Anaesthesia for Childbirth the Focus of Doctoral Thesis
Dr Annette Theron of the School of Clinical Medicine received her Masters of Medicine (MMed) degree in Anaesthetics with her dissertation titled: “Obstetric Anaesthesia at District and Regional Hospitals in KwaZulu-Natal: Human Resources, Caseloads and the Experience of Doctors”.
Obstetric anaesthesia involves anaesthesia for childbirth, mostly for caesarean sections. Theron’s study sought to determine the number of doctors who were providing obstetric anaesthesia at both district and regional hospitals within KwaZulu-Natal.
This study highlighted the lack of training and experience of doctors in obstetric anaesthesia while dealing with an increased workload. It also identified specific target groups for future training and support.
The training and experience as well as caseloads of doctors were analysed to identify specific groups that could be targeted for support and training.
‘KwaZulu-Natal has the largest number of deliveries within South Africa, with over 50% occurring at district hospitals,’ said Theron. ‘From 2008 to 2010, KwaZulu-Natal had 15 anaesthesia-related deaths at district hospitals, three at regional hospitals and two at tertiary hospitals.
‘Through the use of two separate questionnaires, the study was directed independently to Medical Managers and doctors providing operative obstetric services. Doctors were asked to provide details of their qualifications, experience and current workload, while Medical Managers were asked for caseload and staffing data.’
Theron’s study included 48 hospitals, 12 of which were regional, and 36 which were district hospitals. Of the 48 medical managers, 38 responded while 266 doctors provided feedback.
It was found that anaesthesia skills or experience were not a prerequisite for 157 (59% of 266) responding doctors at the time of employment. Foreign-trained doctors were providing obstetric anaesthesia in 71% of the responding hospitals. However, 24 (9% of 266) doctors reported no anaesthesia training during internship, all of these were foreign-trained doctors, thus one of the identified target groups.
‘Another target group was Community Service Medical Officers (CSMOs), who constitute 27% of full-time staff at rural district hospitals. They are all expected to practice obstetric anaesthesia independently. These doctors should be trained adequately and assessed during internship, while working in consultant supervised units.’
The study found there were very few practitioners with added qualifications in anaesthesia working in rural hospitals, with only 3% of the responding rural doctors, who had a Diploma in Anaesthesia (DA). Only one district doctor had a DA and more than five years experience. These experienced doctors were also identified as a target, in order to enable them to aid in training and providing support to their junior colleagues.
It was established that sessional doctors were employed at 22 of 38 hospitals (58%) to provide obstetric anaesthesia - mostly district hospitals were reliant on these doctors. They represented a group of doctors, who act as the “occasional” anaesthetist with low caseloads and uncertain skills and training - a group that needs to be assessed further and may also have special training needs.
Theron is an anaesthetic specialist, based at King Edward VIII Hospital and is hoping to produce another publication on the topic of Obstetric anaesthesia soon. Her study was supervised by Professor C Rout.
- Zakia Jeewa