|
Home About SPA Join SPA Education / Meetings Newsletter Job Opportunities Volunteer Service Abroad Links of Interest
     |
SPA Newsletter.
Letters from AfricaEditor's Note: Many of you may have wondered what happened to my colleague Dr. Mark Newton who had sent letters from Kenya a few years ago. He and his family moved back to Denver for a few years to catch up "modern medicine". We didn't think "Letters from Denver" would have quite the same appeal, although some of his and his family's experience in adjusting to life in the USA would probably have been just as interesting! Mark Newton is an American born, raised and trained pediatric anesthesiologist whom I first had the pleasure of meeting in Houston where we were both residents. He completed his pediatric anesthesia training in Denver and stayed on staff there for a number of years before following his dreams to Africa. He and his lovely wife Sue with their (at that time) two young sons moved to Kenya to the Kijabe Missionary Hospital to live and work. Sue trained as a physical therapist and both of them had extraordinary experiences quite outside the scope of their training. They had another child and adopted one while they were in Africa. If you are interested in some of their earlier experiences please look for "Letters from Africa" in previous newsletters available on the website. Mark and Sue had always planned on returning to Africa to continue their work there. Once I completed a four-year stint on the edge of the Rift Valley working at Kijabe Hospital in Kenya, I was welcomed back by Dr. Desmond Henry (Chairman) to resume my position at Denver Childrens' Hospital. I was reassured by Drs. Dave Polaner and Charlie Lockhart that halothane is still available and that my Kenyan halothane inhalation technique would not need to be refined. I was equally overwhelmed by the choice of cereal in the supermarket and the vast array of anesthetic drugs and supplies available in the cart next to my padded O.R. chair. The disequilibrium, which I was experiencing, was not malaria (it was winter in Colorado and not a mosquito in sight) but the weight of too many options. The anesthesia tech asked, "Are you going to use isoflurane, sevoflurane, desflurane, or halothane? Do you want fentanyl, remifentanil, morphine or preservative-free morphine? Do you want a 1 liter, 2 liter, or 3 liter circuit bag? Would you like an infusion pump, arterial line, blood warmer, a fiber optic and a BIS?" How was I going to formulate a plan for a pediatric case in a large teaching hospital in the west when I had not used a BIS in four years? I felt like a wildebeest that was on the edge of the Mara River during the "Great Migration" and could not decide on when to take the leap! My comfort zone increased over the next month when events occurred which reminded me of anesthesia practice in Kenya. In Denver, the hospital's electricity supply was interrupted and as the alarms blurred, I relaxed and reminisced. We were told the succinylcholine supply was very low, I adjusted my plan since I understand drug shortages. And in the cases when the gas analyzer repeatedly malfunctioned, I reverted to my patient monitoring skills, which needed resharpening, and I felt like I was ready for a cup of "chai" (Kenyan tea)! After almost two years at Denver Childrens', my family (wife, four children) and I returned to Kenya to help establish an anesthesia program for rural providers. The needs remain great and the cases challenging. I have already appreciated the donation of books and equipment by Drs. Burdett Dunbar and Quentin Fisher, as well as the Karl Storz Company. A few weeks ago I was longing for that same anesthesia tech that offered me all of the "extras". A Kenyan nurse summoned me to the room to inform me that the patient may have "that problem with temperature". We had a 10-year-old male status post tibial osteotomy who now had a temperature of greater than 40 degrees and our hand held end-tidal CO2 monitor measuring 96. The MH hotline number unfortunately does not work in rural Africa! We gave him our five bottles of dantrolene, which expired in 1996; bicarbonate without an arterial gas analyzer; covered him with ice from my wife's freezer; filled every cavity with cold water; and retrieved our institutions mannitol supply. We celebrated as the temperature and end-tidal CO2 decreased only to be saddened 24 hours later when his acute lung injury developed. Our only ventilator (LP-6), which was used for home care patients, could not provide for the patient's required airway pressures. This case, as well as many others, highlights the need for a medical infrastructure, which is required to care for perioperative pediatric patients. I have read with interest the recent SPA policy statement on the provision of pediatric anesthesia care in the U.S.A. Although my current anesthesia environment is very different, I believe this type of policy is very useful for all institutions. After returning from a recent safari near Tanzania, I again began experiencing a light-headedness in the "theatre" which reminded me of my time at Denver Childrens'. I knew it was not because of my multiple anesthesia drug choices, but as a result of the feisty mosquito in my tent a week earlier! (I recovered in a few days from the malaria). I would certainly welcome any communication. My email address is msnewton@kijabe.net .
Table of Contents
|
|
| © 2010 Society for Pediatric Anesthesia 2209 Dickens Road, Richmond, VA 23230-2005 • Phone: 804-282-9780 • Fax: 804-282-0090 • spa@societyhq.com PRIVACY POLICY • REFUND / CANCELLATION POLICY |
Mark is using and teaching with a donated fiberoptic scope on a child with a large introral mass and a poor airway.
Mark with Maasai community elders, where we are involved with development projects like schools and clinics.