We Need More Reports of Global Health Anesthesia Articles.

Anesthesiology, V 124 • No 2 267 February 2016 I n the Lancet Commission on Global Surgery’s introductory editorial, Meara et al.1 state that “Surgery and anaesthesia are integral, indivisible components of any properly functioning health system.” These components, although undoubtedly indivisible, currently appear unbalanced. A PubMed search for “surgery” paired with the usual indicators of low-resource programs (e.g., “global,” “international,” “low resource,” or “austere”) reveals over 400 relevant articles. A search for corresponding anesthesia terms finds 30. Of course, articles in journals from low-income regions address the scholarly practice of surgery and anesthesia without any such global tags. However, the theme of this essay is the apparent paucity of publications regarding collaborative education, funding, or service programs addressing the anesthesia needs in lowincome countries (LICs). There are many reasons that indexed global anesthesia articles are scarce. Many LIC journals publish infrequently, are difficult to obtain, and are not internationally indexed.2 To address this, there are ongoing collaborations intent on increasing the production, quality, sustainability, and availability of journals from the low-resource world.3 In the meantime, specialist journals from high-income countries (HICs) consider many such articles too esoteric for their readership. More traditional global health journals often deem anesthesia articles too specialized for their readership. Reports of volunteer experiences are common in the non– peer-reviewed literature.4 Most are snapshot reports and interesting only for a general readership unfamiliar with the topic. Many reflect the viewpoints of their publishing societies, with little controversy or innovation. Given the recent recognition of surgery as a global health priority (i.e., the 68th World Health Assembly resolution on “Strengthening Emergency and Essential Surgical Care and Anaesthesia,”5 the Lancet Commission on Global Surgery,1 and the dedicated surgery volume in the World Bank’s “Disease Control Priorities 3”6), we may see an increased interest by HIC journals in global anesthesia articles. To take advantage of such enthusiasm, we must address another potential reason for the dearth of publication, that is, the work is not being done. This is not a reference to simple participation in the global health endeavor. Anesthesiologists from HICs are fundamental to a myriad of surgical service missions7,8 and education, staff-development, and capacitybuilding programs in LICs.9,10 Rather, the thesis is that too few HIC anesthesiologists are analyzing their programs and publishing their conclusions. Despite 15 yr of international work, this author’s publication history is very limited. This essay is the product of an exploration of this shortfall, its importance, and potential incentives to change. Despite filling 177 African journals11 with relevant work, local practitioners are at capacity. With less than 1 anesthesia provider per 100,000 population12 (compared with 24 per 100,000 in the United States),13 and workloads of 2,000 procedures per year per provider,14 anesthetists in LICs have little time for scholarship. Many are not trained in scientific research, and most have limited scholastic resources.15 Clinicians in HICs, whether academic or private practitioners, have received more training, have greater access to academic institutions, and can dedicate focused time to the problem. not only do scholarly collaborations support capacity building in LICs, but, as Søreide et al. argue, they provide significant opportunity to “mutually enhance care for patients with surgical disorders,”16 that is, international collaborative research can facilitate quicker patient enrollment to larger studies with more generalizable results, benefitting patients at both ends of the income spectrum. This cannot happen unless HIC anesthetists actively engage in the academic process. Many expert HIC clinicians, inexperienced in global anesthesia provision, travel to LICs armed with good intentions and donated equipment. Adverse events frequently We Need More Reports of Global Health Anesthesia Articles