Training and experience of doctors administering obstetric anaesthesia in the Free State Level 1 and 2 Hospitals

Background All the published Saving Mothers Reports generated by the National Committee of the Confidential Enquiries into MaternalDeaths in South Africa have associated anaesthesia-related maternal deaths with the lack of skills of the doctors administering the anaesthesia. The Reports have shown the Free State to be one of the provinces in South Africa with the highest rate of obstetric anaesthesia deaths. Therefore, the current study was performed to determine whether a deficiency exists in the training and experience of doctors administering obstetric anaesthesia. The identifying of such a deficiency would call for the implementation of remedial measures.Methods The study was performed in 2005 using questionnaires designed by the first two authors of this paper. All Level 1 and 2hospitals in the Free State performing Caesarean sections (CSs) were visited. The doctors administering obstetric anaesthesia were each asked to respond to a questionnaire. The questionnaires enquired about previous training and experience in anaesthesia and, more specifically, obstetric anaesthesia, as well as anaesthesia and nonanaesthesia qualifications. In addition, questions were asked regarding supervision, and whether other duties were performed while administering anaesthesia. Results The response rate was 69% (105/148 doctors). Of the respondents, 9.5% were interns, 24.7% community service doctors, 47.6% medical officers, 15.2% general practitioners (GPs) and 2.9% specialists. Twenty-three per cent of respondents had been in their present post for five years or more. Most doctors had received 4 weeks or less training in anaesthesia as an Intern, not including obstetric anaesthesia in 13 cases. Six doctors (GPs or medical officers) had been appointed in posts in which obstetric anaesthesia was required, without previously having administered obstetric anaesthesia. At the time of the survey, two doctors had never performed spinal anaesthesia and five had never administered general anaesthesia for CS, although all were regularly administering obstetric anaesthesia. Apart from the specialists, the Diploma in Anaesthesia was held by only one doctor, a medical officer. Half of the interns were not directly supervised while administering obstetric anaesthesia, while more than half the community service doctors were employed in hospitals where no senior support wasavailable. The doctors frequently had both to administer the anaesthetic and to perform neonatal resuscitation. Twelve ofthe doctors concerned had often also to perform the surgery itself. Most of the doctors requested further training in obstetricanaesthesia and improved senior anaesthetic assistance.Conclusions There is a lack of experience, training and supervision amongst doctors administering obstetric anaesthesia in the Free State.Doctors regularly have to perform other duties, whilst administering obstetric anaesthesia, which may put the mother atrisk from inadequate observation. These may be contributory factors to the high rate of maternal deaths from anaesthesia

An Audit of the Use of Regional Anaesthesia for Caesarean Section in the Free State: from 2002 to 2004

Regional anaesthesia (RA) is associated with a lower mortality than general anaesthesia (GA) for obstetric anaesthesia. Accordingly, the Saving Mothers Report 1999-2001 proposed that 75% of Caesarean section (CS) should be performed under RA.2 An initial audit found that in the Free State, 71% of CS’s were performed under RA in 2002. Various educational interventions promoting the use of RA for CS were then instituted and the audit repeated for 2004, to determine whether there had been any change in the use of RA for CS’s from 2002 to 2004 and the 75% target achieved

Obstetric anaesthesia: the source of the crisis

The Saving Mothers Reports have consistently shown that, out of all the provinces of South Africa, the Free State has one of the highest rates of maternal deaths arising from anaesthesia.The province's Department of Health requested the University of the Free State's Department of Anaesthesiology to investigate the problem. We examined possible factors, including training and experience of doctors administering anaesthesia, availability of suitable anaesthetic drugs and equipment, and use of regional anaesthesia. All the level 1 and 2 hospitals in which caesarean sections (CSs) were being performed were investigated. The foremost problems identified were lack of training and experience in administering obstetric anaesthesia, and lack of senior anaesthetic assistanceSouth African Medical Journal Vol. 98 (2) 2008: pp. 123-12

The radiation environment over the African continent at aviation altitudes: First results of the RPiRENA-based dosimeter

The radiation environment over the African continent, at aviation altitudes, remains mostly uncharacterized and unregulated. In this paper we present initial measurements made by a newly developed active dosimeter on-board long-haul flights between South Africa and Germany. Based on these initial tests, we believe that this low-cost and open-source dosimeter is suitable for continued operation over the Africa continent and can provide valuable long-term measurements to test dosimteric models and inform aviation policyComment: Accepted to appear in Journal of Space Weather and Space Climat

Errors in drug administration by anaesthetists in public hospitals in the Free State

Objective. To investigate errors in administering drugs by anaesthetists working in public hospitals in the Free State province. Methods. Anonymous questionnaires were distributed to doctors performing anaesthesia in public hospitals in the Free State, i.e. 188 doctors at 22 public sector hospitals. Outcomes included demographic information on respondents, information regarding the administration of anaesthetics, reporting of errors, and the occurrence of errors during anaesthesia. Results. The response rate was 46.3%; 48.8% were medical officers, and 39.3% of participants were involved in at least one event of erroneous drug administration. Registrars and specialists reported the most errors. Most events were of no clinical significance, caused no permanent harm to patients, and most commonly involved fentanyl and suxamethonium. Of the respondents, 23.8% indicated that they were aware of a South African standard for colour-coding syringe labels, and 92.9% indicated that they would report anaesthetic errors if a single reporting agency for such events existed. Conclusions. More than a third of participating anaesthetists were involved in a drug error at some stage in their practice. Preventive systems and precautionary measures should be put in place to reduce drug administration errors

Enemy at the gates: Rapid defensive trait diversification in an adaptive radiation of lizards

Adaptive radiation (AR), the product of rapid diversification of an ancestral species into novel adaptive zones, has become pivotal in our understanding of biodiversity. Although it has widely been accepted that predators may drive the process of AR by creating ecological opportunity (e.g., enemy-free space), the role of predators as selective agents in defensive trait diversification remains controversial. Using phylogenetic comparative methods, we provide evidence for an “early burst” in the diversification of antipredator phenotypes in Cordylinae, a relatively small AR of morphologically diverse southern African lizards. The evolution of body armor appears to have been initially rapid, but slowed down over time, consistent with the ecological niche-filling model. We suggest that the observed “early burst” pattern could be attributed to shifts in vulnerability to different types of predators (i.e., aerial versus terrestrial) associated with thermal habitat partitioning. These results provide empirical evidence supporting the hypothesis that predators or the interaction therewith might be key components of ecological opportunity, although the way in which predators influence morphological diversification requires further study

Errors in drug administration by anaesthetists in public hospitals in the Free State

Objective. To investigate errors in administering drugs by anaesthetists working in public hospitals in the Free State province. Methods. Anonymous questionnaires were distributed to doctors performing anaesthesia in public hospitals in the Free State Province, i.e. 188 doctors at 22 public sector hospitals. Outcomes included demographic information on respondents, information regarding the administration of anaesthetics, reporting of errors, and the occurrence of errors during anaesthesia. Results. The response rate was 46.3%; 48.8% were medical officers, and 39.3% of participants were involved in at least one event of erroneous drug administration. Registrars and specialists reported the most errors. Most events were of no clinical significance, caused no permanent harm to patients, and most commonly involved fentanyl and suxamethonium. Of the respondents, 23.8% indicated that they were aware of a South African standard for colour coding syringe labels, and 92.9% indicated that they would report anaesthetic errors if a single reporting agency for such events existed. Conclusions. More than a third of participating anaesthetists were involved in a drug error at some stage in their practise. Preventative systems and precautionary measures should be put in place to reduce drug administration errors