Central Line
Episode Number: 91
Episode Title: The Value of Global Engagement
Recorded: March 2023
(SOUNDBITE OF MUSIC)
VOICE OVER:
Welcome to ASA’s Central
Line, the official podcast series of the American Society of Anesthesiologists,
edited by Dr. Adam Striker.
DR. ADAM STRIKER:
Welcome back to Central
Line. I'm Dr. Adam Striker, your host and editor. And today I'm welcoming two
guests to the show, Drs. Kumar Belani and Ana Maria
Crawford. Both guest editors of the April ASA Monitor. Today we're going to
discuss global engagement, and I'm certainly excited to learn more about this
broad, complex and important topic. So Drs. Belani
and Crawford, welcome to the show.
DR. KUMAR BELANI:
Thank you.
DR. ANA MARIA CRAWFORD: Thank you.
DR. STRIKER:
Let's start off with
just diving right into what this topic really is. Global engagement is a broad
term, and I'm sure that means different things to different people. I myself
would like to know what it really encompasses. Dr. Belani,
do you mind starting us off and telling us a little bit about that term?
DR. BELANI:
Yes, Dr. Striker. Global
engagement is a broad term. And when we talk about global engagement, we are
actually talking about engaging globally on health-related activities from
educational research, knowledge exchange, clinical service so that we can
understand our global and cultural diversity and see how that pertains to
patient safety, particularly as it relates to our field of anesthesiology and
perioperative care, including pain management.
One of the goals of
global engagement in health is to learn from each other and bring up to speed
efficiencies and safety principles with our global partners. We want to make
sure that, you know, just like when you go from one country to another and you
take a bus drive from the airport to the hotel, there are rules and regulations
and safety principles in place and one feels comfortable because those are
universally available and adopted. The same thing in global health. We would
wish that wherever we go, wherever we are, and whenever we are there, we have
the same safety and facilities available to take care of us. So this is how
broad global engagement and health is. It's basically providing service to
mankind and making sure that this service is safe and up to date and has equal
access and good health for everybody.
DR. STRIKER:
So, Dr. Crawford, do you
mind broadening that framework out, to use the term, quote, global engagement,
that encompasses global health, advocacy, diversity, etcetera? Why that
matters? Why is this framework more useful than what we've done before?
DR. CRAWFORD:
Yeah. First, I'd like to
just second everything that Dr. Belani said, that
global engagement certainly encompasses global health. The global health field
has really exploded across North America and Europe. And it's really almost
exclusively used in North American and European literature. And I think that
that suggests that historically we have been building these programs in service
to patients across the globe. But it's really important to realize that we need
to have partnerships that are bidirectional, and that means that we benefit
from our colleagues just as much as they benefit from us. And really
recognizing that global engagement means more about building a community across
the globe or a global community than it does about, you know, a high resource
setting, you know, teaching and sharing with a low resource setting. Because
there's a lot for us to learn from our colleagues who work with resource
constraints. It’s really speaks a little bit more towards building a global
community and having a bidirectional impact. And I think it makes all of us a
bit stronger when we when we consider the perspectives of a diverse global
community.
DR. STRIKER:
So when you say
bidirectional, does that mean that it's been flowing mainly in one direction
from our country to to the rest of the world and not
the other way?
DR. CRAWFORD:
Certainly, certainly. The
advent of any sort of international health had its history in war times where
people wanted to protect their troops. So it was always like thinking about the
diseases in another country and either how to protect yourself or how to treat
what was called in the past tropical diseases or infectious diseases. And so it
was really about taking resources and expertise from highly resourced settings
and then sharing them in some of these other places that didn't have the same resources
or access to education and systems building, etcetera.
As global health has
continued to grow, it still has a unidirectional character to it. And I feel
like expanding the definition from global health to global engagement is really
important in making everyone think a little bit more about what we can learn
from our colleagues that are adept at navigating, for example, supply chain
issues or delivering safe anesthesia and perioperative care with a less carbon
footprint, for example. So there's there's a lot of
things that, you know, our colleagues working with less resources are
incredibly innovative in. And having that bidirectional narrative versus we're
going there to help them is really a shift.
