Natalia Belii, MD. Ph.D
I am a Moldovan specialist in Anaesthesiology, working in a paediatric hospital in Chisinau, the capital of the country, and would like to share with you a short story about anaesthesia equipment.
Have you ever had a situation when you go, and you don’t know where you’re going; you arrive, and you don’t know how you will go back? The towering inscription “Air Emergency Medical Services” on an old, rattletrap car sounds good, but it doesn’t help you at all.
Called to the emergency room for a foreign body in the airways, you have to deal with the anaesthesia machine you are provided with, and that is if there is one at all. And it isn’t always one that meets minimal requirements needed for taking care of a child. You wouldn’t believe how difficult it would be to fulfill all the tasks in this case.
It seemed a terrifying ordeal for both of us, specialist and resident. That day I was travelling with Dr Silvia Petrovna, the head of the anaesthesia department in my hospital to a remote city, in the North of the country. There, far away from the much better equipped hospitals in the capital of the country, the dim process of assembling the anaesthesia machine “from remains” seemed near-impossible. From several non-functioning machines, we had to put the bits together to turn them into a trustworthy one. Even today I am still wondering about how Dr Petrovna was finding and matching them all. I must also mention that during that time we were already allowed to speak our mind, about everything. For instance, about the single-use endotracheal intubation tubes that were sterilised and reused, or about ketamine as the only drug available, or about sevoflurane administered using the halothane vaporiser.
To say that I was in panic is is a huge understatement. “How do we work without a monitor, Dr Petrovna?”, I asked in panic. “Carotid pulse”, sighed the head of the department. “The pulse is normal, the child is pink…”, obviously she tried to calm me down. “And don’t turn your eyes to the machine. Look at the child!” she said. The inhalatory induction was rapidly going through the same stages described almost a century ago by Guedel .
It was pointless to pretend that you are fine in the presence of the person who taught you how to apply a face mask on an infant just a month before. “Your hands are shaking again, Natalia!” resumed Dr Petrovna.. “I’ll pinch you as if you were my daughter to calm you, and don’t even dare to object!”. She was speaking clearly, calmly, lowering her eyes, like adults bending down to their child level so they can look the kid directly in the eyes. And there was no colleague in the country who did not respect her and follow her instructions.
“You have children, don’t you?” she asked me, and that was the first and last time I saw the blue eyes of Dr Petrovna in tears. „It seems to me that you have two… and now you came here from the field of adult anesthesiology”. „“Then…” she continued, “if you want to get back to your children in the evening, to hug them, please place the reservoir bag in a way you can keep your eyes on it.” and she moved it toward me with a firm movement. Although she was talking to me, she didn’t look at me. “she toddler is not breathing well… start ventilating her”.
The trip back from Soroca had lasted long enough that Dr Petrovna had the time to tell me the story of her life. About how she was a student from Chernovitz. About love. About perestroika (the reformation of the Communist Party of the former Soviet Union). About how she worked in the past without a pulse oximeter. About night shifts. Such events in one’s life make our personality stronger.
Fortunately, things started to change in this part of the world.
Little by little, and with the support of the European Society of Anaesthesiology (ESA), newer equipment started to show up, offering a significantly better anaesthetic monitoring and safer conditions for the surgical patient.
In addition, the Moldovan anaesthesia residents got the possibility of spending various periods of training at European universities, clinics and health centres, and get accustomed to new, modern equipment.
Along with well-known names in the field of patient safety, I had the opportunity to be part of a working group for updating the International Standards for a Safe Practice of Anaesthesia . On that occasion I met experts from different countries who have faced or still face the same problems as the Moldovan anesthesiologists. For me this was a unique experience and a real challenge.
By the time medical science and technology progress reached us, the cases at the periphery of the country continued to need updated anaesthesia services. Anaesthesia machines had to be studied thoroughly and known, the new ones, but also the old ones. Dr Silvia Petrovna wasn’t going to come with us every time when we were called for to peripheral hospitals. Thus, we have found ourselves in a hospital being obliged to use a collection of old machines. This is of course better than nothing, because we had worked with them for half a century, so we had no right to look at them as to old garbage. We just couldn’t throw them away either, as they used to save lives, including those of children
We still have old machines and other pieces of equipment. Younger colleagues from all over the country used to visit us, have a look at the old machines. “It looks like being in a museum”, they used to say. And they went on, advising us: “do not throw them away, you might need them from time to time…One never know what can happen”.
So one day, an idea formed: why not to use an already existing location, for creating a local museum, a museum of anaesthesiology?! And thus, to offer a chance to the new generation of Moldovan anaesthesiologists to see how we started this profession in our country, and how did we use our clinical abilities in order to face critical situations in the absence of modern equipment.
In other words, we would like to preserve the past, and build on it a better future.
So, with the endorsement of the Moldovan Society of Anesthesiology and Reanimatology I am sending an appeal to the ESA and to anesthesiologists from all countries, but also to the anaesthesia industry to help us with exhibits that could find a place in our future, tiny, museum.
Any single device, any old piece of old equipment, would be more than welcome.
And thanks everybody in advance for your support.
- Guedel A. E. Stages of anesthesia and re-classification of the signs of anesthesia. Anesthesia and Analgesia. 1927; 6:4.
- Adrian W. Gelb, Wayne W. Morriss, Walter Johnson, Alan F. Merry, on behalf of the International Standards for a Safe Practice of Anesthesia Workgroup. World Health Organization-World Federation of Societies of Anaesthesiologists (WHO-WFSA) International Standards for a Safe Practice of Anesthesia. Can J Anesth. 2018; 65:6, pp. 698–708.