Anaesthesia Champions: Dr. Alhassan Datti Mohammed

Gradian works with wonderful, committed anaesthesia providers around the world whose hard work often goes unnoticed. So we’re happy to introduce you to some of them through a new series we’re calling “Anaesthesia Champions.”

In this first post, we asked Dr. Alhassan Datti Mohammed, from Nigeria, a few questions about his experiences. Dr. Datti works with the organization PRRINN-MCNH (Partnership for Reviving Routine Immunisation in Northern Nigeria). Since its inception, PRRINN-MNCH has grown to encompass a focus on maternal, neonatal and child health in addition to immunization and now operates in four states in the Northern Nigeria.

Dr. Datti is the principle investigator on a PRRINN-MNCH study of the impact of access to safe, reliable general anesthesia on emergency obstetric care and neonatal outcomes. Dr. Datti will present on his preliminary findings of this study and the experience of a hospital transitioning from Ketamine-only to inhalational general anesthesia at the upcoming All-Africa Anaesthesia Congress in Cairo in April.

Q & A with DR. DATTI

1) How did you choose to specialize in anesthesia and where did you train?

During my undergraduate days (1986-1991) we had no career guidance on specialization. We just wanted to qualify as Medical Doctors. We were very much aware of the acute shortage of medical doctors and very few of us knew what we wanted to be in the coming years. I wanted to be a general physician or cardiologist, but my mind kept shifting towards the sub-specialization (Ophthalmology, Anaesthesiology and Psychiatry). I was wondering why there were so few people in those areas. I remember very well during the 4 weeks of posting in anaesthesia, most of the anaesthetists we saw working were nurse anesthetists. Before the end of the posting an older man came and delivered two lectures on anaesthesia topics. He introduced himself as Professor Nwachukwu. He was from Eastern Nigeria and the first fellow ever at the WACS (West African College of Surgeons) in Nigeria. (He died about 7 or 8 years ago.) I was shocked that this “small” field of anaesthesia had a Professor.

I then went to the medical library, which was rich with lots of volumes of JAMA (Journal of American Medical Association) and I perused through journals related to anaesthesia. Most of them referred to respiratory physiology, cardiology, and autonomic nervous systems – anaesthesia dealt with nearly every aspect of medicine! It was like if you learned anaesthesia, you become a multi-specialist of some sort and you can apply your knowledge almost 100%…with no mistakes!  After the mandatory one-year youth corps service (NYSC), that memory came and I ventured into it after a few years of working as a Medical Officer in my home state, Jigawa.

I received my training from 1997-2003 at the University of Ibadan and University College Hospital, Ibadan, Southwest Nigeria (established in 1957 and the premier teaching hospital in Nigeria) where I obtained the Postgraduate Diploma in Anaesthesia. Here, I also received the residency training that qualified me for admission as a Fellow at West African College of Surgeons (WACS) in Anaesthesia in 2007. I happened to be the 1^st ever Fellow of this College from both Kano (and Jigawa) State in Northwest Nigeria.

2) What do you see is the greatest challenge to the safe, reliable delivery of anesthesia in Nigeria?

Acute shortage of manpower, lack of basic equipment and essential drugs. Also, where the equipment exists there is poor maintenance culture. This vicious cycle has encouraged the heavy reliance on Ketamine-only anaesthesia for every surgical case in both urban and rural areas.

3) Can you share an experience where your equipment failed, jeopardizing the safety of the patient?

There was a time during my training that a reservoir bag busted and I could not ventilate the patient under my care [for C-section] using a general anaesthetic, relaxant technique. It was frightening really, but the technician working with me (who happened to be one of the best) knew we had no spare reservoir bag and rushed downstairs and got us one from the first floor, and we were working on the 4th floor. When he first realized, he rushed downstairs and was back within 2 minutes (as if he had run a marathon!). I used the ambu bag before he came back. Even if there were no ambu bag, I would have breathed for the patient through ETT. There was no pulse oximeter either. Fortunately, I had developed enough confidence as a Senior Registrar to deal with this sort of situation. We were lucky in that nothing adverse happened.

4) What impact have you seen the UAM have in the hospitals involved in the study?

The impact was immediate, especially on the users, for freeing them from ketamine-only bondage. Many of the users have been bonded to ketamine because of the lack of equipment to practice the inhalation technique. With the UAM, they are gradually and steadily regaining back their skills in the administration of inhalation general anaesthetic. They are also saving a lot of cost in the most expensive consumable…oxygen.

5) What feedback have you received from the anesthesia providers about the UAM?