Article by Ulrick S. Kanmounye email: firstname.lastname@example.org
Group picture of Congolese physician anaesthesiologists and non-physician anaesthesiology technicians
Concepts of task-sharing and task-shifting in Congolese anaesthesiology date back to the early 1960s. These were implemented since the post-colonial period in order to solve the shortage of physician anaesthesiologists. As such, this non-physician workforce either works in collaboration with physician anaesthesiologists when the former are available or have complete autonomy when physician anaesthesiologists are not present. In most francophone countries, these healthcare staff are known as “State Registered Anaesthetic Nurses” or “Infirmiers Anesthésistes Diplomés d’Etat – IADE” in French. However, it is important to note that while in most francophone countries this appellation has evolved from that of “Anaesthesia and Resuscitation Technician” (Technicien Anesthésiste Réanimateur – TAR), this body is still known as TAR in the Democratic Republic of Congo (DRC).
Prior to the colonial period, the Congolese population went to traditional doctors for matters of health, finance, religion and bad luck. However, on their arrival, the colonial masters banned the practice of traditional medicine which was thought to be a pagan practice. As a result, most traditional doctors went into hiding and their patients went on to seek care from the colonial doctors. Later on during the early sixties, the balance of power was redefined as the country achieved independence. It is during this period that the first TARs were trained by American and Swiss physicians at the Kinshasa Provincial and Regional Hospital (known then as Mama Yemo), the Kinoise Clinic (known then as the Danish Clinic) and Kintambo Reference Hospital.
Back then, these TARs were trained for a year and they earned a certification known as “Capacité”. This contrasts with the three and five year courses that are currently available nationwide to future TARs giving them the titles of “Gradué” and “Licencié” respectively. In the Congolese higher education system, “Graduat” is the equivalent of a Bachelor while “Licence” is the equivalent of a Masters. The wide availability and popularity of these courses has helped the growth of this workforce and as a result, as of 2018 we register 656 gradués and 46 licenciés. In 2017, 729 TARs were registered by the Society of TARs in the DRC with a mean age of 50 years, 35% of TARs were female and 54% of TARs worked in the private sector. Despite this apparently encouraging figures, half of the regions in the DRC do not have TARs whereas Kinshasa alone has more than 500 TARs.
On the other hand, the medical workforce’s evolution has been different. Less than a decade after independence, the first Congolese Anaesthesiologists were trained at the Department of Anaesthesiology of the Kinshasa University Clinic. Since it was created, the Department has had four Department Heads: first was Dr Gribomont (Belgium), then Dr Fares (Egypt), followed by late Pr Nathalis Bele (DRC) and finally Pr Kilembe Manzanza (DRC). Together, they have trained and are training a total of 109 doctors (34 anaesthesiologists, 40 senior residents and 35 junior residents). Sadly, the female gender makes up just 28 of the 109 doctors, the number of residents keeps rising each year and the Department is still the only training site nationwide.
To make matters worse, there are only five of the 26 provinces of the DRC that have anaesthesiologists, 13 anaesthesiologists have immigrated abroad, and Pr Kilembe remains the only professor of anaesthesiology in the DRC. In order to solve some of these problems, the Department decided to create an entrance examination into its residency programme and to send their senior residents to other hospitals in the capital city that have senior anaesthesiologists and an important workload. These decisions have helped control the number of admissions into the residency programme and increase the work experience of senior residents respectively. Finally, the Faculty of Medicine of the University of Kinshasa and the Congolese Society of Anaesthesiology and Resuscitation, have decided to support the professorships of five candidates at the Malagasy and African Higher Education Council – CAMES (Conseil Africain et Malgache d’Enseignement Supérieur) by 2023.
Dr Wilfrid Mbombo (far right and standing), President of the Congolese Society of Anaesthesiology and Resuscitation at the 4th Congress of the society
In conclusion, despite the long history and experience of task-sharing in the field of anaesthesiology in the DRC there are still many patients that do not have access to anaesthesiologists and non-physician anaesthesiology technicians. One of the main problems is the uneven distribution of the anaesthetic workforce. If we want to achieve the global surgery, obstetrics and anaesthesia objectives set by 2030, we need to encourage anaesthesiology staff to relocate in other regions than Kinshasa. In the same vein, if we want to increase the anaesthetic workforce, we need to stop the brain drain from the DRC and to encourage those that are abroad to come back home.