Surgery Without Anesthesia?


A sixteen year old healthy young man lives in a village in rural Africa. He is attending school and is looking for a way to make it to the capital city to further his education. One evening, he suddenly develops a fever and stomach pains. He knows something is not right and that he should seek medical attention. On a good day, he is four hours from the nearest hospital. Transportation will not be available until morning. He waits overnight, all the while getting sicker. The next day he begins the journey using public transportation with 18 other individuals. Along the dusty and bumpy road, they stop several times for various reasons. His fever is quite high now and the pain is worsening. Twenty hours after the illness started, they finally make it to the hospital. Correctly diagnosing that he needs surgery, the nurse informs the patient there is no surgeon at this facility and they will need to go to a neighboring town where they have one (usually). 

After arriving at the second hospital in the late evening, the workers inform him he will be evaluated by the surgeon the next morning. The high fever continues and the abdominal pain is now unbearable. Late morning the next day, the surgeon evaluates the patient and they proceed to the operating room. As is common in rural Africa, the facility does not have a trained anesthetist to provide care for this very sick patient. Finding a nurse from the adult medicine floor to give medication and monitor the patient, they proceed with the two hour operation, barely keeping the patient alive. There is no ICU for critical post-operative care. The patient never wakes up and dies later that day.



Five billion people have no access to safe surgical, obstetric, trauma, and anesthesia care (The Lancet). The fictional story above is a common reality in the developing world. You can substitute a pregnant woman in need of a cesarean section resulting in the same unfortunate outcome. People travel great distances to gain critical surgical and obstetric care. If and when they do make it to the hospital, many facilities are under equipped with poorly trained staff of inadequate numbers. Death rates from preventable surgical illness are very high compared to more developed countries. Even when surgical and anesthesia services are present, mortality rates are still elevated due to multiple factors including poorly trained anesthesia personnel. In African Francophone countries, this is especially true where limited or poorly executed anesthesia service is prevalent. Of those countries reporting perioperative mortality due solely to anesthesia complications, some of the highest death rates are in Francophone Africa. While the surgical, obstetric, and anesthetic need in Africa is complex and multifactorial, a good start at reducing these high death rates is to train competent anesthesia providers to deliver safe perioperative care.


LMIC = low-middle income; HIC = high income

At Bongolo Hospital, one of our core strategies is to "instruct, mentor, and disciple medical professionals through training programs." We strive to enhance and elevate the knowledge and delivery of medical care through our educational programs. Training anesthetists to deliver safe and competent anesthesia is a part of this endeavor. To improve anesthesia and surgical care in African Francophone countries, we come alongside our PAACS surgical training program, started almost 20 years ago to help reduce preventable surgical deaths while building competent Christian leaders. While our hospital is small and the needs for good surgical, obstetric and anesthesia care in the developing world are great, we press on, trying to make a dent in this ever complex problem.