DR. STRIKER:
Okay. Well, I do want to
follow up a little bit on the the personnel aspect in
just a moment, but I'd like to ask Dr. Belani another
question regarding the anesthesiology ratios to population that we all know is
an issue in other countries as compared to our own. For instance, here in America,
I think it's the number is approximately 21 anesthesiologists per 100,000
people. But if I'm not mistaken, it's less than one anesthesiologist per
100,000 people in many low-income countries. I just wanted to get your take,
Dr. Belani, on how that specific problem can be
addressed by this global engagement modality and specifically by
anesthesiologists who want to get involved.
DR. BELANI:
I think you are so
correct. We do have a larger number of anesthesiologists per 100,000. It's
about 30 per 100,000 in the United States. And data from the Indian Society of
Anesthesiologists, which was just recently published in the APSF (Anesthesia
Patient Safety Foundation) newsletter, there are 1.27 anesthesiologists for
every 100,000 people. And if you look at Uganda, the whole country has only 70
actively practicing anesthesiologists for a population of about 45 million,
that's approximately one for every 650,000 people. So there's a huge difference
in trained personnel being available. And this issue has come up in many
meetings with our global engagement colleagues. And one of my own colleagues
who's from Uganda is trying to get this problem solved by creating a system
where people can be educated and trained in working with anesthesiologists like
we have anesthesia assistants here, and that program has been shown to work in
some countries. And with the help of ASA, the American Society of
Anesthesiologists, we should be able to assist in providing the curriculum that
might be needed for these activities so that anesthesia assistants can come
about and be trained rather rapidly so that they can assist anesthesiologists
to provide the much-needed care in those countries.
And I know that the
World Federation of the Society of Anesthesiologists has several programs with
advanced countries where they can have people that are interested in
anesthesia, go to these advanced countries and get educated in anesthesia. And
these individuals then can go back to that country and then become the trainers
for teaching anesthesiology. There is one program that we are affiliated with
in Bangalore, India, that gets medical students who have just become doctors
where they can learn anesthesia in this institution, and then they are
supported by the World Federation for the Society of Anesthesiology. And then
they get their training and they go back. And even faculty can go and rotate at
those places so that this education can be continued and there can be sustained
relationships between these two countries.
The goal is to have
these programs available in in the country so that they can be educational
facilities set up there with a with a good curriculum.
DR. CRAWFORD:
While Kumar was
speaking, a few other ideas came to mind. One component of our ASA membership,
which is somewhat neglected, is our members that are approaching retirement. They’re
incredibly valuable assets to some of these initiatives.
The ASA Committee on
Global Health has several programs which are always looking for volunteers. The
ASA Overseas Program in Rwanda is a very established program that's been
running since it started in 2006 in conjunction with the Canadian
Anesthesiologists Society. It's certainly a program I'm intimately familiar
with. I've been to Rwanda now 14 times, but we're always looking for volunteers
in Rwanda.
And then the ASA Global
Health Committee also has a partnership in Guyana that really needs support,
needs not only volunteers to travel, but volunteers to help develop lectures
and curriculum as as Dr. Belani
was mentioning.
It's also important for
us to really reframe what we consider global health. I mean, we're talking
about health care access and getting rid of disparities for patients across the
entire globe. And so I really feel passionately that that global includes local
and that a lot of our initiatives here in our own communities really are global
health as well.
And then the last thing
that came to mind was, I believe it's 57 or more Native American nations right
here within the borders of the United States. So another way to actually do
international health is actually within the borders of the US, and that's to
address some of the health care disparities that occur within our Native
American indigenous population.**
DR. STRIKER:
Well, I think you
basically just highlighted an important distinction when it comes to global
engagement at this point, as opposed to what we might have all come to know as
global health. And the idea that it's only for people that are interested in
doing mission trips or going abroad. From what you're saying, that's certainly
no longer the case. There's many different ways to think about it if you do not
want to leave the borders of this country.
