funding was obtained for a large-scale effort to improve graduate medical training in Rwanda. This multi-specialty program, named Human Resources for Health and funded by the US government, will allow long-term (6 months to 1 year) visits by US faculty members to help teach their Rwandan counterparts. This may be of particular interest to recent graduates of US residency programs.
Nine universities are involved in this project, and I coordinate the anesthesiology effort at UVA. On a national level, I am a member of the American Society of Anesthesiologists Committee on Global Humanitarian Outreach (GHO). One of the main purposes of this group is to help interested anesthesiologists and residents find appropriate opportunities and organizations for global health work.