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GENERAL ARTICLE

Anesthesia and Its Allied Disciplines in the Developing World: A Nationwide Survey of the Republic of Zambia

Stefan Jochberger, MD^*, Feruza Ismailova, MD, Wolfgang Lederer, MD^*, Viktoria D. Mayr, MD^*, Günter Luckner, MD^*, Volker Wenzel, MD^*, Hanno Ulmer, PhD, Walter R. Hasibeder, MD, Martin W. Dünser, MD^|| For the "Helfen Berührt" Study Team

From the *Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria; Department of Anesthesiology and Critical Care Medicine, University Teaching Hospital, Lusaka, Republic of Zambia; Institute of Medical Biostatistics, Innsbruck Medical University, Innsbruck, Austria; Department of Anesthesiology and Critical Care, Krankenhaus der Barmherzigen Schwestern, Ried im Innkreis, Austria; and |Department of Intensive Care Medicine, Inselspital, Bern, Switzerland.

Address correspondence and reprint requests to Dr. Martin W. Dünser, Department of Intensive Care Medicine, Inselspital Bern, Freiburgerstrasse, 3010 Bern, Switzerland. Address e-mail to Martin.Duenser{at}i-med.ac.at or www.helfen-beruehrt.at.

BACKGROUND: Many surgical interventions worldwide are performed in developing countries. To improve survival of acutely and critically ill patients in these countries, basic problems and demands of anesthesia care need to be identified. Using this survey, we evaluated the current status of anesthesia and its allied disciplines (intensive care medicine, emergency medicine, and pain therapy) in the Republic of Zambia.

METHODS: Questionnaires were sent to 87 hospitals registered at the Zambian Ministry of Health as performing minor or major surgery. The questionnaire consisted of 111 questions grouped into five sections: general hospital information, anesthesia, intensive care, emergency medicine, and pain therapy.

RESULTS: Sixty-eight questionnaires could be statistically evaluated (78%). The most common operations were obstetric/gynecological and abdominal surgical procedures. Dissociative ketamine anesthesia was the technique most often used for general anesthesia (50%). Endotracheal intubation was performed in 10% of patients undergoing general anesthesia. In most hospitals (78%), anesthesia was administered by nonphysicians. Only 5 of 68 hospitals (7%) reported having an intensive care unit, with 29 beds to serve the entire country. Anesthesiologists play almost no role in emergency medicine and pain therapy.

CONCLUSIONS: Anesthesia in the Republic of Zambia is a highly under-developed and under-resourced medical specialty.

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