How to build a career in anaesthesia

A career in anaesthesia might be one of the most lucrative and best paying in Kenya.

Anaesthetists are health-care providers who specialise in drugs and processes that patients require before, during and after surgery.

This ensures patients are comfortable during surgery.

As an anaesthetist, one monitors patients closely after surgery to make sure they recover comfortably. With devolution, opportunities for anaesthetists exists in county government referral hospitals.

Recently, patients at Nyeri Referral Hospital had to wait for long due to a shortage of anaesthetists. The hospital requires 15 anaesthetists for theatres to operate optimally; four to work at night and two during the day shift, two on call and an additional eight to relieve their colleagues. However, the hospital had only five specialists by the time of the incident.

Infant mortality.

The problem is the same in other counties. In Wajir County, for the past 50 years, the county’s Habasweni District Hospital in Wajir South Constituency has not had the services of anaesthetists.

When the international community discusses how to address Millennium Development Goals four and five, increasing maternal health and reducing infant mortality, lack of access to properly administered anaesthesia is rarely part of the conversation.

In Sub-Saharan Africa, the shortage of anaesthesia providers to assist during deliveries has exacerbated the issue of maternal and infant mortality.

Improperly administered anaesthesia, or complete lack of anaesthesia, is one of the top four causes of death in rural hospitals among maternal patients during labour in Sub-Saharan Africa.

The World Journal of Surgery reported in 2010 that only 13 of approximately 120 anaesthesiologists in Kenya work in public hospitals. The remainder are in private practice in Nairobi, with few working in the rural areas. It is estimated that in rural areas, there is only one anaesthesiologist for every 13 surgeons.

According Phoebe Khagame, Administrator at Kenya Society of Anaesthesiologists (KSA), there’s a huge deficit, as the numbers available are far below the recommended WHO anaesthesia to patient ratio.

“We currently have about 150 physician anaesthesiologists, of whom about 50 are in public service with the rest in private practice, and about 60 registrars in training,” says Khagame.

So,what does it take for one to study the course and in which universities is the course offered? Anaesthesia services in Kenya are provided by three cadres of practitioners.

Physician anaesthesiologists are medical doctors who first train as medical officers for six years. After registration as medical officers, they study for four years for a Master of Medicine in Anaesthesia, offered by University of Nairobi and Aga Khan University Hospital.

Registered Clinical Officers Anaesthetists (RCOs) are diploma graduates in clinical medicine from Kenya Medical Training College (KMTC), who can pursue Higher Diploma in Anaesthesia for 18 months at Kenya Medical Training centres, such as Nakuru, Nairobi and Kisumu.

Finally, are Kenya registered nurse Anaesthetists (KRNA), who are also diploma graduates in nursing. They can also pursue a higher diploma in Anaesthesia. There are currently two training institutions, Kijabe Hospital and Kisumu KMTC.

Remuneration is not commensurate with the workload, which sometimes results in practitioners moving to private practice, as that pays better.

“The work of anaesthesia providers has for a long time been misunderstood by other health professionals and the public in general and hence it hasn’t been publicised properly,” says Dr Susan Nabulindo.

The practitioners can also provide emergency services in organisations like Red Cross and AMREF, where they are involved in transfer of patients. Anaesthesiologists are also involved in training, education and leadership roles in institutions where they work.