DR. CRAWFORD:
Absolutely. Another
thought around how to engage without traveling abroad goes back to this theme
of bidirectionality. You know, if we're really trying to impact patient
outcomes and improve patient outcomes, which is really what we're all trying to
do, hosting our colleagues that are working with resource limitations, hosting
them in a highly resourced environment, really teaches a lot of lessons that
are almost impossible for us to convey while we're in country. For example, we
have had three cohorts come through Stanford University as visiting scholars,
and we surveyed what they took away from their time with us and the lessons
were really remarkable. They really don't care about our echmo
or our highly technical aspects of our practice. What they took away was
witnessing an organized health care system, patient autonomy, patient safety,
non-hierarchical feedback between, for example, faculty and trainees. So a lot
of these things--good open communication, professionalism, open discussions
about quality improvement, etcetera. And these things are really, really hard
to teach if you go and embed yourself in a completely different culture. And
when our colleagues come here, they are better able to see what works in our
system that may actually be adaptable and work in their system as well.
So developing these
bidirectional partnerships really is a benefit to both sides. And going back
to, you know, our colleagues that are nearing retirement, engaging in these
types of programs is is really a good way to impact
patient outcomes in another country, but not necessarily requiring travel.
DR. BELANI:
I agree with Dr. Anna
Crawford. Many of our faculty that are coming from abroad and rotating here on
their visits, what they like most is not only what Dr. Crawford said, but they
also like to learn about how to do research, how to pursue academics, how to
create clinical trials so that they can actually go back and do the same things
in their own countries. And that program has worked out very well. It's not
just our people going there, but having them come and learn here also.
DR. STRIKER:
I'm just curious, a lot
of anesthesiologists coming from other countries where there's, as you
mentioned, are resource limited, would bring a lot of insights into our own
practices that are resource rich in how to manage practices, whether it's more
efficiency, less waste, or in a in a manner that perhaps uses less resources.
And I'm wondering, do either of you have any insight into how that is perceived
in our current organizations when individuals come over from other resource
limited countries, how it's perceived by them, you know, when it comes to the
plethora of resources we have. And if there's anything we can actually
realistically implement, whether it's methods or insights, that they have to
perhaps more efficiently utilize our resource, given the large administrative
structure that many of us are working under.
DR. BELANI:
You bring up a great
point. One of our fellows, was rotating abroad. When she came back, she said, Wow,
they hardly use any blood when they do pediatric heart surgery over there. And
she thought that was actually something not correct. But then she realized that
it's because it was not needed and the surgeons were quite quick. They didn't
lose much blood and the patients got a caudal morphine, which gave them
significant pain control without having to worry about giving them additional,
you know, intravenous opioids. And seeing that was an eye opener for her. And
then when she came back here, she started to talk to the surgeons and figured
out that this caudal morphine approach will work quite well even here. And that
became instituted pretty readily as soon as, you know, that was discussed with
the groups over here. So there's a lot to learn when they go and see the
efficiencies that are available in other places, the cultural differences, and
the way that they manage without having to waste a lot of time and money.
DR. CRAWFORD:
Another thing that comes
to mind along those lines is the health care industry's effect on climate
change. So a lot of us are familiar with recent study this past year that came
out and essentially equated the health care industry to a country and said it
would be the fifth largest contributor to carbon emissions. In our setting,
we've really focused a lot on patient safety. And with that has come, you know,
the establishment of kits and single use items, which certainly has a downside.
One striking difference when you are operating in the theaters and somewhere
that doesn't have as ample resources is really how they're able to do a safe
anesthetic and surgery with a lot less waste. And the surgeries that we do
here, I think we're all familiar. We'll see one, two, three, sometimes up to 5
or 6 or more bags of trash that are taken out of the OR for every single case.
And in Rwanda, for example, I see them with just a simple kick bucket. So it's
really, really remarkable the amount of reusable materials they have. And
they're still able to deliver a safe anesthetic.
DR. STRIKER:
Yeah. Do you think the
administrations that you have been a part of or at least heard about, when new
efficiencies are identified, or new methods are implemented, are receptive and
embracing of those changes?
DR. CRAWFORD:
With looking at hospital
waste, I mean, I certainly think that's gaining traction. There's a there's a
lot of attention to obviously climate change. And so I think people are looking
for ways to improve our efficiency and waste patterns. So that's again, one
area we certainly have a lot to learn.
You know, they use
obviously sterile materials for every every surgery,
but a lot of it is reusable. I don't know if you remember, but we used to have
cloth gowns and cloth drapes and things that were processed. And so we've cut a
lot of that out because of either concerns about safety or infections or the
cost of processing. And the cost of climate change might actually outweigh the
cost of processing. And so it's just something I think that we should really
think about and look at other systems that are able to do it with a lot less
waste, with the same efficiency. I mean, there's certainly differences in
infection rates and safety profiles, but, you know, I think our pendulum has
swung too far and the amount of single use disposable waste that we have
generated.
