Janowicz Anna, Kasole Tuma, Measures Emily, Langley Meg, Goma Fastone M, Ismailova Feruza, Kinnear John A, Bould M Dylan
From the *University Teaching Hospital, Lusaka, Zambia; †Tropical Health and Education Trust, Lusaka, Zambia; ‡University of Zambia School of Medicine, Lusaka, Zambia; §University of Zambia Master of Medicine Anesthesia Program, Postgraduate Medical Institute, Anglia Ruskin University, United Kingdom; ‖The Children's Hospital of Eastern Ontario, The University of Ottawa, Ottawa, Ontario.
Anesth Analg. 2017 Jul;125(1):287-293. doi: 10.1213/ANE.0000000000002048.
Data from 2006 show that the practice of anesthesia at the University Teaching Hospital in Lusaka, Zambia was underdeveloped by international standards. Not only was there inadequate provision of resources related to environment, equipment, and drugs, but also a severe shortage of staff, with no local capability to train future physician anesthetic providers. There was also no research base on which to develop the specialty. This study aimed to evaluate patient care, education and research to determine whether conditions had changed a decade later.
A mix of qualitative data and quantitative data was gathered to inform the current state of anesthesia at the University Teaching Hospital, Lusaka, Zambia. Semistructured interviews were conducted with key staff identified by purposive sampling, including staff who had worked at the hospital throughout 2006 to 2015. Further data detailing conditions in the environment were collected by reviewing relevant departmental and hospital records spanning the study period. All data were analyzed thematically, using the framework described in the 2006 study, which described patient care, education, and research related to anesthetic practice at the hospital.
There have been positive developments in most areas of anesthetic practice, with the most striking being implementation of a postgraduate training program for physician anesthesiologists. This has increased physician anesthesia staff in Zambia 6-fold within 4 years, and created an active research stream as part of the program. Standards of monitoring and availability of drugs have improved, and anesthetic activity has expanded out of operating theaters into the rest of the hospital. A considerable increase in the number of cesarean deliveries performed under spinal anesthetic may be a marker for safer anesthetic practice. Anesthesiologists have yet to take responsibility for the management of pain.
The establishment of international partnerships to support postgraduate training of physician anesthetists in Zambia has created a significant increase in the number of anesthesia providers and has further developed nearly all aspects of anesthetic practice. The facilitation of the training program by a global health partnership has leveraged high-level support for the project and provided opportunities for North-South and international learning.
2006年的数据显示，赞比亚卢萨卡大学教学医院的麻醉业务按照国际标准来看发展滞后。不仅在环境、设备和药品方面资源供应不足，而且人员严重短缺，当地没有培养未来麻醉医师的能力。也没有发展该专业的研究基础。本研究旨在评估患者护理、教育和研究情况，以确定十年后情况是否有所改变。
收集了定性数据和定量数据，以了解赞比亚卢萨卡大学教学医院当前的麻醉状况。通过目的抽样确定关键工作人员，对其进行半结构化访谈，包括在2006年至2015年期间一直在该医院工作的人员。通过查阅研究期间相关部门和医院记录，收集了详细说明环境状况的进一步数据。所有数据均采用2006年研究中描述的框架进行主题分析，该框架描述了与该医院麻醉业务相关的患者护理、教育和研究情况。
麻醉业务的大多数领域都有积极进展，最显著的是为麻醉医师实施了研究生培训计划。这使得赞比亚的麻醉医师人数在4年内增加了6倍，并形成了该计划的一个活跃研究方向。监测标准和药品供应情况有所改善，麻醉业务已从手术室扩展到医院其他区域。在脊髓麻醉下进行的剖宫产手术数量大幅增加，这可能是麻醉实践更安全的一个标志。麻醉医师尚未负责疼痛管理。
建立国际伙伴关系以支持赞比亚麻醉医师的研究生培训，使得麻醉服务提供者数量大幅增加，并进一步发展了麻醉业务的几乎所有方面。全球卫生伙伴关系对培训计划的推动，为该项目争取到了高层支持，并提供了南北交流和国际学习的机会。
