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Anesthesia in Developing Countries: One-Way Traffic?

Section Editor(s): Saidman, LawrenceMisra, Satyajeet MD, DNB, PDCC; Koshy, Thomas MD, PDCC

doi: 10.1213/ane.0b013e31818fa426
Letters to the Editor: Letters & Announcements

Department of Anesthesiology; Sree Chitra Tirunal Institute for Medical Sciences & Technology; Trivandrum, Kerala; India;

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To the Editor:

Jochberger et al.1 present an account of the state of anesthesia in developing countries with special reference to Zambia. Although they must be congratulated in describing a far-from-ideal case scenario as far as the discipline of anesthesia in such countries is concerned, the development of a specialty cannot occur in isolation. When healthcare resources as a whole are limited and under-utilized, it is impractical to expect that mere cooperation with developed countries would improve anesthesia services. For the specialty to grow and develop, surgical facilities have to continuously grow hand-in-glove, if not ahead.

Second, growth of any discipline cannot be dependent upon a “one-way traffic.” If the developed nations have technology and expertise to offer, then developing nations have a plethora of diseases endemic and unique to them which would go a long way in the teaching and training of doctors from developed nations. In this context, we refer to an excellent treatise on a developing nation fellowship and how, such a cross-fertilization has helped the growth of the program in not only the country of origin, but also in other nations.2

Third, the authors in their results comment that the presence of an anesthesiologist had no influence on the technique of general anesthesia. However, in their discussion, they write that the presence of a physician anesthesiologist strongly increased the likelihood of endotracheal intubation for general anesthesia. It would be helpful if they could clarify the obvious contradiction in their results. Finally, they find that patients treated in Zambian intensive care units are mostly children or young adults, as compared with developed nations. This would hardly be surprising considering the fact that average life expectancy in that nation in 2006 was 40 yrs.1

Satyajeet Misra, MD, DNB, PDCC

Thomas Koshy, MD, PDCC

Department of Anesthesiology

Sree Chitra Tirunal Institute for Medical Sciences & Technology

Trivandrum, Kerala


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1. Jochberger S, Ismailova F, Lederer W, Mayr VD, Luckner G, Wenzel V, Ulmer H, Hasibeder WR, Dünser MW. “Helfen Berührt” Study Team. Anesthesia and its allied disciplines in the developing world: a nationwide survey of the republic of Zambia. Anesth Analg 2008;106:942–8
2. Wattenwyl R. Ten years after the initiation of congenital heart surgery in guatemala: observations after a one year fellowship in the pediatric cardiac unit in a low income country. Thorac Cardiovasc Surg 2008;56:205–9
© 2009 International Anesthesia Research Society