Attending: Quentin Fisher, George Gregory, George Politis, Alan Roth, Paul Samuels, Steve Stayer

I truly apologize to those who were at SPA but might have missed the announcement changing the venue of the meeting. I hope we can get the information out better next time!

1. Information Clearinghouse Database for Voluntary Medical Services Abroad: This is now online at SPA's website: Please look over your organization's information, or let us know if an organization you know of is not represented. We need someone to consider how improve the website, to create linkages to/from other useful sites, and to solicit additional agency listings as required.

2. Mobile slide program: In the past we discussed helping develop brief slide lectures with captions or additional text (and handouts if available) for volunteer providers. Although this project was not active this year, we would like to revitalize it. Raz Samandari ( and Paul Samuels ( will help you convert a few slides into a brief curriculum; hard-copy slides can be scanned into Powerpoint and returned to you. Among the topics suggested for which they are seeking lectures and slides are:

• Pediatric Airway,
• Fluid Management in Infants and Children
• Neonatal Resuscitation
• Pediatric Regional Anesthesia
• Sedation
• Post-Anesthetic Care
• Pediatric CPR and Resuscitation
• Inhalation Anesthetics and the Pediatric Patient

This is a really worthwhile endeavor; even if you do not travel abroad regularly, your contributions would be immensely helpful. It need not be a major effort; just gather up a few notes from your introductory lecture topics and contact Raz or Paul to get started.

3. Malpractice Insurance: The SPA Board has requested us to find out how extensively volunteers abroad are covered, and whether this constitutes a problem. When you travel abroad, does your insurance cover your practice? Does the sponsoring agency have malpractice coverage? Do you know if your sponsoring agency has ever made "settlement" payments because of an adverse event? We need a SPACIES member who would be interested in investigating these questions. We would like information presented by next October's SPA meeting. Please contact me, and I can provide the email addresses of SPACIES members and of agencies listed on the VMSA database.

4. Consensus Statement: Contributions by five members of SPACIES have been consolidated into a lengthy statement, which is now in a revision process. A draft was reviewed the week by the SPA Board and the editor of A&A, both of which organizations have expressed an interest in promoting it. It should serve to support anesthesiologists who need to know what should be done for a well-organized short-term surgical program, and some of the potential pitfalls. Earlier versions have been posted to your emails in August; please let me know of suggestions for changes, additions, etc. If there is a section you wanted to write and was not included, please get in touch (

5. New Idea: Symposium! It has been suggested that SPA, through SPACIES, sponsor a panel discussion on anesthesia for children in voluntary service programs abroad. It would serve as a forum to learn about each other's practices and problems, as well as a way to introduce others to this interesting realm of anesthesia practice.

A number of topics suggested themselves, partly modeled on a smaller gathering that Interplast sponsored for its members at the 2000 ASA meeting. We felt that the SPA's famous pro/con format would be an interesting way of exploring topics with audience participation. Suggestions included:

• Can a VMSA organization really succeed in transferring its program to local providers (i.e. can any of them achieve their goal of putting themselves out of business at a particular site?).
• Should VMSA programs expect to adhere to the same standards of care as US-based hospital practice?
• Should QA data be collected and how should it be managed? What is an acceptable rate of complications?
• Should neuromuscular blocking agents be used when mechanical ventilators are not available?

Other topics, less controversial, but very informative might include:

• Changing from halothane to sevoflurane;
• Anesthesia systems (related to sevo / halothane question)
• Use of premedications in sites where this is not a usual practice (most of the underdeveloped world!);
• Assessing risk with minimal laboratory and radiological support (e.g. murmur, cough, anemia);
• Scary cases

6. Quality Assurance / Quality Improvement: As far as we know, very few VMSA programs track their morbidity / mortality statistics. Among those at the meeting, we were aware only of case-by-case review of major morbidities and deaths, but no systematic approach to such issues as unexpected ICU admission, unexpected transfusion, re-intubation and other PACU-based problems, or near-miss events. Last year at the SPA meeting, Dr. Navedo presented some data from Heartcare that might serve as a model for tracking events and outcomes.

7. AAP Section on International Child Health (SINCH): Members of the AAP may want to look into this as an additional source of information and international contacts. SINCH hosts a variety of activities, including:

a. Child Health Network at The site has an interactive and searchable database similar to the SPA database, but focused on Pediatrics. The sponsors hope users will utilize it for forming international collaborations in child health

b. Child disaster network for volunteer health professionals able to respond on short notice.

c. Booklet, "Working in International Child Health" is a 100-page manual by Donna Staton on how to prepare for international work, with advice on health, political and logistical issues, as well as an extensive bibliography of books and websites. I have 8 copies available. If you would like one to share with your colleagues, please send me an email ( , or call the AAP office on Sections (800-433-9016 x 4926) to request one.

Respectfully Submitted

Quentin Fisher, MD