Practice of ambulatory anesthesia in honduras: The central American experience

Abstract

H ONDURAS IS A developing country, with scarcely 5 million inhabitants and 112,000 km 2 of territorial extension. The entire country has only 52 anesthesiologists, all of whom completed residency training abroad because it is not available in the educational programs of the local medical schools. What occurs is that the anesthe~ sia specialists train paramedical personnel to be anesthetic technicians who will be working at the public hospitals under the anesthesiologist's supervision. This allows them to meet the needs of the people in the field. Even though Honduras has not suffered the deleterious effects of war, it endures other problems, such as the two clearly separate socioeconomic poles of the miserable poverty (in the largest percentage) and the ostentatious richness, with a very small middle class. The world crisis is more visible in this type of society, which has generated excessive violence, thievery, and misery. Nevertheless, there are some advantages in this ongoing smuggle. Necessity is the mother of invention, and although anesthesiologists in Honduras do not have international fame, they have been obligated to improvise with materials and equipment in their dally practice (adhesive tape has become our number 1 auxiliary). The adoption of a saving policy to face the precarious situation has helped to overcome the necessities. The upper class might not be accustomed to these medical behaviors, but the resources must be well spent and waste avoided i f it is possible. New inventions from the medical engineering field have given us accurate devices to obtain better measurement, precise evaluation, and prompt treatment of the patient. The great activity of pharmaceutical laboratory chemists have launched many new products to the medicine market that make the practice of anesthesiology easier, safer, and more efficient. In developed countries this reality has made a real change because of the lower costs for medical care due to the ability to have patients hospitalized for a shorter period of time. It is economically attractive for the administration of hospitals or health care facilities to treat several patients per day with a short postoperative time rather than to have beds perpetually occupied. The profits are larger with the new methods. In Third World Countries, many things regarding medical service are done backwards (day surgeIaj is no exception) because of the difficulty to obtain expensive modern drugs and devices. There are arguments among the administrations because they would rather give affordable (or inexpensive) health care, believing this is the best solution to the crisis that the health care system faces, without making an effort to understand and compare the cost per day for inpatient care versus the technology investment and the acquisition of new drags that will allow a short hospital stay, which is what makes this kind of practice profitable. What occurs in private practice regarding this matter? Hospital permanency of the postsurgical patient is extended as much as possible because of the profits obtained by them; therefore, we believe that the ambulatory surgery programs are not attractive to these kinds of nonspecific day surgery centers. In the late i940s some ideas of day surgery programs took shape in Latin America, but it was not until 1970 that Honduras began those programs when some procedures were done in long-stay medical centers under ambulatory surgery criteria. In those early days the operations performed were mostly adenotonsillectomy, circumcision, inguinal herniorrhaphy, cystocele correction, hand surgery, and more, but percent-