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Earnest call to anaesthetists to stay and serve the country
View(s):- COAISL President Dr. Vinodini Wanigasekera seeks collective attention to stem critical brain drain as patient safety is in jeopardy
By Kumudini Hettiarachchi
They keep the patients alive, calm and pain-free during surgery, while monitoring vital functions including the heart rate and breathing.
Numerous have been the successes of the College of Anaesthesiologists and Intensivists of Sri Lanka (COAISL), since its birth back in 1957 as the Ceylon Society of Anaesthetists. However, the ‘crown’ of the Presidency lies heavy on Dr. Vinodini Wanigasekera and her Council which have just concluded their annual academic sessions from January 19-21 in Colombo.
With the theme of the sessions being ‘Moving forward amidst the challenges’, one being the “alarming” dearth of anaesthetists, Dr. Wanigasekera herself has first-hand experience about the agony it entails though at a different time.
She was then 39 years old and expecting her only child – an “elderly primigravida” when a pregnancy for the first time is over 35 years of age. She was on her last weekend on-call at Matara, the sole Consultant Anaesthetist for the region over the weekend, before her Caesarian delivery two days later. Her colleague was off for the weekend as he had to man the hospital on his own for the next three months.
Having worked the whole day and clocking out at 2 the next morning, she was home by 3 a.m., when she went into labour. All plans had gone awry – the first plan was to travel to Colombo for the Caesarian which was now not doable. After her Paediatrician neighbour rushed her to a nearby private hospital, she was still on the phone, arranging on-call duties and how her Intensive Care Unit (ICU) could mitigate her unavailability.
Dr. Wanigasekera says the irony was that there was no anaesthetist to anaesthetise her. Many were willing to come to her aid but without highways, the journey from Colombo would take four hours and she just could not wait.
Next was the final plan – getting two senior medical officers from her own team over, to anaesthetise her. They did come but she could see their anxiety. The good news came thereafter, when an anaesthetist from the next station 50kms away, volunteered for the task and by 7 a.m. Dr. Wanigasekera’s precious baby girl was born.
Looking at the present, Dr. Wanigasekera stresses that the goal of anaesthetists is to ensure the delivery of safe patient care to all and achieving it today seems like Sir Edmund Hillaryreaching the summit of Mount Everest back in 1953.
“That was a collaborative effort involving skill, strategy, commitment, appropriate climbing gear and support teams. We should have our own ‘metaphorical’ gear together with a combination of skills, strategic planning and support teams,” she says, ticking off the crucial checklist of health administration, procurement, training and transparency, together with workforce commitment and honesty.
The head-table at the inauguration of the academic sessions (from left): Immediate Past President Dr. Anoma Perera; President Dr. Vinodini Wanigasekera; Chief Guest Dr. Helgi Johannsson, Vice President of the Royal College of Anaesthetists, United Kingdom (UK); Guest-of-Honour Prof. Ramani Moonasinghe, National Clinical Director for Perioperative and Critical Care, National Health Service, UK; Orator Dr. Nilmini Wijesuriya; and General Secretary Dr. Anushka Seneviratne
Urging the strengthening of what has been achieved in their field, she reminds post-graduate trainees and young Consultants that Sri Lanka uniquely supports its citizens from primary education to postgraduate training including overseas training. This significant investment draws on the nation’s limited resources and “there is a moral obligation for you to serve your country for at least a minimum number of years”.
The “sobering” reality is a critical shortage of consultants, with nearly half the workforce having migrated as also post-graduate trainees in search of greener pastures. This exodus has left peripheral hospitals vulnerable, jeopardizing the quality and safety of care of patients. This situation has been worsened by a critical scarcity of resources and escalating corruption. The intense scrutiny by the media especially of adverse events and system failures causes agitation and waning of public trust, adding further strain on the workforce.
Dr. Vinodini Wanigasekera delivering the Presidential address at the inauguration of the COAISL annual academic sessions
The dearth of anaesthetists is evident from most stations on the 2023 Annual Transfer List being marked ‘vacant’ and the updated membership registry of the COAISL. Therefore, Dr. Wanigasekera seeks “collective” attention as the gaps pose a significant risk to patient safety.
She says: “It is imperative to attract and retain talented professionals while initiatives should also be taken to put right inefficient workforce utilization by identifying priority stations as an immediate solution to mitigating this problem.
“Implementation of transparent transfer and replacement schemes by avoiding ad hoc measures and providing reassurances to anaesthetists with some welfare measures as well as non-oppressive and non-suppressive action for those who have remained in Sri Lanka are essential remedies. The COAISL will help monitor implementation and gather feedback to boost morale and job satisfaction of consultants.”
Another worry for COAISL is the severe impact on critical care services and Dr. Wanigasekera says that there are around 110 ICUs across the country. In 2013, critical care emerged as a distinct specialty, branching off from anaesthesia. A post-MD training was established to create dedicated critical care specialists. However, a severe shortage of these specialists persists due to migration, with 90% of the ICUs being managed by anaesthetists.
Pointing out that critical care trainees predominantly undergo training under anaesthetists, she explains how the formal accreditation option for anaesthetists to provide critical care services has now been eliminated due to a blanket rule by the training institution. This has compelled anaesthetists to deliver critical care services nationwide, without formal recognition.
“We believe that the training body should tailor programmes to meet the country’s needs as a priority and call upon the Health Ministry to advocate with this body to support the re-establishment of this lost opportunity, while the COAISL would also lobby directly with it,” she aasures.
Quoting American actor Christopher Reeve who said that ‘heroes’ are “ordinary individuals who find strength to persevere despite overwhelming obstacles”, Dr. Wanigasekera adds that all her colleagues serving the country are “true” heroes.
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