Anesthesiology Residency and Fellowships

Global Health

Vietnam, Lauren Nakazawa, MD (Class of 2016)

This past winter, I was fortunate to have the opportunity to travel to Ho Chi Minh City (HCMC), Vietnam, with the non-profit organization Health Volunteers Overseas. I applied for and received one of eight Traveling Fellowships from the Society for Education in Anesthesia – Health Volunteers Overseas (SEA-HVO). These two organizations have partnered together to sponsor senior anesthesiology residents’ travels to one of HVO’s several sites worldwide, in order to provide training and mentorship to local anesthesia providers. HVO’s motto is “transforming lives through education,” and volunteers from over a dozen medical subspecialties, including anesthesiology, work to improve global health care quality by empowering and teaching the local workforce in resource-scarce countries.

I first learned of the extent of the “global healthcare crisis” as a medical student at Penn, where I pursued a Certificate in Global Health. Worldwide, 400 million people lack access to essential health services, there is a shortage of over 7 million healthcare workers, and 5 billion people have limited access to safe surgical and anesthesia care1,2,3. These statistics were both shocking and upsetting to me, and inspired me to pursue a career dedicated to international healthcare. I felt that I could make the greatest and most sustainable impact through teaching and training the healthcare providers, who would continue to apply this knowledge to improve the care of their own patients even after my departure. With this in mind, I joined HVO and embarked on my first volunteer experience to the Hospital for Traumatology and Orthopedics (HTO) in 2012. I traveled with Dr. Daniel Vo, a former Penn Anesthesia resident and previous recipient of the SEA-HVO award. HTO is a 440 bed orthopedic and trauma hospital in the heart of HCMC that is a major teaching institution and referral center in south Vietnam. Both staff anesthesiologists and nurse anesthetists provide anesthesia care. Dr. Nguyen Chung, the former Chair of the Department of Anesthesiology at HTO, provides oversight for HVO volunteers. During my month-long trip, I presented lectures on topics of interest to HTO’s anesthesia department, assisted in a workshop on ultrasound guided peripheral nerve blocks, learned about the practice of delivering anesthesia in a resource-scarce environment, and forged friendships with the local anesthesia providers. This volunteer experience had an incredible impact on me, and inspired me to pursue a research project studying the effects of medical volunteerism on HVO anesthesia volunteers themselves.

During my residency at Penn, I wanted to continue my global health endeavors and my involvement with HVO. With the support of the Penn Anesthesia department, I applied for the SEA-HVO fellowship. When I was selected to receive an award in 2016, there were many reasons why I wanted to return to HTO in Vietnam with Dr. Vo as my faculty mentor. I wanted to continue to build my professional relationships with the local staff, deepen my own understanding of the challenges of delivering anesthesia in an international setting, and see what changes have been enacted as a result of HVO’s involvement. On this journey, many things remained the same: the warm welcome and hospitality shown to us by our Vietnamese hosts, the intellectual curiosity and drive for continual improvement by the anesthesia providers, and the resourcefulness of the staff to provide excellent patient care despite limited resources. However, I was encouraged to see many positive changes were made. During my first visit, the majority of staff did not use ultrasound for peripheral nerve blocks, but instead used an anatomic landmark-based technique. Since then, there has been widespread adoption of the ultrasound, and the staff is comfortable in its use. The staff reported that acquisition of this skill enhanced the quality of care for their patients, and were improving the safety and success of their blocks. They felt like the efforts of the HVO volunteers over the years providing ultrasound workshops, formal classroom as well as hands-on teaching, and continual practice and reinforcement of these concepts was instrumental in this widespread change.

During this last volunteer experience, we continued this multi-modal approach to teaching. We provided daily morning lectures on topics requested by local providers, followed by going into the operating rooms to continue the discussions and exchange of knowledge. My didactic lectures included topics such as Local Anesthetic Systemic Toxicity, Peripheral Nerve Anatomy and Mechanisms of Injury, Acute Pain Management of the Opioid Tolerant Patient, Complications of Peripheral Nerve Blockade, and Multimodal Analgesia. Lectures were all translated into Vietnamese so that practitioners who were not as fluent in English would benefit from the teaching. Furthermore, we also provided a hands-on advanced airway management workshop with a simulator mannequin, demonstrating fiberoptic bronchoscopy techniques and the use of various supraglottic airway devices. We also provided clinical demonstration in the form of a brief refresher course on ultrasound for regional techniques. We applied ultrasound for peripheral nerve blocks not frequently performed at the hospital, such as adductor canal and infraclavicular nerve blocks. Afternoons were spent teaching and observing in both the operating rooms and the preoperative area, where most of the blocks are performed.

My month spent in Vietnam was one of the highlights of my educational experience during residency. It solidified my interest in pursuing a fellowship in Regional Anesthesia, sparked personal and professional growth, and reinforced the importance of building collaborative relationships with local healthcare advocates. Penn Anesthesia has a legacy of residents and faculty involved in HVO and other global health endeavors, and I’m thankful for the mentorship and inspiration from my friends and colleagues in the Department.

For more information about HVO and the SEA-HVO Traveling Fellowship application process, please visit www.hvo.org and www.seahq.net.

Special thanks to the Chair and Program Director of Penn Anesthesia, Drs. Lee Fleisher and Robert Gaiser, for their support and encouragement as I pursue my goals of becoming a leader in the global healthcare workforce.

References:

  1. “Universal Health Coverage (UHC).” Media Centre. World Health Organization, Dec. 2015. Web. 6 June 2016.
  2. Campbell J, Dussalt G, Buchan J, et al. A universal truth: no health without a workforce. Forum Report, Third Global Forum On Human Resources for Health, Recife, Brazil. Geneva, Global Health Workforce Alliance and World Health Organization, 2013.
  3. Meara JG, Leather AJ, Hagander L, et al. “Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development.” The Lancet 386.9993 (2015): 569 – 624.