Message from Uganda

*ANAESTHETIST-THE UNSUNG HERO-WHO IS ONLY REMEMBERED WHEN SOMETHING GOES WRONG NOT WHEN ALL GOES WELL.*

A lot has been going on in social media concerning Anaesthetists in Uganda but many people on this planet earth do not actually know *Who* Anaesthetists are, *What* they do, *How* they do it and under *What* environment they do it.

In simple terms, Anaesthetists are Medical Professionals responsible for keeping the patient free from pain and maintain the normal functioning of the body organs during any surgical procedure.  This involves administration of drugs and continuous close monitoring. So for every surgery to take place, there *MUST* be an Anaesthetic provider.

In Uganda, we have about 500 Anaesthetic Providers (physicians and non physicians including trainees).  With a population of 40m people, it means every anaesthetic provider is responsible for about 80,000people( 1:80,000). This ratio is a very very small number of anaesthetic providers to potential clients. *Think about that* :

It's because of this that you will rarely find Anaesthetists working in teams as it should be the case. For big Hospitals like National Referral and Regional Referral Hospitals, it's common to find one Anaesthetist working with different surgical specialities. While surgeons work in bigger teams of Senior Consultants, Consultants, Fellows, Registrars, SHOs and JHOs, you will find this team which has about 15 members with just one Anaesthetic provider!! Out of 15 if one person misses even for a month, one will not easily notice because others will do the work and life will go on, but if the Anaesthetist misses even a few hours for genuine reasons being the only one on the team a Memorandum of Complaints and Blame  will be drafted!!!
In emergencies, Anaesthetists  change sets of Surgeons in one day, while Surgeons will not cross over to other disciplines.
For instance, If you call an Obstetrician for a fracture femur, or an Orthopedic surgeon for an elective c/s  or a Cardiologist for neurosurgery, trust me you will not like the response. But Anaesthetist may be called for  all such cases at ago and will have to decide which one takes a priority; and whoever is delayed will not like the situation - hence negative attitude towards Anaesthetists accompanied with blames & complaints.

*Why do we  have very few anaesthetists in Uganda compared to other medical disciplines?*

According to *WHO,* delivery of surgical care is highly dependant on the *availability* and *retention* of trained anaesthesia health workforce. www.who.int< bulletin< volumes. As it stands now, Over 95% of Anaesthetic providers in Uganda are non physicians (Anaesthetic Officers) These are senior nurses/midwives or senior clinical officers who do an intensive two year training in anaesthesia. Over 90% who cross to Anaesthesia will have sentenced them selves to

-No promotion for the rest of their professional life in service,

-No social interactions like parties, burials of their loved ones, leisure time and some degree of infertility because no time to make love!!! Our commissioner Clinical services once told us  a true story of Anaesthetist who was called from the reception on her wedding day because there was a mother with obstructed labour.

Because of this situation, some trained Anaesthetists prefer to go back to their former Medical Disciplines because there is no chance for promotion while others go outside the country where they are received as *heroes.*

*PROPOSED SOLUTION.*For retention of anaesthetic officers Uganda*

1.Let the entry salary be at least at U4. ( one step higher than where they were prior to training in Anaesthesia). As long as this is not done we shall keep training for other countries and we shall keep lamenting over Anaesthesia provision.  We shall be like someone who is "fetching water using a basket"

2.Let there be promotions at all levels like it is with other Medical disciplines.

3. Let the anaesthetist be given accommodation nearby their work stations as it used to be in the past.

4.They should be included in hospital management matters e.g management meetings and decision making processes especially on matters to do with Anaesthetic equipment and supplies.

5.Anaesthetists should be considered for regular and progressive refresher courses for retooling, professional proficiency & excellence purposes.

6.Let there be reasonable  improvements in working conditions and supplies because the reality on the ground in as far as this matter is concerned is worrying

*CONCLUSION:*
With the above suggested remedies taken in good faith and implemented, I can assure anyone who cares to listen that no more complaints and blames will occur in this medical discipline.

For God and My Country.

Solotiinah N Musinguzi.
*PRESIDENT (MESSENGER) UGANDA ANAESTHETIC OFFICERS' ASSOCIATION*