Anesthesia in South Africa

Anaesthesiologists are trained at seven Medical Schools in South Africa.
The Faculty of Anaesthesiologists of the College of Medicine of South
Africa regulates standards and examinations. The specialist qualification
is FCA(SA) i.e. Fellow of the College of Anaesthesiologists of South Africa
is equivalent to the British FRCA .The various Medical Schools also offer
the M.MED(Anaes) degree which is more or less equivalent to the fellowship.
The South African Society of Anaesthetists is busy implementing a CME,
Credentialling and Recertification program.

The South African Society of Anaesthesiologists arranges an annual congress
with international participants. This is usually combined with a weekend
refresher course. The Anaesthesiology Foundation based in Johannesburg also
organizes an excellent annual refresher course. Several of the teaching
departments organizes special training courses for examination candidates.
Special courses like airway management is occasionally arranged.

Pain management is being taught and practiced to an increasing extent, but
mainly in the academic centers at present. Critical Care training is an
essential part of the training of anaesthesiologists with a variable period
of Residency. Critical Care units exist in many peripheral hospitals but
often function as high care units only due to lack of equipment, funds or
trained medical and nursing staff.

Previously many SA anaesthesiologists (and other professionals alike) left
the country for political reasons. Nowadays even more leave due to
financial considerations. This has a major impact both in academic and
private hospitals. The excessive work load and decreasing income in real
terms forces more and more anaesthesiologists to leave academic medicine
or even the country. This has been less of a problem in the private sector
where each patient pays for equipment used. However with Managed Health
Care coming this may also soon change. The major academic centers are still
centers of excellence but private funding has become essential.

The number of specialists trained are far too few to render adequate
anaesthesiology service at all levels. General Practitioner anaesthetists
carry a huge part of the burden. Unfortunately not all are adequately
trained for the task. The SA College of Medicine runs a six months diploma
course, the DA(SA), at the various teaching hospitals and some recognized
peripheral hospitals. This definitely improves the standard at a primary
level. Consultant cover at peripheral hospitals is very rare, even in the
major cities. The factors mentioned above, namely lack of equipment, poor
remuneration, excessive workload, lack of support of administrators, are
the major reasons.

The recommended private fee for a caesarean section lasting forty minutes
is US$113. Most patients are however charged less. The scales of benefit
fee (Medical Aid fee) is US$41. For comparison a major car service
excluding parts costs US$104.

Equipment quality varies from the very best to very poor. The Academic and
certain private hospitals having the best and smaller state hospitals are
much worse off. Just about all American, British, European and Japanese
manufacturers sell there equipment locally. This huge variety makes
maintenance and repair a bit of a nightmare. Operation of equipment
unfamiliar to new staff obviously carries its own risks. New drugs are
freely available except in non-academic state hospitals.

Pieter Bothma