Some people think anesthesiology is a “lonely” occupation. For the most part, we practice independently from others in our specialty. Sure, we have groups and departments, and colleagues on the medical staff, surgeons, nurses, and others we see and work with frequently. We all have our favorite specialists, ones we would send our family members to or see for our own health needs. But when it comes to the actual delivery of an anesthetic, we are often working alone. Even when we are training others or working in a care team model, most of the decisions we make and carry out are done in isolation. To intubate or use an LMA, muscle relaxant or not, narcotics or a block or both – these are the decisions we make on a routine basis. And while we might need more information from the surgeon or the patient, we ultimately decide these things on our own. Unlike most other specialties, we carry out much of the treatment that we prescribe. This may lead to isolation and burnout; it may contribute to the reasons that non-anesthesiologists don't really understand what we do on a daily basis and may not be helping our cause to help others understand our role in perioperative care. This means that we need to learn the skills of explaining our thoughts and our decisions and how to clearly articulate them. Interpersonal and communication skills are one of the core competencies required for residency training and are equally as important as patient care and medical knowledge (asamonitor.pub/3ysMdak). Learning to effectively communicate is one of the many skills that anesthesiologists need to master in order to become leaders. It is becoming increasingly important that anesthesiologists become leaders in perioperative management and advocacy, for the continued success and health of our specialty.
COVID-19 has made global isolation worse for virtually everyone. While some were isolated at home, many anesthesiologists faced increased burdens at work and at home while managing households, virtual education for children, child care, and caring for sick, elderly, or isolated family members – all without the usual opportunities for interaction with our peers, family, or in other venues. In fact, there are many reports of anesthesiologists leaving the field entirely, entering early retirement, or reducing hours. The impact has been particularly relevant for women (ASA Monitor 2020;84:e1-2).
Although it is tempting to focus only on our U.S.-based health care issues and the impact that COVID-19 has had on our life and practices, the reality is that the urgent need for improved access to safe surgery and anesthesia care around the world has not abated; in fact, it is likely that the world will face continuing urgent needs both because of and in spite of COVID-19. Frequent news reports of serious, life-threatening oxygen shortages underscore the worldwide crisis. These reports come from Africa and Asia and also from America (asamonitor.pub/3jW1fiE).
In 2015, the Lancet Commission report “Global Surgery 2030” indicated that 5 of the world's 7 billion inhabitants lacked access to essential surgery. Although many countries have made progress on delineating National Surgical, Obstetric, and Anesthesia Plans, many countries have not yet made plans, and even fewer countries have made substantial progress toward reaching their goals. COVID-19 has made this difficult situation even worse (World J Surg 2020;44:2451-7).
What do our anesthesiologist partners around the world need? They need education, CME, comradery, advocacy training, tools of quality and safety, and research. They need help to support young anesthesiologists throughout their countries, just as we build mentorship and support networks for our colleagues in the U.S. We need a global health track at the ASA annual meeting, more visibility for our Global Scholars, more host sites for observerships when travel is approved, more interactive virtual education and simulation, hands-on clinical training for low- and middle-income visitors to the U.S., more subspecialty fellowship training around the world, and more collaborative work with surgeons and nursing in partnerships around the globe (Int J Surg 2021;28:63-9). We need bi-directional partnerships, health equity education, knowledge and research, not just for our trainees but for all of us (ASA Monitor 2018;82:68-9; Curr Anesthesiol Rep 2017;7:30-6).
How can you get involved? Volunteer with organizations that need help – not so much to travel somewhere, but to teach and advocate for science, technology, engineering, art, and math (STEAM) education. Be an educator, be a tutor, or become faculty for education for the incarcerated. Not sure where to start? Global includes local and start here (“Global Includes Local” ASA Monitor 2021;85:21-2) or here (“Volunteerism Is Global Health” asamonitor.pub/3xN4UEt).