DR. BELANI:
That's correct. And we
have a relationship with a missionary hospital in Bangalore, India. And when
our trainees go there, they can see how the areas next to the operating room
are used to save reusable equipment that is cleaned, sterilized, and returned
back in clean packs, back for use in the operating room. And this is done
diligently every day. And people realize that they are very careful in how many
syringes they open and how many they toss without thinking. And what is the
piece that can be saved and reused or what shouldn't be wasted. They learn all
that when they are there and see what differences there are between a place
where there's a lot and a place where there is, you know, not much that you can
use. So there's a close eye that the attention to these things when they're
working in those missionary hospitals.
DR. STRIKER:
Yeah, I can only
imagine. You know, we could talk about this extensively, which is resource
utilization and how we've gotten into the single use items a lot more and, you
know, for a number of reasons, at least in this country. And what the true risk
profile is versus environmental and monetary cost with utilizing all of these
items and more disposable items now. It is a big topic and one that generates a
lot of strong feelings, especially when it comes to different countries and the
in the resources they're given.
DR. CRAWFORD:
Yeah, absolutely. And
you know, for a while it was mandatory that we all had sleeves on and wore
these paper jackets and we had to have the disposable head caps and and things that we that turned out didn't really have that
much of an impact on surgical site infections. Similarly with the with the
pandemic I'm an intensivist as well and was working at two different county
hospitals and one of them was using paper gowns that we just kept throwing, you
know, all this PPE away, which was just remarkable. And the other one had
reusable cloth gowns, which I was really pleased to see. And then they did away
with them and went with the paper as well. But the pandemic was horrendous for
the amount of trash and waste that we generated from the health care system. So
we're going to see more epidemics, pandemics. I mean, that's just the way it
is. And so it's certainly something to think about moving forward.
DR. STRIKER:
Yeah, absolutely. Well,
I do want to talk about global advocacy and diversity and also touch on how
this impacts physician well-being. But let's do that after a short patient
safety break, if you both don't mind staying with me.
(SOUNDBITE OF MUSIC)
DR. DEBORAH SCHWENGEL:
Hi, this is Doctor
Deborah Schwengel, Chair of the ASA Patient Safety Editorial Board. Mass
casualty incidents exert extreme stress on health care Institutions. Hospital
incident command systems and crisis standard of care protocols exist in most
hospitals. But gaps in knowledge of protocols can leave clinicians feeling
unprepared. Anesthesiology departments can and must prepare by educating staff
and allocating proper time and resources for training and rehearsals. These
range from classroom-based teaching, such as lectures, workshops, game-based
learning and tabletop simulations to small and large scale hospital
simulations. Pay extra attention to vulnerable populations such as pediatric,
pregnant, geriatric, and mental health patients. And don't forget to address
mental health care for patients and staff. The time to prepare is now.
VOICE OVER:
For more information on
patient safety, visit asahq.org/patientsafet22.
DR. STRIKER:
Well, we're back. I'm
talking with Dr. Kumar Belani and Ana Maria Crawford
about global engagement. Wanted to discuss specifically the aspects of that
related to global advocacy and diversity. But let's start with global advocacy.
You know,
anesthesiologists are familiar with advocacy in a number of of
realms. And anesthesiologists can play a crucial role here. Our professional
societies comprise the World Federation of Societies of Anesthesiologists, or WFSA,
which is a partner of the World Health Organization. And we've talked many
times on this show about how essential our role in perioperative care is for
patient safety. But on a global level, what role do anesthesiologists play? Dr.
Belani, do you mind talking a little bit about that?
DR. BELANI:
Oh, all of us are
interested in global health, and we are aware that health is a human right and
we have to ensure that everyone in this world has a right to his or her health.
And it will be great if the best health care can be provided to the poorest of
the poor as it is to those that can afford it without difficulty. And so for
this, we certainly need to have a strong advocacy and make this happen.
