UM Physicians Spread Regional Anesthesia Proficiency to Jamaica

Physicians at a small, rural hospital in Jamaica traveled to the University of Miami Miller School of Medicine recently to observe how anesthesiologists in the U.S. perform regional anesthesia blocks.

Dr. Ralf Gebhard provides hands-on instruction to clinicians in Jamaica.

“One of the reasons we are physicians is to spread our knowledge as far as possible,” said Ralf Gebhard, M.D., professor of anesthesiology and chief of the Division of Regional Anesthesia and Acute Perioperative Pain Management at the Miller School. “The beauty of regional anesthesia specifically is really that it can be practiced safely in low-resource environments.”

Five Jamaican doctors came, one week at a time, to observe the latest nerve block techniques at UM/Jackson Memorial Hospital. Their visits to the U.S. are a natural extension of the Medics on a Mission program – a global health educational initiative in which Gebhard and colleagues traveled to share their expertise at St. Ann’s Bay Hospital along the northern shore of Jamaica annually for the past five years.

In contrast with general anesthesia, regional anesthesia can be simpler and safer to perform in developing countries, particularly in the aftermath of natural disasters. “The technique is really ideal for this type of environment,” Gebhard said. “We saw this back in 2010 with the Haiti earthquake when all the infrastructure was destroyed.”  Typically, a needle, a syringe and a method to locate the nerve are all that is required. Battery operated nerve stimulators or a portable ultrasound machine – like they one they use at St. Ann’s Bay Hospital – help clinicians locate the nerve and perform a regional block.

But it’s not just the resources and environment. In Jamaica many patients seek care when they are sicker. For example, vascular patients who need a lower leg amputation often present with multiple morbidities, Gebhard said. “Putting them to sleep in an environment like Jamaica can be more risky than performing a nerve block procedure.”

Feedback from the visiting Jamaican anesthesiologists has been very positive. They observe and learn multiple new techniques that “they can take back home and put it into practice,” Gebhard said.

The Jamaican physicians were impressed by the sheer size of the UM/Jackson program, the number of resources, and the multidisciplinary team — which includes clinicians like fellows and nurse practitioners they do not have in Jamaica.

““What we get out of it is the satisfaction of teaching someone this technique and making the practice of anesthesia safer in these limited resource environments,” Gebhard said. “We will continue this exchange program where we go down and teach and they come here and observe.

“The ultimate goal is to create local experts who can then continue to teach generations of anesthesiologists in those techniques locally, rather than us coming once a year.”

Tags: anesthesiology, Gebhard, Jamaica, visiting doctors