The needs are too great for any one of us to meet on our own or by any one non-governmental organization (NGO), non-profit organization, or institution. And thus, we need to re-visit our focus on partnerships. Once only the realm of private practice mergers, health system acquisitions, or industry-supported clinical research programs, partnerships are now the imperative that we need in order to forge the way forward. We need partnerships to educate and train anesthesiologists around the world. We need partnerships to identify important research questions relevant to the delivery of anesthesia care around the world. We need partnerships to inform where and how our trainees learn about global health, health equity, and safe anesthesia for all. In addition to the other articles in this edition of the ASA Monitor, here are just a few examples that highlight our past successes and provide illustrations about the value and impact of the many partnerships and relationships that ASA members have participated in and benefit from:
The ASA Committee on Global Humanitarian Outreach (GHO) has focused on partnerships throughout its history and is actively working on continuing and improving these relationships. Signature programs include the ASA Charitable Foundation, Overseas Teaching Programs in Rwanda and Guyana (in a partnership with the Canadian Anesthesiologists' Society International Education Foundation (CASIEF) (asamonitor.pub/2VLh97L) and the Resident International Anesthesia Scholarship Program, which includes partnerships with host hospitals and Cure International (ASA Monitor 2020;84:19-20).
Starting in 2011, the Nicholas M. Greene, MD Award for Outstanding Humanitarian Contribution is awarded at the ASA annual meeting. Prior winners have been strong advocates of partnerships. This year's winner is Edward Clune, MD. His work in Botswana is a prime example of an academic partnership between the Department of Anesthesia, Critical Care and Pain Medicine at Beth Israel Deaconess Medical Center and Botswana. Look for an upcoming article highlighting this work.
ASA, through its Charitable Foundation, has a longstanding partnership with Lifebox (ASA Monitor 2021;85:37), whose co-founder and chair, Atul Gawande, MD, has just been nominated for Assistant Administrator of the Bureau for Global Health, U.S. Agency for International Development (USAID)(asamonitor.pub/3jV9pYC).
The ASA annual meeting has long been considered one of the foremost anesthesiology meetings in the world. Beginning in 2015, ASA has sponsored the Global Scholars Program, which seeks to bring young leaders in anesthesiology from around the world to the meeting. Due to the COVID-19 pandemic, there were no global scholars selected in 2020, but for 2021, 13 scholars have been selected (see Table). Although they will not be able to travel to the U.S. for the meeting in person, this highly motivated group of physicians will attend the virtual component of the meeting, will participate in subspecialty meetings, and will present their work online. Be sure to look for their posters! Benefits of being an ASA Global Scholar include national and international recognition, development of mentoring relationships, sponsorship for continued work in regional, national, and international working groups, and development of skills in advocacy and leadership. Prior recipients were able to participate in observerships in selected institutions; this, along with conference attendance, supports networking opportunities, forming a basis for future institutional ties and other partnerships and, of course, lifelong friendships. In addition, prior recipients are now chairs of departments, work with ministries of health, have developed National Surgical, Obstetric, and Anesthesia Plans, and much more (ASA Monitor 2020;84:50-1)!
Angela Enright, MB, FRCPC, will present the Ellison C. Pierce Patient Safety Memorial Lecture: “Anesthesia Safety in an Asymmetrical World” at the 2021 ASA annual meeting in San Diego. Dr. Enright was the 2012 recipient of the Nicholas M. Greene, MD, Award for Outstanding Humanitarian Contribution and is a staunch advocate for partnerships (asamonitor.pub/3AKvXlR).
The World Federation of Societies of Anaesthesiologists (WFSA) is a federation of national societies, and ASA is one of its largest members. ASA members are therefore part of the WFSA through ASA. All ASA members are welcome and encouraged to volunteer for projects, teaching, writing for the Anesthesia Tutorial of the Week, global advocacy, and fund-raising. Volunteers are the foundation of what the WFSA does, and the WFSA could not succeed without them (ASA Monitor 2021;85:14-5).
And don't forget the five ASA Foundations: the ASA Charitable Foundation, the Anesthesia Foundation, the Anesthesia Patient Safety Foundation, the Foundation for Anesthesia Education and Research, and the Wood Library-Museum of Anesthesiology (ASA Monitor 2020;84:4-5).
Please join the efforts of the GHO committee and others as we seek to make the world a better, safer place. Visit our websites, our booth at the annual meeting, and meet and encourage our Global Scholars. Be an active member of partnerships that work toward these aims. We look forward to partnering with you!
Disclosure: Dr. Drum is a councilmember of the World Federation of Societies of Anaesthesiologists.