Anesthesiology, Perioperative and Pain Medicine

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Q&A with Stanford Anesthesia's Residency Director

June 2012

Stanford Anesthesia senior resident describes his experience with the SEA/HVO Travelling Fellowship

As you may know anesthesia residents who have finished their first year of training and are interested in spending a month teaching in a developing country may apply for the Society for Education in Anesthesia Health Volunteers Overseas (aka SEA HVO) Traveling Fellowship. (www.hvousa.org and www.seahq.org)

This year Stanford Anesthesia senior resident Dr. Rohith Piyaratna participated in this wonderful Global Health opportunity. I asked him to tell us a bit about his experience there. Dr. Joshua Landy Visiting Scholar with me at Stanford then edited the below.

When Rohith Piyaratna was leaving Ethiopia to return to California, he decided it wouldn’t be his last visit there. Over the previous four weeks, which had gone by a lot faster than expected, he worked with and taught local Anesthesiology trainees, gave lectures on theoretical and clinical topics in anesthesia, and developed friendships with many of the hospital’s consultants.

Rohith was placed at Black Lion Hospital, the largest general hospital in Ethiopia, as a member of Health Volunteers Overseas (HVO). In conjunction with the Society for Education in Anesthesia and Stanford’s Department of Anesthesiology, the HVO-SEA participants are invited to spend one month working and teaching at various under-serviced areas in the world, including Vellore, India; Blantyre, Malawi; Lima, Peru, and several other places.

In his daily journal, Rohith describes the diverse case mix including general, thoracic, obstetrical and gynecological, orthopedic, pediatric, trauma, and urologic cases. For example:

A 23-year-old male was stabbed in the chest 2 months ago. He now presents with chest pain and tachypnea. His chest x-ray showed a large L layering effusion. When the left hemithorax was opened, we found that the abdominal contents had herniated through a defect in the diaphragm causing a left-sided pneumonia and empyema. The stomach was necrotic and had to be completely excised. The case took a long time. At the end the patient was saturating well with moderate tidal volumes, though was very tachypneic, thus precluding extubation. Luckily, there was a ventilator free in the SICU. At the end of the case, we switched the double-lumen tube for a regular tube and transported the patient to the ICU. By the time we left the hospital, it was 8 pm! Probably one of the longer days a volunteer will have at Black Lion but luckil, these are very rare. Still managed to go to the gym and have a good dinner at Adams pavilion and was quite exhausted.

The first case in the pediatric room was a 10-day-old neonate with Down’s syndrome, Tetralogy of Fallot (TOF) and suspected duodenal atresia who was scheduled for an exploratory laparotomy. When I first heard about the case, I was flabbergasted. I promptly told the students that I had never done a pediatric case involving TOF, especially one that sounded really sick.
He was tiny and was the bluest baby I have ever seen. He was on oxygen and I asked for a pulse oximeter to be placed to assess how bad his shunt was. His saturation while on oxygen was between 60-80% ! I looked through his echocardiography reports and found that he had a large VSD – so large in fact that you could barely hear the murmur through it! I basically told the anesthesiologist to talk to the surgeon and the patient’s family and inform them fully that this was a very high risk case. After a discussion with the family and surgeon, we decided not to [proceed].

Outside of the OR, both clinical and didactic teaching opportunities were readily available. Lecture topics were delivered weekly and included basic and advanced material, including acute pain management, blood gas analysis, special populations in anesthesia (pregnant and geriatric) patients, one-lung ventilation, and even neurosurgical anesthesia. Ample opportunity was present to help the local trainees improve their hands-on skills in airway management, regional and epidural techniques, and crisis management. The students are described as having “…a very good theoretical knowledge base…” and “eager to do neuraxial techniques.”

Rohith summarizes his trip as, “Overall, a wonderful experience! I felt like I made a difference after my time over there. I learned a lot myself from watching and teaching the students and it did help prepare me for my transition into an attending/consultant anesthesiologist. I would definitely go again.”

Residents that engage with this fabulous experience gain from a humanitarian perspective, and achieve personal and professional growth.

Ro is starting community practice in Sacramento. We wish him well.

Thank you,
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