Ten Years of Experience Training Non-Physician Anesthesia Providers in Haiti.

Surgery is increasingly recognized as an effective means of treating a proportion of the global burden of disease, especially in resource-limited countries. Often non-physicians, such as nurses, provide the majority of anesthesia; however, their training and formal supervision is often of low priority or even non-existent. To increase the number of safe anesthesia providers in Haiti, Médecins Sans Frontières has trained nurse anesthetists (NAs) for over 10 years. This article describes the challenges, outcomes, and future directions of this training program. From 1998 to 2008, 24 students graduated. Nineteen (79%) continue to work as NAs in Haiti and 5 (21%) have emigrated. In 2008, NAs were critical in providing anesthesia during a post-hurricane emergency where they performed 330 procedures. Mortality was 0.3% and not associated with lack of anesthesiologist supervision. The completion rate of this training program was high and the majority of graduates continue to work as nurse anesthetists in Haiti. Successful training requires a setting with a sufficient volume and diversity of operations, appropriate anesthesia equipment, a structured and comprehensive training program, and recognition of the training program by the national ministry of health and relevant professional bodies. Preliminary outcomes support findings elsewhere that NAs can be a safe and effective alternative where anesthesiologists are scarce. Training non-physician anesthetists is a feasible and important way to scale up surgical services resource limited settings

Conserving forest tree diversity in Guinée Forestière (Guinea, West Africa) : the role of coffee-based agroforests

In the current deforestation context, agroforestry is increasingly considered in the tropical zone for its potential contribution to biodiversity conservation. In Guin,e ForestiSre (Guinea, West Africa), coffee-based species rich agroforests are currently expanding on agricultural land around most villages. To assess the role these agroforests play with respect to biodiversity conservation, we compared their tree structure and diversity with those of a neighbouring natural forest. Eighty plots were sampled using a variable area transect method (60 plots distributed into 3 village agroforests, 20 natural forest plots). The structure of coffee-based agroforests showed obvious signs of farmers' management: density of mature trees was significantly lower than in natural forest and most juvenile trees were eliminated and replaced by coffee trees. However, tree seedling density was not significantly different than in natural forest. Tree species richness and diversity were also lower than in natural forest but much higher than in any other agricultural or agroforestry land use system. These results are close to those obtained in the coffee-based agroforests of Central America, confirming that coffee-based agroforests retain many forest species that play a key role in the conservation of regional forest tree diversity