Anesthesiologist

Anesthesiologist – Based in Yemen, Chad, Sudan, Haiti, and other countries.  

Start Date: Flexible (several rotations available) 

Contract duration: 3 months 

About us 

Doctors Without Borders/ Médecins Sans Frontières (MSF) provides medical assistance to people affected by conflict, epidemics, disasters, or exclusion from healthcare. Our teams are made up of tens of thousands of health professionals, logistic and administrative staff - bound together by our charter. Our actions are guided by medical ethics and the principles of impartiality, independence and neutrality. We are a non-profit, self-governed, member-based organization. 

Context 

Access to safe surgery and anesthesia in low resource settings remains a significant global health challenge. The greatest need is found among rural and marginalized populations living in low- and middle-income countries where surgery patients are often at higher risk of complications because of underlying, unrecognized medical conditions.  

MSF has more than 50 years’ experience of providing surgical care in settings of civil conflict and war, natural disasters, and other humanitarian crises. In 2022, MSF personnel performed 92,690 surgical interventions where anesthesia was required.

Core activities within MSF surgical programs primarily focus on delivering lifesaving and essential surgeries, encompassing trauma, general, orthopedic, and obstetric procedures. These surgical interventions are typically conducted in district-level hospitals, with differing degrees of collaboration with local health authorities, although MSF-managed facilities are also prevalent. Perioperative anesthetic care is an essential component of these services. A key aspect of MSF's operations involves capacity building in essential surgery and anesthesia care, with a significant emphasis on engaging local healthcare providers. 

Responsibilities of MSF anesthesiologists: 

• Carry out anesthesia and prepare anesthetic equipment 
• Coordinate operating room staff  
• Supervise and train staff  
• Pre-and post-operative follow-up of patients 
• Collecting, analyzing and reporting data 

See below for more details on MSF anesthesia provision in practice. 

Requirements 

• Degree in Medicine and completed residency in Anesthesiology. 
• Full and current registration 
• At least six months of clinical experience within the last two years 
• Experience in pediatric, obstetric, and trauma anesthesia.
• Experience in the use of dissociative anesthesia (e.g., with ketamine).
• Experience in the use of epidural anesthesia.
• Ability to work with limited resources and in challenging working conditions.
• Respect for MSF's anesthesia and surgery protocols and standards.
• High level of English and/or French. Knowledge of both languages ​​will be prioritized.
• Computer skills at a user level.
• Minimum availability of three months, although longer availability will be appreciated.  

Terms of employment 

• 3-month contract. 
• Monthly salary is non-negotiable and can vary between 1850€ and 2000€. Details available here.
• All logistics are organized by MSF, including flight tickets, visa administration and shared accommodation (including food & housekeeping).  
• Initial preparation before your first assignment. 
• Security management is handled by an experienced manager in each project location. Each MSF employee must comply with the security rules in place.  
• Detailed briefings. 
• Psychosocial assistance. 
• Coverage, such as medical care and vaccination package, accident insurance, including repatriation. 

Accepting applications until May 31st 2024 

More details on MSF Anesthesia Provision in Practice 

General anesthesia is widely used whether it be with intubation or without intubation. Ketamine, Propofol and Thiopental are the hypnotic agents most utilized for intravenous induction of anesthesia. Additionally, Isoflurane and Halothane are frequently employed for inhalational anesthesia in such contexts, with Sevoflurane emerging as a newer option. Anesthesia machines, such as the Diamedica Glostavent®, are standard in MSF as they are designed for use in remote environments with minimal skilled maintenance. It's essential for anesthesia providers to understand the pharmacology and clinical use of these agents before deployment to low-resource settings. 

Regional anesthetic techniques, including local infiltration and spinal anesthesia, are widely used in MSF projects and are often preferred over general anesthesia, which may demand more equipment, trained staff, and monitoring and implicate fewer side effects. Spinal anesthesia can be taught and practiced safely by anesthesia providers with limited training. The use of regional nerve blocks is increasing and requires more expertise but provides excellent postoperative analgesia. The use of catheter techniques remains very limited because of the increased postoperative surveillance required. 

Pain management can be challenging in MSF projects for several reasons. 

1. Limited availability of opioids due to local regulatory restrictions. About 80% of the global population live in areas where access to opioid analgesia is lacking.
2. Inadequate postoperative human resources to monitor for opioid-related adverse effects, notably respiratory depression.
3. Insufficient local knowledge and expertise in alternative pain management techniques.
4. Limited understanding of the physiology of pain and pain pathways and clinical implications for its management.
5. Cultural attitudes related to the phenomenon of pain and the use of opioids in perioperative pain relief. 

MSF uses a multimodal, protocol-based approach to the assessment and management of pain related to surgery and trauma, which uses both pharmacological and non-pharmacological techniques. Clinical tools to support pain assessment and management are available in many local languages. 

Obstetric procedures account for a substantial proportion of the surgical workload in MSF projects. Complications of pregnancy and delivery, including severe pre-eclampsia, eclampsia, hemorrhage, sepsis, unsafe abortion and exacerbation of pre-existing conditions are leading causes of morbidity and mortality. Anesthesia providers are central to their prevention and management. 

Emergency pediatric surgery is performed in MSF surgical missions for both traumatic and non-traumatic cases, with 22 to 40% of surgical interventions performed by MSF on children. In regular projects, pediatric surgery is limited to emergencies due to lack of subspecialty skills and resources. MSF projects resourced with adequate pediatric capacity in anesthesia and surgery perform more specialized care. 

Finally, anesthesia providers play a pivotal role in the delivery of perioperative care in MSF projects collaborating with nursing staff, surgeons, other healthcare workers and clinical managers. In addition to provision of clinical care and participation in surgical ward rounds, anesthetists’ duties may also include supervision of operating schedules, organization of the emergency workload, supervision of IPC precautions in the operating theatre and wards, and oversight of pharmacy orders and supplies.