title: Teaching neuraxial anesthesia techniques for obstetric care in a Ghanaian referral hospital: achievements and obstacles.
abstract: Anesthesia providers in low-income countries may infrequently provide regional anesthesia techniques for obstetrics due to insufficient training and supplies, limited manpower, and a lack of perceived need. In 2007, Kybele, Inc. began a 5-year collaboration in Ghana to improve obstetric anesthesia services. A program was designed to teach spinal anesthesia for cesarean delivery and spinal labor analgesia at Ridge Regional Hospital, Accra, the second largest obstetric unit in Ghana. The use of spinal anesthesia for cesarean delivery increased significantly from 6% in 2006 to 89% in 2009. By 2012, >90% of cesarean deliveries were conducted with spinal anesthesia, despite a doubling of the number performed. A trial of spinal labor analgesia was assessed in a small cohort of parturients with minimal complications; however, protocol deviations were observed. Although subsequent efforts to provide spinal analgesia in the labor ward were hampered by anesthesia provider shortages, spinal anesthesia for cesarean delivery proved to be practical and sustainable.
authors.affiliation: From the *Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina; †Department of Anesthesiology, Ridge Regional Hospital, Ghana Health Service, Accra, Ghana; and ‡Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Adeyemi J
authors.initials: AJ
authors.lastname: Olufolabi
authors.forename: Evans
authors.initials: E
authors.lastname: Atito-Narh
authors.forename: Millicent
authors.initials: M
authors.lastname: Eshun
authors.forename: Vernon H
authors.initials: VH
authors.lastname: Ross
authors.forename: Holly A
authors.initials: HA
authors.lastname: Muir
authors.forename: Medge D
authors.initials: MD
authors.lastname: Owen
mesh_terms: D000328:Adult; D016362:Analgesia, Obstetrical / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D000776:Anesthesiology / Q000193:education*; D002585:Cesarean Section; D002985:Clinical Protocols; D003479:Curriculum; D003906:Developing Countries; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D005869:Ghana; D006801:Humans; D008493:Medical Missions; D011247:Pregnancy; D016730:Program Development; D015397:Program Evaluation; D012017:Referral and Consultation; D013663:Teaching / Q000379:methods*; D016896:Treatment Outcome