Odinkemelu Didi S, Sonah Aaron K, Nsereko Etienne T, Dahn Bernice T, Martin Marie H, Moon Troy D, Niconchuk Jonathan A, Walters Camila B, Kynes J Matthew
From the Vanderbilt University School of Medicine, Nashville, Tennessee.
Phebe Nurse Anesthesia Program, Phebe Paramedical Training Program and School of Nursing, Suakoko, Liberia.
Anesth Analg. 2021 Jun 1;132(6):1727-1737. doi: 10.1213/ANE.0000000000005456.
The health system of Liberia, a low-income country in West Africa, was devastated by a civil war lasting from 1989 to 2003. Gains made in the post-war period were compromised by the 2014-2016 Ebola epidemic. The already fragile health system experienced worsening of health indicators, including an estimated 111% increase in the country's maternal mortality rate post-Ebola. Access to safe surgery is necessary for improvement of these metrics, yet data on surgical and anesthesia capacity in Liberia post-Ebola are sparse. The aim of this study was to describe anesthesia capacity in Liberia post-Ebola as part of the development of a National Surgical, Obstetric, and Anesthesia Plan (NSOAP).
Using the World Federation of Societies of Anaesthesiologists (WFSA) Anaesthesia Facility Assessment Tool (AFAT), we conducted a cross-sectional survey of 26 of 32 Ministry of Health recognized hospitals that provide surgical care in Liberia. The surveyed hospitals served approximately 90% of the Liberian population. This assessment surveyed infrastructure, workforce, service delivery, information management, medications, and equipment and was performed between July and September 2019. Researchers obtained data from interviews with anesthesia department heads, medical directors and through direct site visits where possible.
Anesthesiologist and nurse anesthetist workforce densities were 0.02 and 1.56 per 100,000 population, respectively, compared to 0.63 surgeons per 100,000 population and 0.52 obstetricians/gynecologists per 100,000 population. On average, there were 2 functioning operating rooms (ORs; OR in working condition that can be used for patient care) per hospital (standard deviation [SD] = 0.79; range, 1-3). Half of the hospitals surveyed had a postanesthesia care unit (PACU) and intensive care unit (ICU); however, only 1 hospital had mechanical ventilation capacity in the ICU. Ketamine and lidocaine were widely available. Intravenous (IV) morphine was always available in only 6 hospitals. None of the hospitals surveyed completely met the minimum World Health Organization (WHO)-WFSA standards for health care facilities where surgery and anesthesia are provided.
Overall, we noted several critical gaps in anesthesia and surgical capacity in Liberia, in spite of the massive global response post-Ebola directed toward health system development. Further investment across all domains is necessary to attain minimum international standards and to facilitate the provision of safe surgery and anesthesia in Liberia. The study results will be considered in development of an NSOAP for Liberia.
利比里亚是西非的一个低收入国家，其卫生系统在1989年至2003年的内战中遭到重创。战后取得的成果又因2014 - 2016年的埃博拉疫情而受到影响。本就脆弱的卫生系统出现了健康指标恶化的情况，包括埃博拉疫情后该国孕产妇死亡率估计上升了111%。获得安全手术对于改善这些指标至关重要，然而关于利比里亚埃博拉疫情后外科手术和麻醉能力的数据却很稀少。本研究的目的是描述利比里亚埃博拉疫情后的麻醉能力，作为制定国家外科、产科和麻醉计划（NSOAP）的一部分。
我们使用世界麻醉医师协会联合会（WFSA）麻醉设施评估工具（AFAT），对利比里亚卫生部认可的32家提供外科护理的医院中的26家进行了横断面调查。接受调查的医院服务了约90%的利比里亚人口。该评估调查了基础设施、工作人员、服务提供、信息管理、药物以及设备情况，调查于2019年7月至9月进行。研究人员通过与麻醉科主任、医疗主任访谈以及在可能的情况下进行实地考察来获取数据。
麻醉医师和麻醉护士的人力密度分别为每10万人口0.02人和1.56人，而外科医生的人力密度为每10万人口0.63人，妇产科医生的人力密度为每10万人口0.52人。平均每家医院有2间可正常使用的手术室（OR；可用于患者护理的处于工作状态的手术室）（标准差[SD] = 0.79；范围为1 - 3间）。接受调查的医院中有一半设有麻醉后护理单元（PACU）和重症监护病房（ICU）；然而，只有1家医院的ICU具备机械通气能力。氯胺酮和利多卡因广泛可得。只有6家医院随时都有静脉注射用吗啡。接受调查的医院中没有一家完全达到世界卫生组织（WHO） - WFSA规定的提供手术和麻醉的医疗设施的最低标准。
总体而言，尽管埃博拉疫情后全球针对卫生系统发展做出了大规模响应，但我们注意到利比里亚在麻醉和外科手术能力方面存在若干关键差距。有必要在所有领域进一步投资，以达到最低国际标准，并促进在利比里亚提供安全的手术和麻醉服务。本研究结果将在为利比里亚制定NSOAP时予以考虑。
