The 2005 Saving Mothers study reveal shocking findings.
Mari Hudson writes in What's New Doc
A study on anaesthesia-related maternal deaths in the
Free State was conducted in 2005 and the findings were published in
the March/April 2008 edition of the South African Journal of Anaesthesia
and Analgesia, the official journal of the SA Society of Anaesthesiology.
Dr Gillian Lamacraft and Dr PJ Kenny of
the department of anaesthesiology at the UFS.
The high mortality rate related to obstetric anaesthesia
is a direct consequence of inadequate training, experience and
supervision of interns, community service doctors and medical officers.
Why the study was conducted
All three Saving Mothers reports (published in 1998, 2001 and 2004 respectively) stated
that the Free State and Limpopo were the provinces with the highest
mortality rate associated with obstetric anaesthesia. A shocking 5,4%
of all maternal deaths were anaesthesia-related.
Previous studies had shown that the methods of administering anaesthesia
and the availability of appropriate drugs and equipment are not
to blame, so it was decided to establish whether human skill was the
problem in the Free State.
Highlights from the study
- One in five doctors in rural hospitals had not administered a general
anaesthetic during obstetric procedures before their current position,
and almost as many had not administered a spinal anaesthetic. Yet
all of them administer anaesthesia at level 1 and 2 hospitals, mostly
- Six doctors (GPs or medical officers) had been appointed to posts in
which obstetric anaesthesia was required without previously having
administered general anaesthesia for Caesarian sections. Despite this
they were regularly administering obstetric anaesthesia.
- 32% of doctors now administering obstetric anaesthesia in level 1
and 2 hospitals in the Free State had gained no anaesthesia experience
at all as interns, neither supervised nor unsupervised. Some of
these doctors have been trained elsewhere in Africa.
- In most cases where doctors had in fact gained experience in
anaesthesia as interns, the training was inadequate and the supervised
experience too short.
- One in five doctors who had been supervised during their anaesthesia
training as interns were supervised by junior medical officers.
- Only one doctor in the study, a medical officer, had earned a diploma
in anaesthesia. None of the other medical officers with more than five
years’ experience or any of the 16 GPs had a diploma in anaesthesia.
- 97% of doctors had to resuscitate a newborn baby while administering
anaesthesia for a Caesarean section.
This is an edited extract of an article first published in What’s New Doc, 2nd issue, March 2009. What’s New Doc is a publication for medical doctors, produced in association with Health24.
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