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Hand-Pumped Anesthesia Could Help With Surgeries In The Dark


The Ebola outbreak has highlighted the fragile state of hospitals across Africa. Doctors and nurses are in short supply and so are things like electricity. Surgeons often are forced to operate in the dark. And when the power goes out, so does the anesthesia machine, which means patients can wake up in the middle of surgery. But at Johns Hopkins Medical Center in Baltimore, doctors are working on a creative solution to some of these problems. NPR's Nurith Aizenman reports.

NURITH AIZENMAN, BYLINE: Hey, how are you?

UNIDENTIFIED MAN #1: Good, how are you?

AIZENMAN: Hopkins medical fellow Dr. Tiffany Frazee is about to be put to the test. And she's just come off a night shift.

DR. TIFFANY FRAZEE: So I've had about three hours of sleep.

AIZENMAN: Dr. Frazee has spent years training to be a pediatric anesthesiologist. And just like an airplane pilot practices in a flight simulator, Dr. Frazee has run through a lot of scenarios at the Hopkins Surgery Simulation Center. This one is starting off pretty typically. She's got her scrubs on. The pretend patient is lying on the table. He looks a little creepy. Picture a baby doll's head attached to plastic tubes where the lungs would be.

DR. BENJAMIN LEE: Our patient is a one-year-old. And he's going for an umbilical hernia repair.

AIZENMAN: Dr. Benjamin Lee is running the simulation. He heads into an observation room. It's separated from the operating room by a one-way mirror. He uses a walkie-talkie to give instructions to the final player in this drama; the pretend surgeon.

LEE: Dr. Samson, can you hear me? Give me a thumbs up if you can.

AIZENMAN: Dr. John Samson signals back and starts to spray disinfectant on the manikin.

DR. JOHN SAMSON: I'm going to go ahead and prep the patient. Get this all prepped up and everything.

AIZENMAN: So it's all going smoothly. Our guinea pig, Dr. Timothy Frazee, gets the anesthesia flowing. The pretend baby boy is under. Dr. Samson starts to cut him open and then...

LEE: OK, let's have the power come out right now.

AIZENMAN: All the lights go off. The OR is in total darkness.

SAMSON: Hey, what's going on? Another power failure. We keep having power failures every day. What is this?

AIZENMAN: See, in this scenario, the team is supposed to be in Sierra Leone. And even before Ebola ravaged Sierra Leone's health system, hospitals there - in fact, hospital throughout Africa have been dealing with power outages sometimes multiple times a day.

FRAZEE: There's a flashlight. Please turn it on.

AIZENMAN: Dr. Lee and Dr. Samson, in real life, they're also both anesthesiologists. They decided to run this scenario because they've done a lot of volunteer work in Africa. They've seen first-hand how dangerous it can be when there's a power failure in the middle of surgery.

SAMSON: Are you sure everything's, OK? He's stable and everything right?

FRAZEE: He does appear stable. It's...

AIZENMAN: One of the biggest problems is that the machines that are usually used to deliver anesthesia can't work without electricity. In no time at all, the patient starts to wake up in the middle of surgery. It's nerve racking for the doctors.

SAMSON: How am I supposed to operate under these conditions?

AIZENMAN: But recently, these doctors learned about a new machine specially designed to be used in poor countries. If the power goes out, the anesthesiologist can keep this machine going manually. They use a plastic bag, sort of like an old-fashioned bellows, to keep oxygen flowing to the patient. Dr. Frazee directs a tech to start using it.

FRAZEE: Lift the bag more.


FRAZEE: Yep. And compress.

AIZENMAN: So this scenario they're putting her through is actually for a study. They want to see how easy it is for an anesthesiologist to use this machine.

SAMSON: Wait a minute. Is the patient going to stay asleep?

FRAZEE: The patient will.

AIZENMAN: But Dr. Frazee only got a quick tutorial before they threw her into the scenario. But Dr. Lee says she's clearly got the hang of it.

LEE: You can call this in. I think we're done.

AIZENMAN: Dr. Frazee confesses she found this experience unsettling. Sure, the anesthesia machine kept working, but every other piece of equipment was off-line.

FRAZEE: It's very disconcerting to be taking care of a one-year-old on whom you have none of the electrical monitors that we're used to because here, we would never ever, you know, do a case without all of those things in place.

AIZENMAN: Still, she says, in much of Africa, that's what doctors and nurses have to deal with. And that's what's really behind this exercise. There's a growing awareness that the expensive, sophisticated machinery developed for surgery in the U.S. and Europe - it's totally unsuited for use in low-income countries. More and more health workers are saying we need to find practical ways to make surgery in these places safer and more widely available. Nurith Aizenman, NPR News. Transcript provided by NPR, Copyright NPR.

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