When, on March 2 1876, an unidentified young African man presented himself to Reverend Doctor Robert Laws for a surgical operation, he must have been apprehensive.
This is because according to a November 1985 article titled ‘The first anaesthetic in Central Africa’, practitioners were largely experimenting on how to conduct painless surgical operations, especially in Africa, where infrastructure was just being set up.
“The Reverend Doctor Robert Laws (1851-1934) followed in the footsteps of David Livingstone to Central Africa. At the beginning of a long and distinguished career as a medical missionary in Christian service to the country that has since become the Republic of Malawi, he was a prime mover in the setting up of a mission station at Cape Maclear, on the shores of Lake Malawi (formerly known as Lake Nyasa and closely associated with the discoveries of Doctor Livingstone). There, on 2 March 1876, Laws used chloroform to produce surgical anaesthesia when he operated on a young African male who had a cystic tumour above his left eye,” the abstract for the article reads.
Fortunately, people such as Professor Paul M. Fenton have been promoting the cause of anaesthesia in the country.
As such, he did extensive research and summed up his findings in the article ‘The Malawi Anaesthetic Machine. Anaesthesia’, which he published in 1989.
No wonder, his observations are spot on.
An article titled ‘Anaesthesia Training in Malawi’, which summarises what Fenton wrote in ‘The Malawi Anaesthetic Machine. Anaesthesia’, reads: “Surgery requiring general or regional anaesthesia is performed at mission and government district and central hospitals. The former have from 100 to 250 beds and the latter up to 850 beds, though they often have much greater than this number of in-patients. The workload, staff and methods of anaesthesia have been described.
“The development priorities in the health strategy of the Ministry of Health are centred in primary health care activities. In the past, little emphasis has been placed on the establishment of a properly defined anaesthesia service, with minimum standards of competence for its practitioners. Malawian doctors in government clinical practice are few in number…. At the time of writing, there is only one (expatriate) physician anaesthetist for the whole country.”
At the time Fenton published the article, the only Malawian anaesthetist who had a recognised specialist qualification was working outside the country.
As such, Fenton pointed out, anaesthesia is thus mainly administered by unsupervised paramedical staff who may have considerable experience but minimal or no formal training.
“However, the specialty has traditionally been unpopular with these health personnel in Malawi (known as medical assistants and clinical officers) for various reasons: Specialist physician anaesthetists have, for many years, been few in number, temporary, or even non-existent, and as a result the specialty has been leaderless and therefore unattractive for paramedical personnel to choose a career.
“Clinical officers and medical assistants who have been designated as anaesthetists after a training period are perceived by themselves and others as having poor promotional prospects compared to their contemporaries in other specialties. Very few have had the benefit of attending refresher courses at any time, or have any specialist supervision of their practice, and they are usually left for years to get on with the job. The current emphasis of external funding agencies on primary health care activities has exacerbated this situation, giving the impression that anaesthesia is a forgotten corner of domestic medicine,” it reads.
Touched by the situation in Malawi, Fenton founded the Malawi School of Anaesthesia in 1988.
That was two years after he started working in the country.
He ended up working in the country for 15 years.
Generally, the Royal College of Anaesthetists defines an anaesthetist as a specialist doctor who is responsible for providing anaesthesia and pain management to patients before, during and after operations and surgical procedures.
Fenton told me on Saturday that a lot has changed in the country’s health sector.
“We came to start working in Malawi in 1986. In 1988, I established the school of anaesthesia after realising that there was a terrible crisis in anaesthesia, unnecessary deaths, specialty in it did not exist at all. And it was a struggle. At the time, nobody was interested in it. Even in the Ministry [of Health], nobody was interested it.
“I used to call it the department of the unknown specialists because nobody, not even surgeons, was interested [in it]. All people wanted was to do the work [in the theatre] instead of spending six or so months on training. Now things have improved and there are local anaesthetists who are doing a good job, thereby improving health outcomes and reducing incidences of unnecessary death,” Fenton, who was in the company of his youngest son, pointed out.
When he came to Malawi with his wife and three children, his youngest son was two years old, such that he did all the schooling in Malawi.
“I started the school of anaesthesia with about 15 people and we only had a campus in Blantyre. Now there is a campus in Lilongwe, with 65-plus people. Anaesthesia is now being taken seriously,” he said.
The anaesthetist was, therefore, there when the European Union funded the construction of structures that advanced the cause of anaesthesia at Queen Elizabeth Central Hospital (QECH) in Blantyre.
On his part, anaesthetist Cyril Godiya said the area contributes to positive health outcomes.
“This is because apart from providing anaesthesia to those in need, anaesthetists get patients ready for surgery and look after them afterwards. They also do resuscitation and stabilisation of patients in the emergency department. They also provide pain relief in labour and obstetric anaesthesia, intensive care medicine, pain medicine, among others. They also provide pre-hospital emergency care.
“In short, anaesthetists support every part of the body, including managing a patient’s breathing. They ensure that if a patient is bleeding or has a cut, that should not compromise the patient’s life. The anaesthetist plays an important role in ensuring that a patient receives the best care they can,” Godiya said.
Another anaesthetist Rose Kapenda, who works as an anaesthetic clinical officer at QECH, explained that they decided to recognise Fenton’s on Saturday last week, when they presented gifts to him.
She stressed that it was important to recognise Fenton’s efforts because his contribution to Malawi’s healthcare sector was immeasurable.
“He contributed greatly to the development of the healthcare profession, especially anaesthesia, in Malawi, hence local anaesthetists decided to present a gift to him. As the founder of the school of anaesthesia in Malawi, he played a key role in helping save lives,” she emphasised.
According to the Royal College of Anaesthetists, anaesthetists often occupy key management roles by working as a clinical or medical director. They often lead the clinical management of intensive care units alongside other specialties and work closely with emergency physicians to treat emergency patients.
“They provide care for patients in chronic pain clinics, provide anaesthesia in psychiatric units for patients receiving electroconvulsive therapy, as well as the provision of sedation and anaesthesia for patients undergoing interventional radiology and radiotherapy,” it says.
The World Health Organisation (WHO) indicates that “surgery and anaesthesia care are essential to a comprehensive primary health care (PHC) approach and to a people-centred continuum of emergency, critical and operative care (ECO) services. Surgeons and anaesthetists treat a wide variety of conditions, from cancers and injuries to complications of pregnancy and infections.
“Billions of people currently lack safe, timely and affordable access to these services. Universal access to these services would save lives, prevent disability and promote economic growth. WHO‘s goal is to strengthen health systems to improve the delivery of comprehensive surgical and anaesthesia care, ensuring access without financial risk, to all people everywhere,” the global body says.
