. WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTE
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL
REGIONAL COMMITTEE Forty-seventh session Seoul 9-13 September 1996
WPRJRC47ING017
30 September 1996 ORIGINAL: ENGLISH
STATEMENT BY DR KWANG-WOO KIM, REPRESENTATIVE OF THE WORLD FEDERATION OF SOCIETIES OF ANAESTHESIOLOGISTS (WFSA) The World Federation of Societies of Anaesthesiologists is an international nongovernmental organization in official relations with the World Health Organization (WHO). It works with the active support of, and in conjunction with national societies of anaesthesiologists wherever they exist in the world. It has a particular concern for the needs of our colleagues in developing countries and has been active in the production and distribution of educational materials and the organization of refresher courses in many African Countries. Having a record of successful collaboration with WHO headquarters in Geneva, we are now seeking means of working effectively with WHO regional offices, including those in the Western Pacific, African and East Mediterranean Region. Possible areas of cooperation Since 1982 WFSA has cooperated with WHO (Geneva) on a number of projects. There have been substantial benefits from combining WHO's breadth of view, its specific resources (such as the publications, clinical technology, ARI and pharmacy departments) with the professional knowledge and expertise of the only body which represents anaesthesia worldwide. We now seek to extend that cooperation with WHO's Western Pacific Region looking for ways to work together to help provide a safer and more effective anaesthetic service for the people of the Region. Although anaesthesia is often seen as a technology based specialty, we see education as our first priority. A trained person may be able to improvise with less than perfect equipment but an untrained anaesthetist is unsafe with any equipment whether simple or sophisticated.
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We do of course try to assist with the choice and provision of appropriate equipment (having learned from past mistakes that simple exporting of western equipment is rarely effective). These are the areas in which we believe that cooperation with WHO could be most fruitful: Training and education • Specialist physician anaesthetists There is a tremendous shortage of physicians trained in anaesthesia (anaesthesiologists) in the developing countries of the western Pacific. We are aware of the excellent workshops run by WHO in countries such as the Lao People's Democratic Republic and Myanmar, and would seek to consolidate these efforts with a continuing postgraduate training programme. Plans for this are already at an advanced stage, and the first three trainees (from Lao People's Democratic Republic) will be starting the programme (which is based in Bangkok) this year. It is planned in the future to extend the coverage to countries including Cambodia,. Myanmar and Viet Nam. Physician
anaesthetists must have a key role in setting standards and providing leadership in training and research, as well as in many instances being the sole providers of the clinical service on which essential surgery depends. • Training for non-specialists WFSA has in the past also assisted in various parts of the world in the provision of training for general duties medical officers and others who in the context of district hospital practice may be involved in delivering anaesthetic care to patients. We have considerable practical experience of the range of techniques which are appropriate in such situations, and in the most effective ways of training non-specialists to be safe anaesthetists. Subjects: basic sciences and technical training clinical anaesthesia obstetric anaesthesia
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Methods of training Distance learning including the production by WFSA of linked clinical and educational packages aimed at district hospital anaesthetists In-country refresher courses and workshops Overseas training
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Production and distribution of teaching materials including printed material, videotapes, electronic publishing It may be that elements of all of the above could be incorporated into a joint regional project. This would require detailed planning and close liaison with the WHO Western Pacific Regional Office. Such a project would have four components: Knowing what needs to be done (WFSA already has much expertise and experience in this area) Selecting the things which can be done and done effectively (in relation to regions, ministries, facilities, etc.; here the advice of WHO is crucial to success) Doing them (a joint effort) Applying the lessons learned to other areas and other specialties.
The programme in Bangkok began in June 1996 with three Laotian trainees who have already a minimum of two years experience. They are joining the Thai residency training
programme which will rotate them through a number of hospitals and they will receive formal teaching in basic sciences, clinical anaesthesia, intensive therapy and pain control. Each one will be assigned a tutor to help with both professional and personal problems. They will be regularly
evaluated and will sit the in-training evaluation examinations along with their Thai contemporaries. A grant ofUS$ 6000 per candidate will be made by WFSA for training expenses. The following year there will be trainees from Cambodia, Myanmar and Viet Nam, for whom teaching will be conducted in English.
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At the end of training, a WFSA certificate of training will be awarded to successful candidates. The Pacific course is based in Suva, Fiji, and led by an Australian lecturer (Dr Steve Kinnear). Over a two-year period, trainees from Fiji and two or three from other Pacific Islands will work through a carefully planned syllabus which will lead to a diploma or possibly a masters degree. A part of this training will take place in Australia and or New Zealand, and financial help for this, and for the non Fijians (when in Fiji) will be available from WFSA and from the Australian Society of Anaesthetists. • The way forward WFSA proposes that the Western Pacific Region should nominate a contact person to whom WFSA would then submit detailed proposals for joint activities in the promotion of anaesthetic training and the improvement of anaesthetic safety, with special reference to the role of district hospitals in primary health care. /
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Previous WHOIWFSA joint projects 1983-1985 Production of WHO manual "Anaesthesia at the District Hospital" (Published by WHO 1988, now published in English, French, Spanish, Portuguese and Russian. Arabic and Hindi versions planned) 1986 Production of WHO formulary for drugs used in anaesthesia (revised in 1993)
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1989 Production of slide/tape teaching sets in anaesthesia, now to be issued on video and possibly other electronic media 1990 Production of standard specification for oxygen concentrators suitable for use in developing countries. This has resulted in the development and production of three machines capable of coping with the special environmental and logistical problems of developing countries and remote locations. 1986-1993 WHOIWFSA field training workshops in anaesthesia and surgery - including China, Lao People's Democratic Republic, Philippines and Myanmar 1991-1994 Production of WHO manual and videotapes on management of ARl in developing countries 1988-1994 Joint advice to UNICEF on standardization of oxygen equipment 1992-1999 Field trial of oxygen concentrators in Upper Egypt