The Anesthesia Record

I was incredibly proud to see the May article of the AANA NewsBulletin in print.  One of my best friends, Adam Leonard, guest authored an amazing article in which he discusses his recent mission trip to the Dominican Republic.  As I prepare for my very own mission trip to the country next month, I am thankful for Adam's unique perspective; it reminds me just how fortunate I am to be given this opportunity to see another country while giving back and doing work that I love.

*Note: With finals and graduation on the horizon, the month of April got away from me and I'm just now posting last month's article.  The April NewsBulletin article can be found here. 

On a Mission: An SRNA’s Experience Abroad

A number of nurse anesthetists routinely travel to developing countries to provide those in need with life-changing anesthesia services. While most of us can only imagine what this experience must be like, a handful of nurse anesthesia students are given the opportunity to serve on medical missions in the midst of anesthesia school.  My close friend and classmate, Adam Leonard, recently returned from such a trip.  The travel stories and photos he shared upon his return served as a welcome reminder that our daily struggles as students will ultimately prepare us to handle any situation in any practice environment.  Adam has agreed to share his experience in this month’s column and I hope that his story will inspire other SRNAs to seek opportunities abroad and serve as a reminder that anesthesia school, while immensely challenging, is worth the effort.

By Guest Columnist Adam Leonard, RN, BSN

Throughout the developing world, access to safe anesthesia is a scarce commodity.  Many organizations in the United States assemble teams of surgeons, anesthesia providers, and operating room staff to deliver safe anesthetics in these underdeveloped parts of the world.  In October of 2010 I traveled to the Dominican Republic (DR) to administer anesthesia on a medical mission with one of these non-profit organizations. We traveled to a remote area in the Western side of the nation, not far from the Haitian border.  The facility consisted of a small clinic, with two small operating rooms in which to work.  Our strongest analgesic was PO acetaminophen and the power supply to the clinic was unreliable leading to frequent power outages in the operating rooms.  The days were long and hot, the conditions and equipment were sub-standard, and it was one of the greatest experiences of my SRNA career.

The opportunity to work in the developing world and deliver anesthesia offers some fantastic professional, educational, and developmental opportunities to an SRNA.  I worked with Amy as she developed her platform for the Student Representative position to the AANA Education Committee.  The issues that she focused on; raising the awareness of nurse anesthetists and improving health and wellness in the nurse anesthesia community are both addressed when we consider international volunteer work.  Additionally, international volunteer work provides an educational experience for SRNAs that cannot be replicated in the United States.

Raising Awareness

Accompanying me on this trip was one of my classmates, our CRNA mentor and a medical team comprised of an ENT surgeon, a general surgeon and OR staff.  During the course of our five-day trip we anesthetized over 20 pediatric patients for ENT procedures and just as many adults undergoing a variety of general surgical procedures.  The ENT surgeon had never worked with CRNAs before as his practice in the US is staffed entirely by anesthesiologists.  His trepidation working with nurses was obvious in the beginning of the week.  He had multiple questions about my training and CRNA practice in general.  He was surprised to hear about our history and scope of practice and he was impressed by the anesthetic outcomes he witnessed that week in the operating room.  This was an excellent opportunity to educate medical professionals about CRNAs and CRNA issues.  I was proud to be able to represent our community in such a manner. 

The local doctors and nurses also had questions for me about my CRNA training and our scope of practice.  One of the locally trained anesthesia providers sat with me in the operating room one afternoon and asked me about my anesthetic techniques.  We traded ideas about induction and emergence.  It was interesting to hear him talk about drugs we no longer use with any frequency in the United States, such as atracurium and halothane.  This too was a great experience educating others about our profession.

Improving Wellness

There is nothing like anesthesia training.  It demands of a great deal of our time and energy.  It is highly stressful and requires us to spend time away from our families and loved ones.  I remember preparing for the trip thinking it was one more thing I had to accomplish in my quest to graduate. In the DR my mentality changed from just trying to “get through” another clinical day to feeling like I was working for a higher good.  Despite the long hours and difficult working conditions, I felt my work was improving the lives of others.  I was so inspired by the dedication and the hard work of my coworkers and the local people working at the clinic.  Despite a language barrier we all showed great teamwork in providing outstanding care to the patients we treated.

Going to the developing world helped me regain my perspective on what truly matters in my life; my family, our health, and the opportunities available to me.  I didn’t realize how much I was taking all of these things for granted.  It is only when I was confronted with people without such good fortune that their relevance became so apparent.  This trip reenergized me, it reminded me of one of the main reasons I became a nurse in the first place; to help those in need.   When I returned to the United States I was more relaxed, having gained a renewed perspective on my anesthesia training.

An Educational Experience

This trip reinforced for me why we nurses make such incredible anesthetists.  Conditions such as these, with no end-tidal monitors, no mechanical ventilators and marginally reliable equipment, made me solely focus on the best monitor I had: my patient.  I judged how anesthetized each patient was based on how forcefully the bag filled and emptied on my gas machine. I measured respiratory rate in the same manner.  As I turned up the dial on my vaporizer, it was amazing to see my patient’s respirations slow down and decrease in tidal volume.  I estimated blood pressures by palpating pulses when our blood pressure cuff failed on us in the middle of a case and I never paid such close attention to my patient’s urometer in all my anesthesia training.  It was a trip back in time and I felt like I was delivering anesthesia under some of the same conditions that our foremothers dealt with on a daily basis.

I also learned to give an entirely different anesthetic than I normally would in the US.  On opposite ends of the anesthesia spectrum there are two basic types of providers: “pushers” and “gassers”.  The pushers give lots of narcotics up front in the beginning of the case and give very little vapor.  Gassers, on the other hand, rarely touch narcotics and run their patients very deep on the gas.  During my training I have leaned towards the former technique.  I really enjoy the heavy narcotic up front, leading to a really smooth emergence with excellent tube tolerance and very little coughing. At the clinic, however, there were no narcotics to administer, so I was forced to learn a straight gas technique.  I really enjoyed expanding my base of knowledge with this type of anesthetic and feel I am better provider because of this experience.

Conclusion 

I encourage all SRNAs and CRNAs to get involved in international healthcare.  As anesthesia professionals we have a skill set that is valuable and scarce.  This enables us to make real differences in the lives of the underserved in developing nations.  By providing safe anesthesia to these communities, we can considerably improve their perioperative outcomes.   I call on my soon-to-be CRNA colleagues to invite a student to join them on their next volunteer experience abroad.  Nurse anesthetists have the ability to enrich the education of an SRNA by serving as a preceptor on a medical mission trip.  I am so thankful to my preceptor for facilitating this life changing experience.  

For those interested in national and international volunteer work, a list of organizations looking for anesthesia personnel can be viewed on the AANA website at http://www.aana.com/ProfessionalDevelopment.aspx?id=25656.

Thank you so much to Amy for giving up her column for a month so I could write about an issue so important to our profession and to me.