Making a Difference to Paediatric Perioperative Care in South Africa

South Africa has been described as the world’s most unequal society, with a Gini coefficient of 0.63 in 2015. 55.5% of the country’s 57 million people live below the poverty line, with 25.2% living below the food poverty line.

As a doctor, the country’s inequalities are glaringly obvious when it comes to access to healthcare. With only 17% of the population able to afford private medical care, access to healthcare facilities and providers for over 45 million South Africans is through government funded facilities, which are resource-strapped. The situation is reminiscent of the line in the famous U2 song – we live in a country where “the rich stay healthy and the sick stay poor”.

Over 80% of the country’s anaesthesiologists work in the private sector, leaving approximately 250 anaesthesiologists working in the public sector nationally. Nearly all of these are in major urban centres where central and tertiary hospitals, and thus specialist services, are based. Anaesthesia outside of these major cities, in the smaller towns, districts and rural areas where the majority of the population need to access healthcare, is largely provided by non-specialist medical officers who have had limited anaesthetic experience, and usually no formal training in paediatric anaesthetic care.

These medical officers report feeling out of their depth, unsupported, and have concerns about patient safety.

The SAFE Paediatric course is a three day course developed by the Association of Anaesthetists of Great Britain (AAGBI) and the World Federation of Societies of Anaesthesiologists (WFSA), and teaches principles of safe paediatric anaesthesia and life support skills with the aim of empowering anaesthesia providers to improve the safe perioperative care of children. With the support of the WFSA and the South African Society of Anaesthesiologists (SASA), we received grant funding through THET to roll out this course.

Our team, comprising a strong local and international faculty, delivered five SAFE Paeds courses during the project. We enlisted South African consultant anaesthesiologists as trainers and mentors and in total trained 141 doctors from various regions of the country. Significant improvements were seen in both knowledge and skills after the course and demand has been high for further courses to be run across South Africa.

We trust that the knowledge and skills these doctors have gained will improve paediatric care in the many areas of our country where specialist skills are not available.