I recently spent a few days in Bloemfontein. This would not have been my first choice of holiday destination, but it was the venue for the annual South African Society of Anaesthesiologists (SASA) congress. I enjoy attending meetings and congresses because it gives me a chance to catch up with the people who taught me anaesthesia and who have subsequently left state, or worse, the country.
Having spent 5 days with these people, I have some observations.
Firstly, we are so far behind the curve (in state practice) that it is not even funny. I attended a mini course on transesophageal echocardiography (TEE), presented almost entirely by ex Free State Universtity consultants who are working at a cardiac surgery centre in the UK. More on the TEE later..
We suffer under a huge burden of rheumatic heart disease, with resultant dysfunction in mitral and aortic valves. My surgical colleagues have a single response to this disease - replace the valve. Apparently, the standard of care is to repair the valve. Because our surgeons don’t repair, we have not been trained to assess valves adequately with the echo. So, hopefully I can now give some input and suggest valve repair. They also dope patients for trans-apical aortic valve replacements - a procedure which is exceptionally high risk, given that these patients are too sick for routine aortic valve surgery.
Secondly, we have lost so many brilliant minds in the field. Looking at a large group of anaesthesiologists, the most prominent thing for me is the age gap. There are lots of young guys like me (<35) and there are lots of people in their late fifties and up. In between, there is nothing. Where are all these anaesthetists? They have gone - Canada, United Kingdom and Australia. One hospital in Canberra currently has 5 consultant anaesthesiologists who are South Africans, all from Jhb. This is a big problem for us and reflects the problems in this country. There was much debate about whether they were “pulled” overseas, or “pushed” - General consensus was the latter.....
Thirdly, and perhaps most alarmingly, there is a very high incidence of moonbags. The less said about this, the better.
"The Golden Hour"
3 days ago