And I can give a good
example of how this has been done at the world's largest cardiovascular
centers, which is Narayana Health. They do 35 to 40 open hearts a day. And the
group there figured out that the only way they can do this is to make sure that
they can provide care to everybody and give the best care to everybody. And
they felt that this can only be done by developing a health scheme where
individual farmers paid a little bit of money every month and created what's
called the Ashwini Health Scheme. And this has been publicized a lot in the
Harvard Business School. And for pennies, these farmers, along with a little
bit of contribution by the government, were able to guarantee good, adequate
health to these people and giving them the best health for a very inexpensive
cost. So it was the advocacy that was done by the institution and getting
involved with the government, getting involved with the people, and carrying
this even to extensive levels by bringing in other countries to participate.
And we are having this program spread to nearby countries, and they also are
serving Uganda and other countries in Africa by telemedicine. And doing all
this, they are able to provide the best care with all the monitoring safety
principles that we as anesthesiologists would like to promote globally. And it
was a great thing to learn that this can be done in a country with limited
resources as compared to some of the other countries.
Nothing is possible
without good advocacy, creating awareness and education.
The Indian College of
Anesthesiologists has actually one of the benefits of this pandemic resulted in
getting good Zoom webinars, and for the last two years, they have created about
140 webinars which are available free to anybody that can log in and get educated
on anesthesia topics. And this is done every week. And the American Society of
Anesthesiologists and the Society of Ambulatory Anesthesia participate in these
webinars at least twice a year. And it is these types of things that, as
anesthesiologists, we can bring to the community and make safety top profile
when we provide care to our patients.
DR. CRAWFORD:
Adam, if I may add to
that, I think anesthesiologists are really amazing. Our skill set is quite
unique. You know, not only do we engage with patients from birth to death,
we're in the labor and delivery, we're in the ICUs, we're often running down to
the emergency department or the wards, we have a presence in the clinics. And
all of that is in addition to the operating rooms or operating theaters. So
we've we've really engage with patients at every every level, which makes us true physicians, in my opinion.
But we're also experts at logistics and transport and throughput. And so when
we take a step back and look at the amazing skill set that anesthesiologists
possess, that can be applied in countless ways on advocating for patients. And and it's not just in our own institutions and not even at
just our own professional societies here, but, you know, engaging with the ASA,
engaging with the WFSA, really has an impact on health organizations across the
globe. The WFSA has got the ear of the W.H.O. constantly, and I just think
anesthesiologists sometimes work quietly in the background. But our skill set
is really, really unique and we're all physicians first, and we have this
amazing skill set and perspective that really should be shared to advocate for
patients.
DR. STRIKER:
Yeah, well stated. It has
become of paramount importance that we as physicians demonstrate to people
outside of our specific specialty just how valuable those skill sets are,
whether it's executives, administrators, other physicians, other health care
personnel. Yeah, I couldn't agree more.
DR. CRAWFORD:
A lot of times our
patients aren't even quite sure what we do. You know, they certainly think
about us in in regards to epidurals and going to sleep for surgery. our skill
set is amazing, we need to use our voices as advocates and that again, global
includes local. So that's at the institutional level and country and, and
globe.
DR. STRIKER:
Yeah. And I think the
term itself, advocacy, I think has been for a long time associated with just
legislative activity. And there are so many other ways to be an advocate. And
probably it's important to be an advocate in multiple ways: an advocate for the
profession, an advocate for your colleagues, but more most importantly, an
advocate for your patients and the public. And so I think it's a term that, you
know, continues to evolve in a good way and hopefully, hopefully get that
continue to get that message out.
Well, I, I do want to
touch a little bit on the diversity aspect. And Dr. Crawford, we've well
established in previous podcast episodes how important it is to have diverse
physicians for diverse patient populations. And I wanted to touch on how this
works in concert with global engagement. How important is it to grow diversity
on that front and vice versa? How can global engagement serve to improve
diversity as it comes to our patients? Diversity includes various aspects—its
culture, background, geography, etcetera.
DR. CRAWFORD:
Yeah, it's hugely
important and I think we're all working pretty diligently towards greater
diversity. Sometimes you're right about the breadth of the definition and, and
diversity is often thought of in our non-modifiable characteristics. But
diversity comes in many forms and has many layers to it. Again, kind of
stepping back to a like a broader framework of, of what global engagement
means, it is defined by our community being a global community. And so I see
global engagement as an incredibly valuable tool for both diversity of our
patients and of us and our colleagues. And I think that that works in a couple
of ways.
