Anaesthesia & Intensive Care is severely under-resourced in Tanzania. Whereas Sweden has 2400 specialist Anaesthesiologists, Tanzania has only 13. Most anaesthesia and intensive care is carried out by nurses, or by partially trained Anaesthetic Officers. The knowledge and skills of these staff were largely gained during their initial vocational training. A lack of in-service training and educational material results in knowledge that is old and out-of-date. Working alone, without supervision and incentives, the anaesthesia practitioners are poorly motivated. Neglect from policy makers and a lack of research capacity means anaesthesia and intensive care is absent from the national health agenda. Furthermore, old and poorly functional or even absent equipment as well as a limited selection of drugs contribute to the critical state of anaesthesia and intensive care in Tanzania.
The importance of good quality anaesthesia and intensive care is increasingly understood. Reducing mortality in low income countries requires good quality healthcare and anaesthesia and intensive care has a vital role in many aspects of hospital services. Without good quality anaesthesia and intensive care, maternal mortality following obstetric complications will not be reduced, neonatal deaths from asphyxia and sepsis will continue, case fatality rates from cerebral malaria, severe pneumonia and severe diarrhoea will stay high and deaths due to traffic accidents will remain common. Patients with acute, life-threatening conditions can often be saved with good quality anaesthesia and intensive care. Without it they die.
A new focus on improving Anaesthesia and Intensive care in Tanzania is essential. More specialists are needed and training and education should be improved both in-service and for new trainees. Supervision, guidelines and regular contact with colleagues would help to improve motivation. Motivation could be further improved with contact with anaesthesiologists in other countries, leading to an understanding that there are alternative ways to work. Research into the optimal ways of managing anaesthesia and intensive care when resources are limited is required. Purchasing or acquiring new equipment would be of benefit. Prioritising anaesthesia and intensive care nationally and internationally would lead to reduced mortality and improved care in hospitals in Tanzania.
The Muhimbili Karolinska Anaesthesia & Intensive Care Collaboration (MKAIC) has been set up to tackle these issues. It was started in September 2008 on the initiative of Muhimbili National Hospital in Tanzania. It is now an official partnership with the full support of the departmental heads at Muhimbili and Karolinska University Hospital.