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
bot123@global.co.za