Our patient population
is is increasing in diversity, and it's hugely
important that our providers reflect that. I also think that we, for example,
in my practice, we have over 300 faculty and many of them are from all over the
globe. And so I think it's important to actually give a little bit of
recognition to everything that they bring and they bring with them intimate
knowledge of different cultures, languages, religions, perspectives. Really
learning from each other even within our own practices is really going to make
all of us stronger and better providers to our diverse patient population.
Also an important thing
is realizing that I can't remember the percentage, but a very large percentage
of the health care workforce within the United States is made up of foreign
medical graduates, and that number is increasing and it's increasing not only
through immigration but also through the match itself. So I think that is a
plus, especially in a country where we are short doctors, we're short nurses,
and our health care workforce is struggling. We're seeing more and more people
suffering from burnout, etcetera. Reframing our community as as global and recognizing that the diversity that brings
all of us is really valuable. And I think it makes all of us stronger and
better providers, better caretakers of our patients and each other.
DR. STRIKER:
Well, Dr. Belani, let's talk a little bit about wellbeing of
clinicians. In the editorial you argue that global engagement improves mental
health and well-being of our clinicians. Do you mind talking about a little bit
about how engagement might help stem burnout tide?
DR. BELANI:
I think that's a great
point that you bring out. You know, we all go to medical school to learn and
practice medicine. Some of us get involved in global health. And when we do,
when we go to these other places and interact with people, it's like taking a
break from what you're doing at home and able to share your knowledge and see
what the other people are doing. You get a sense of satisfaction and you
interact with people of different backgrounds. You engage with them socially.
You look at the things they do after work. You meet with them, you discuss
things. And then you talk about the possibility of doing joint studies, looking
at how quality can be improved in those places. You get an opportunity to
invite them to your place. and you feel like you belong to the specialty So
it's like taking a little vacation from your work and going and sharing what
you learned in medical school, seeing how others are practicing, and seeing
what the local cultures are. And you learn a lot. You build up camaraderie,
friendship and see what those local cultures mean.
You know, like Dr.
Crawford said, our communities are becoming more and more multicultural. So
culturally we are quite diverse and and just
interacting with them and going to the countries where they came from and
seeing what goes on there really makes you opens up your mind and you feel so
comfortable. And the time for having a burnout doesn't exist.
DR. STRIKER:
Well, that's as
important a reason as any to stay globally engaged. But, Dr. Crawford, do you
mind talking a little bit about the importance for most of the clinicians out
there to stay globally informed and engaged? How does that impact our understanding
of of of the world we
inhabit and how does it impact us locally where we're practicing?
DR. CRAWFORD:
Yeah. I would maybe push
back a little bit on having lower stress levels when you're working abroad. Our
colleagues that are working in resource constrained settings are certainly
dealing with a lot of stressors -- higher mortality rates, heavier workloads,
less staffing, less pay, you know, a completely different medical legal
environment. And so it can be quite stressful not only for our colleagues
abroad, but also for us that travel there. It's really difficult to watch your
complications and mortality rates when, you know, it could be different.
But I think as far as
wellness and physician burnout, I think global engagement certainly can play a
role. And I think the evidence supports that. You know, when you feel like
you're part of a community, when you volunteer or when you give to others, it's
been demonstrated to improve happiness and well-being. Our burnout is, is
oftentimes due to emotional exhaustion and depersonalization, loss of meanings,
feelings of ineffectiveness. And all of that is driving these high rates of
physician burnout that we're seeing. Providing more opportunities for community
building and community engagement even at the global level is certainly an
opportunity to improve physician well-being.
I absolutely love my
global community. I have friends all over the world and that's just a really
good feeling. And the world is a big place. But I think once you become an anesthesiologist
and especially one that's working globally, the world becomes really small and
it feels like you have friends everywhere. So really get a lot of joy out of
having a global community, learn a ton from, you know, my friends abroad. And
it's also just a great opportunity for us to all help each other, take the best
care of patients that we can.
