Prior was rarely performed, with hardly more than a

Prior to the development of effective anesthesia, elective surgery was rarely performed, with hardly more than a case per month recorded. Patients who did choose to have surgery were forced to undergo the pain that accompanied it, whether the operation was having a tooth pulled, an amputation, or an organ removal. The history of anesthesia is particularly extensive. Dating back to the BCE era, man sought pain-relievers from his surroundings. There are instances of opium poppy and henbane being used to relieve pain. Dr. William Morton had been in search of a better pain relieving agent than what had been previously used by many dentists: nitrous oxide. He consulted his chemistry teacher at Harvard, Dr. Charles Jackson, for his research. What part Jackson actually played in Morton’s decision to use ether by inhalation became the topic of controversy, but there is no doubt that it was Morton who tried it in his patients. Having been successful with his trials, Morton offered to demonstrate his method to Dr. John Warren, who was a surgeon at the Massachusetts General hospital. In 1846, William Morton successfully demonstrated that sulphuric ether could be used as a relatively safe agent for pain alleviation during surgical procedures. Credit is given to Oliver Wendell Holmes for the noun anaesthesia and the adjective anaesthetic. Holmes wrote Morton in November of that year suggesting the use of these names. News of Morton’s  demonstration soon crossed the Atlantic, reaching acclaimed medical centers in Paris and London. Within two months, word of its discovery had spread over the entire European continent. One historian compared the impression of this news worldwide to the debut of penicillin or the news of the destructive force of the atomic bomb. What makes this history particularly interesting is the lack of sources with corresponding evidence and information. In fact, scholars do not even agree on the specific date in which Morton performed his procedure.  The author of one anesthesia history compared the development of anesthesia to a chain “stretched at first with tenuous links around the world, with the links later strengthened by contributions from far away anesthetists.” Despite excitement over the new discovery, there was a delay in its immediate acceptance due to impractical techniques. It was gradually established that failures with ether anesthesia were not to be attributed to the inefficiency of the drug but either to improper technique when applying the drug or faultiness of the apparatus. As a result, many doctors, chemists and medical instrument manufacturers set about constructing new equipment designed to eliminate failures. As early as 1847, numerous improvements and innovations appeared. The introduction of ether anesthesia completely changed the surgical approach to many operations. Prior to its introduction, the agony of the patient made speed the number one priority of a surgical operation . Using anesthesia, procedures could be carefully carried out, providing the surgeon with a higher likelihood of securing a successful outcome.  Anesthesia has developed from a mistrusted novelty into a specialty of great precision and complexity and, today, with the use of readily available safe medication and monitoring technology, anesthesia has become a valuable part of any surgery. The development of anesthesia still continues to have a major impact on healthcare today. Anaesthesia is now not merely limited to the operating room but also involves the services related to the emergency room, intensive care unit, cath lab, magnetic resonance imaging (MRI) suite, resuscitative rooms, electroconvulsive therapy (ECT) room, and other life-saving hospital services. Better drugs, improved monitoring and specialized training have been responsible for great improvements in patient safety and comfort during and after surgery. However, what is so common to people in developed nations is seriously lacking in developing nations. A trend in the history of global health as we’ve studied in class is one in which the developments of health technologies are impactful in developed areas, but have had limited impact on the overall health of people living in underdeveloped ones. These historical global health trends are still being seen today in regards to access to anesthesia technologies. Even though there are vast global disparities in access to safe anesthesia, governments and major donors have been reluctant to prioritize the issue and little effort has been made to address the issue. The poor state of anaesthesia services in certain areas of a few sub-Saharan countries has been described by anaesthetists working in these countries and in overseas medical missions. It is probable that even in the 21st century, millions of people in developing countries do not have access to resources that should be considered a basic human right: access to safe anaesthesia and pain relief during surgery and childbirth. However, the extent of the problem remains largely unquantified both nationally and internationally. There is currently no strategic way of assessing anaesthesia service provision, particularly in rural areas. Accurately measuring access to safe anesthesia remains challenging, because there is no single indicator that describes access and quality of anesthetic services, unlike access to essential medicines where registry-level data are available. As discussed in class, it