A comparative review of obstetric anaesthesia training, supervision and experience of public sector doctors in the Free State, 2005 vs. 2019
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Date
2021-03
Authors
Machai, Seta Liteboho
Journal Title
Journal ISSN
Volume Title
Publisher
University of the Free State
Abstract
Introduction: Obstetric anaesthesia is ranked first as a contributor to “potentially preventable deaths per underlying cause” of maternal death in South Africa. Lack of training, experience and supervision has been cited as the cause of these deaths. This study aimed to evaluate those public sector doctors administering obstetric anaesthesia in the Free State and compare training, experience and supervision findings with those of 14 years ago in a similar study by G Lamacraft. Method: This was a cross sectional analytical study carried out between the 11th and 19th December 2019. All caesarean section sites within the Free State were identified from a list obtained from the provincial government. Hospital CEOs and clinical managers were informed prior to the visit. On Arrival a list of doctors administering obstetric anaesthesia was obtained from the clinical manager. An audience with the doctors was requested and those that could not come were traced to their work areas and given the questionnaire. An implied consent was stated at the beginning of the questionnaire which was self-administered. The same questionnaire as by Lamacraft (with one added question) was handed over after a brief description of the study and collected into a box at the end of the session. The collected data was kept anonymous. Results: A total of 124 medical doctors met the inclusion criteria with 103 of them completing the questionnaire, thus an overall response rate of 83%. Level 1 and level 2 hospital response rates were 78% and 91% respectively. This was an improvement from the 69% overall response rate of 2005. Exposure to obstetric anaesthesia during internship has improved: in 2005 12% of respondents lacked exposure but this dropped to 5% in 2019. The reported level of supervision also improved: In 2005 21% of supervision was by junior medical officers and only 25% by consultants compared to 2019 where junior medical officer’s supervision contributed 15% and consultants 44%. A lack of exposure and training post internship was observed with only 1 doctor having a Diploma in anaesthesia in 2005 compared to 5 in 2019. Employment of a senior anaesthetist improved: 54% and 47% reported to have no senior anaesthetist employed by their hospital in 2005 and 2019 respectively. Unfortunately the added responsibility of neonatal resuscitation while administrating anaesthesia to the mother increased slightly from 42% in 2005 to 47% in 2019 Conclusion: Training, supervision and experience of doctors in level 1 and 2 hospitals in the Free State post internship has marginally improved in the last 14 years. Greater improvement has been noted during internship training.
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Keywords
Dissertation (M.Med (Anaesthesiology))--University of the Free State, 2021, Anaesthetist, Medical officer, Community service doctor, Intern doctor, Level 1 Hospital, Level 2 Hospital, Maternal death, Institutional Maternal Mortality Ratio, General anaesthesia, Spinal anaesthesia, Obstetric anaesthesia