DR. STRIKER:
Well, we're all victims
of our own habitat. And I think just if nothing else, everybody has their own
stressors and work environment issues they deal with. And when that's all
you're dealing with, those things take on a great level of importance. And I
think just being able to expose yourself to other stressors that others are
dealing with in and of itself is probably helpful because it maybe resets your
own perspective on what you have to deal with back at home, wherever that is.
DR. CRAWFORD:
Certainly. And it
perhaps makes us feel like we're all in the fight together. It also creates
friendships and community where, you know, if you if you need to be vulnerable,
you feel like you can. Which which is another big
part of wellbeing is just feeling like you can be supported even if you need to
take a break or need to switch up your practice somehow. It goes back to
community again for me. And how do you define your community? You know, is that
is that a local community or a global community? And I feel like one thing I've
learned from working in multiple different places and is that we're we're more alike than we are different. We have a lot in
common and we face a lot of the same struggles, especially as
anesthesiologists. And so I think having that community and seeing how lucky we
are to have the resources and the systems that we have, it really is a good
reminder of gratitude.
DR. STRIKER:
Yeah. Complicated issue,
certainly multifactorial. And I think you touched on a number of important
points and aspects that we as a society probably should look at and examine as
we move forward.
Well, before we go, I
wanted to just talk about the ASA Monitor issue specifically and ask each of
you, as you worked on it, what stands out to you or what do you want the
readers to take away from this issue on global engagement? Let's start with
you, Dr. Belani.
DR. BELANI:
Well, I think I've been
involved in global health since 1999. And in the beginning when I started,
people were coming to the United States for their heart surgeries because we
were the leader. But it appears now that they have become experts so that many
people are actually going there for heart surgery because it's less expensive
and communities from different parts of the world are going over there at the
low cost. So this has been a great success where our programs with this
engagement have shared the knowledge with each other and those places now are
doing a lot on their own and they're able to do this because of these global
engagement collaborations that have been going on. By the same token, we've
helped them set up educational systems which are becoming so, so good over
there. There are many more anesthesiologists that know how to use
transesophageal echocardiography, for instance, in India, then then in the
United States. But that's picking up very rapidly here. I hope with this issue
at ASA Monitor, one can look at all the aspects of global health engagement,
and especially for our trainees to be able to use the opportunities in their
learning years to take advantage of the activities that are going on in
different places at different universities, and learn from them, and then make
sure that our goals of anesthesia care are globally superior and equal in
different places.
DR. STRIKER:
And Dr. Crawford, how
about you?
DR. CRAWFORD:
Yeah. First, I would say
that it was really, really fun. And it's so great to read the ideas and the
perspectives of all of our colleagues that put this issue together. There's a
great discussion about cultural competency. There's great updates about the ASA’s
program in Rwanda and Guyana. There's updates on global health fellowships for
trainees. And I personally love the scope of global health and global
engagement work from the, you know, trainee years through retirement. I think
capturing the value and wisdom of our colleagues that are that are nearing the
end of their careers is really an untapped resource that I would love to see us
harness.
As far as like a
departing theme, I would just say this isn't your dad's mission trip. You know,
global health and global engagement have really expanded to include building
global communities and networks of people. And I think when we're building our
global health programs, we really have an ethical obligation to keep patient
outcomes in mind. You know, they're great tools for recruiting residents and
recruiting fellows and retaining faculty. But really, we have an ethical
obligation to keep partnerships bidirectional, and we have an ethical
obligation to make sure that that when we build and how we build actually has
the intended outcome and motivation, and that's to improve the lives of our patients
across the globe.
DR. STRIKER:
Well, thank you both for
joining me tonight to talk about this incredibly important topic. It's been a
fascinating conversation and I really look forward to reading more in the
Monitor issue.
DR. CRAWFORD:
It's been a pleasure.
Thank you.
DR. BELANI:
Thank you, Dr. Striker.
And it was great doing this interview with you.
(SOUNDBITE OF MUSIC)
DR. STRIKER:
To our listeners, thank
you for joining us on this episode of Central Line. If you want to learn more
about this topic, there is certainly a lot more to read about in the upcoming ASA
Monitor issue, and you can also check it out at asamonitor.org. And please join
us again in another couple of weeks. Until then, take care.
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** Correction: There are
110 Native American nations within California alone and 573 within the borders
of the United States.