is likely that different countries face different problems and require different solutions. Some countries need local systems improvement, while others need national capital expenditure.One study aimed to assess these important factors in Uganda’s government hospitals as part of a larger study examining surgical and anesthesia capacity in low-income countries in Africa. In Uganda, for a population of 27 million, there are only 13 physician anaesthetists and 330 non-physician anaesthesia providers. As was the case during class discussions, distance to health facilities continues to be a major barrier for people trying to access health services. According to the WHO and other expert opinions on essential surgical and anesthesia standards, there should be a reserve of blood, an oxygen source, a pulse oximeter, and essential medications available at every facility performing surgery. In Uganda, not one hospital surveyed had a continuous supply of these essentials, and none had a usable pulse oximeter. All hospitals reported unreliable supplies of water and electricity and essential equipment was missing across all hospitals, with no pulse oximeters found at any facilities. Pulse oximetry has transformed the safety of anaesthesia and has been considered essential anaesthesia monitoring for many years. In Uganda, oximeters are rarely available and anaesthesia is provided on a daily basis for many patients without oxygen and with no monitoring of oxygen saturation. In addition to these challenges, there is also a lack of vital human resources and infrastructure to provide adequate, safe surgery at many of the government hospitals in Uganda. Medical migration has resulted in many Ugandan doctors emigrating to wealthier countries such as the UK, resulting in a serious shortage of doctors. These factors impede the provision and development of medical care across all specialities, including anaesthesia. Despite these conditions, a large number of surgical procedures are still attempted.Another area of concern is the the lack of proper education in anaesthesia in most of the developing countries. A significant number of physicians perform a part or even their whole anaesthetic training abroad. Having said that, these physicians also later face problem associated with enormous differences between their training environment. These differences are involving access to reliable power, sources of compressed oxygen and other gases, sophisticated machines and modern drugs and the area at which they are imparting training. Majority of trained residents prefer to work in major cities. In turn, this makes the human resource even more unevenly distributed. Some of the residents or staffs who acquired their speciality training outside the country usually stay and practice in  western countries. This is mainly due to the lack of good earnings and proper facilities in these under developing countries. Pediatric anaesthesia in the western world is a separate sub-specialty of anaesthesia and often involves trained physicians from this field. However, in the developing world, pediatric anaesthesia is almost non-existent as a separate entity and a majority of non-physicians are involved in delivering pediatric anaesthesia services. However, the perioperative paediatric mortality rates have increased over the past decades in all over the world, and developing countries have been found to have worse mortality rates. One survey’s results found that more than 80% of anesthesia providers in a poor country acknowledged that they could not provide basic anesthetic care to children less than five years. Even in the era of patient safety, majority of population in developing world do not have access to safe anaesthesia services. In developing countries, there exists a big gap between the growing population and their health care need and there is a long way to go to improve and implement the safe anaesthesia services for all patients. Initiatives are needed to substantially sustain improvement to the situation in developing countries. It is imperative to include relatively inexpensive and simple yet effective methods to improve the standard anaesthesia care in the developing world. Global priority should be given to reducing anaesthetic-related mortality in developing countries by reducing the disparity in mortality compared with developed countries. To fill the gap of inequity in anaesthesia services, researchers recommend assessing the problem within specific regions and to spread the incorporation of new anaesthesia technologies, like pulse oximetry, into the mobile system to provide standard monitors at a cheap rate. A wider spread of facilities would increase countries’ ability to teach medical personnel directly in their countries. In addition, an anaesthesia education curriculum should be developed to produce anaesthesiologists who would know the recent technologies and who could be able to utilize the local resources available. It would probably also be beneficial if the anaesthesia curriculum could also be taught to non-anaesthesia personnel, as well. These personnel could be utilized in underserved areas or areas of need. In social terms, researchers believe that framing the situation as a human rights issue will also help raise support from donors and policy makers. While these solutions are challenging to implement, major investments should be made to modernize and improve the safety of anaesthesia for patients in developing countries.