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Where are they now? A survey of the graduates of Nurse Anesthesia Training School at Ridge Regional Hospital in Ghana.
Abstract Number: SA-39
Abstract Type: Original Research
Introduction:There are few physician anesthesiologists in sub-Saharan Africa. This shortage has led to task shifting to nurse anesthetists and anesthesia assistants to provide anesthesia coverage. In Ghana, there were only 3 anesthesia training programs(1 for physicians and 2 for nurse anesthetists) for a country of 24 million resulting in no or low availability of anesthesia services in many hospitals. In 2007, leaders of Ridge Regional Hospital(RRH) in Accra, and Kybele, Inc. endeavored to start the 3rd nurse anesthesia training school(NATS) in Ghana.Efforts accelerated, a curriculum was created and the school opened in 2008. By September 2015, 5 classes have graduated from the 2 yr program. The purpose of this survey was to gather information from the graduates about their work environment and training preparedness.
Methods:A 39 question survey was developed with input from faculty of RRH NATS and Kybele. Graduates received an email detailing the purpose of the survey and were then called from a member of Kybele not previously affiliated with the training program. Calls were made from May 2014 to September 2015 to graduates of 4 classes(2011, 2012, 2013, 2014).If unavailable by phone, graduates attending a September 2015 refresher course in Accra were given a paper survey.
Results: Among the 93 graduates,75 surveys(80%)were completed. Graduates worked in 39 hospitals across 7 of 10 regions in Ghana, however,46% remained in Accra. Six(8%)worked alone and 16(21%) were 1 of 2 providers. The average number (range) of anesthetist and anesthesiologist per hospital was 5.4(1-24) and 0.4(0-3), respectfully. Fifty-three(70%) had no physician anesthesiologist. Equipment availability varied: 79(98%) laryngoscope, 69(92%) anesthesia machine, 71(94%) pulse oximeter, 46(61%) electrocardiography, 44(58%) capnography and 8(10%) nerve stimulator. Few had rescue airway equipment. Fifteen (21%) of graduates experienced patient death during anesthesia; 2 of 44 responses indicated difficult airway and 5 of 42 spinal anesthesia (SA). For CS, 6/61(10%) reported maternal death during GA and 10/63(16%) SA, but SA was used more frequently. For training quality, 64(85%) felt “definitely” prepared, 8(11%) “somewhat” prepared, 1(1%) “neutral”, 1(1%) “poorly” prepared and none were unprepared. Respondents were most confident in obstetric anesthesia and least confident in pediatric and difficult airway management.
Discussion:A survey conducted among RRH NATS gradates had a high response rate. Most graduates remain in Ghana, filling an important healthcare gap, especially in areas without other providers. The number of deaths reported during anesthesia is troubling and underscores the need to reinforce safe practice and vigilance, although optimum care may be hampered by poor equipment availability. The survey will help guide curriculum development and identified training gaps, especially in pediatric anesthesia and difficult airway management.