Development of Education and Research in Anesthesia and Intensive Care Medicine at the University Teaching Hospital in Lusaka, Zambia: A Descriptive Observational Study.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Faculty experiences regarding a global partnership for anesthesia postgraduate training: a qualitative study.

PURPOSE: Partnerships for postgraduate medical education between institutions in high-income countries and low- and middle-income countries are increasingly common models that can create capacity in human resources for health. Nevertheless, data are currently limited to guide the development of this kind of educational program. METHODS: We conducted semi-structured interviews with visiting and local faculty members in the externally supported University of Zambia Master of Medicine Anesthesia Program. Interviews were thematically analyzed with qualitative methodology. RESULTS: Respondents spoke of differences in clinical practice, including resource limitations, organizational issues, presentation and comorbidities of patients, surgical techniques, and cultural issues relating to communication and teamwork. A key theme was communication amongst distributed visiting faculty. Infrequent face-to-face meetings jeopardized programmatic learning and the consistency of teaching and assessment. Co-learning was considered central to the development of a new program, as visiting faculty had to adapt to local challenges while establishing themselves as visiting experts. An ongoing challenge for faculty was determining when to adapt to the local context to facilitate patient care and when to insist on familiar standards of practice in order to advocate for patient safety. CONCLUSIONS: As a new and evolving program, the findings from this study highlight challenges and opportunities for faculty as part of a partnership for postgraduate medical education. Since maintaining an effective faculty is essential to ensure the sustainability of any teaching program, this work may help other similar programs to anticipate and overcome potential challenges.

A new partnership for anesthesia training in Zambia: reflections on the first year.

PURPOSE: A new postgraduate anesthesiology residency program has been founded as a North-South partnership between the United Kingdom (UK) and Zambia. The project aims to train physician anesthesiologists in Lusaka in an attempt to address the high perioperative mortality associated with anesthesia as well as to provide better professional support for clinical officer anesthesiologists. PRINCIPLE FINDINGS: We present a detailed description of our experiences in establishing a new global health partnership and reflect on the outcomes of the first year of the training program. The formal healthcare partnership between the UK and Zambian governments began in 2009. Funded by the UK Department for International Development and managed by the Tropical Health and Education Trust, a four-year postgraduate Masters in Medicine (Anesthesia) degree was offered beginning in 2011. A volunteer faculty of consultant anesthesiologists from the United Kingdom and Canada has provided teaching support. There are plans to improve continuity by using senior UK trainees in Out Of Program attachments. To date, eight postgraduate Zambian doctors have successfully completed the first year of training and progress into their second year. CONCLUSION: On reflection, some of the lessons learned were very specific to local circumstances and could have been appreciated only after starting the program - flexibility and responsiveness early in the program have been very necessary. Nonetheless, our findings enhance existing knowledge about establishing and conducting global health partnerships in anesthesia.