Anaesthesia: Backbone of surgical care

BY: Philip Afeti Korto
A patient under anaesthesia care
A patient under anaesthesia care

The United Nations (UN) has set aside October 16 every year as World Anaesthesia Day to celebrate anaesthetists globally and to commemorate the first successful demonstration of Diethyl ether Anaesthesia which occurred on October 16, 1846.

Diethyl ether (Et2O) or (C2H5)2O is a colourless, highly flammable and a sweet-scented liquid which was formerly used as a general anaesthetic agent or drug at the time that drugs like halothane and others were not in existence.

Accordingly, this year’s World Anaesthesia Day fell last Saturday, October 16, 2021.

I want to use the occasion to celebrate the Certified Registered Anaesthetists of Ghana, who are working around the clock at anaesthesia clinics and in the operating theatres to save the lives of surgical patients.

These cadre of clinical staff are different from anesthesiologist who are medical doctors specialised in anaesthesia.

Conditions of service

In Ghana, the employer largely pays employees based on academic/professional qualifications and not performance per se.

As such, even though the Certified Registered Anaesthetists (CRAs) perform similar and sometimes the same duties the anaesthesiologists perform, the latter have better conditions of service than the former.

In the public health sector of Ghana, CRAs are found in almost every hospital that has operating theatre and in remote areas where you do not find anaesthesiologists.

In some of the public hospitals, the anaesthesia machines do not function properly all the time and certain anaesthesia logistics are not available on time yet the CRAs improvise in many ways and under strenuous conditions to save lives.

Regulatory body

Both the CRAs and the anesthesiologist are regulated by the Medical and Dental Council (MDC) upon the strength of the Health Professions Regulatory Bodies Act, 2013 (Act 857).

The Ministry of Health (MOH) and the Ghana Health Service (GHS) pay the anaesthetiologists higher than the CRAs.

Perhaps, in recognition of the salary differentials, the MDC collects an annual registration/retention fee of GH¢440.00 from doctors and GH¢330.00 from the CRAs. The difference in the retention fees for the two cadres is GH¢110.00.

Anaesthetists’ roles

Anaesthesia drug administration in the operating theatre is a very difficult task and it demands meticulousness and equanimity since the life of the patient is very critical especially on the operating table.

It is the duty of the Anaesthetist (CRA) to vigilantly monitor certain vital indicators of the surgical patient.

These include but are not limited to blood pressure, pulse, heart rate (electrocardiograph), depth of Anaesthesia as well as input and output rates of infusion and urine respectively.

The CRA does all this simultaneously to enable the surgeon to focus on the surgical procedure at hand (e.g. total abdominal hysterectomy, salpingectomy, thyroidectomy, Caesarian Section, etc.

Mindful of the relevance of the Certified Registered Anaesthetists’ roles before, during and after the performance of surgical procedures, their conditions of service must be treated with seriousness.

Challenges

Unfortunately, the CRAs of Ghana encounter numerous challenges on the job.

Notable among these challenges is unclear or non-existent career progression.

Currently, the CRAs train in various anaesthesia schools located in some hospitals and the schools are affiliated to some public universities.

Professional college

Government has not established a professional college for CRAs and the Ghana College of Physicians and Surgeons has not mounted any specialty courses for the CRAs, hence it is impossible for CRAs to progress and specialise in various areas of Anaesthesia.

Interestingly, there are CRAs with PhD in Anaesthesia yet that qualification is not recognised in surgical practice in terms of remuneration even though some PhD-holding CRAs teach in the universities and for that matter in some of the medical schools.

A chicken and egg situation? Advisedly, the government must establish a professional college for CRAs to facilitate their specialty training and career progression.

It is my understanding that the MDC and Ghana Association of Certified Registered Anaesthetists (GACRA) are in contention over the grade CRA because the MDC wants the CRAs to be called Physician Assistants.

In tandem with this contention perhaps, the MDC bars the CRAs from handling certain clinical cases.

Definitely, this becomes very difficult in places where there are no Doctor Anaesthetists or Anaesthetiologists.

Checks alarmingly revealed that most of the regions do not have Anaesthetiologists or Doctor Anaesthetists.

In their stead, CRAs attend to surgical patients and if a case is beyond their capacity in terms of training and medical consumable availability, they refer the case to teaching and regional hospitals that have anaesthetiologists at post.

Only Greater Accra, Central and Ashanti regions have Doctor Anaesthetists at post. Even that, they are located only in some few hospitals.

Addressing conundrum

Suffice to say that the anaesthetiologists are not many in the country, hence the relevance, career progression and job satisfaction of the CRAs must be taken seriously.

It is true that the anaesthetiologists train the CRAs, hence they must not only train them but also ensure that they allow the CRAs to practise satisfactorily on the job.

The apparent conundrum between some anaesthetiologists and CRAs should be addressed to eliminate its negative cascading effects on patient satisfaction.

To this end, I wish all anaesthesia practitioners in Ghana, particularly Certified Registered Anaesthetists, a happy and fruitful World Anaesthesia Day. Ayekoo!!!

The writer is a Health Service Administrator and a Columnist

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