remote anesthesia – Anesthesia Guidebook

This is part 2 of my conversation with Mason McDowell, DNAP, CRNA. In 2014, he, along with his wife and 2 young daughters, sold everything they owned and moved full time to the heart of Africa… to the town of Beré in the nation of Chad, to provide anesthesia services at hospital with severe resource limitations.

Dr McDowell was a professor of mine and the assistant program director at Western Carolina University when he made the decision to move to Chad. I remember him preparing and talking about the why behind his decision and watching that process unfold was incredibly powerful.

In part one of our conversation (episode 61), Mason talks about the decision to go to Chad, what he and his family did there and why they had to evacuate the country emergently and return to the United States. In this episode, Mason shares advice for those who wish to travel and provide anesthesia for underdeveloped, impoverished and/or remote communities.

The stories Mason shares in this 2-part series are remarkable but they only scratch the surface of his time in Chad. I’ll link to his blog at whyweshouldgo.blogspot.com in the show notes where you can read about the day-to-day, night-to-night tales from providing anesthesia and general medical services in Chad. THOSE stories are heart wrenching. There we innumerable times when Mason and his team had to make decisions based on the severe resource limitation that we simply would never have to make here in the United States. I’d like to share one of Mason’s stories with you here:

4-3-2-1 8 Dec 2014, Bere, Chad by Mason McDowell, DNAP, CRNA

I was called out of our morning meeting at the hospital

around 730am with the wave of a hand. I knew what it was even before I asked for confirmation: Bébé? Oui.

A mother had just delivered twins but baby #2 wasn’t breathing. I gave oxygen, breathed for him with an ambu bag and tried to keep him warm. Danae (the OB/GYN) lifted her scrub shirt to press baby against her skin to warm him as I continued to hand ventilate. Eventually he was breathing on his own and was sent to our “NICU”– that’s the neonatal intensive care unit; except in Chad it means he is getting oxygen while he rests in a tiny cardboard box in our OR with 2 hot water bottles tucked beside him. Guess what? He’s still alive tonight!

Flash forward to around 8pm when our volunteers arrived from the US. They were only here 10 minutes before an urgent phone call: maternity…a mom turned quickly…send Mason now! I threw on scrubs and my friend Shawn (also an anesthetist) hurried along behind me.

We arrived to find a seemingly dead looking pregnant woman laying on the floor and frothing at the mouth. We moved her quickly down the sidewalk to the OR and began CPR. Chest compressions, oxygen/ventilation, IV epinephrine…Nothing. Now thats a terrible situation–lifeless and pregnant. I told Danae “she’s dead-dead …get the baby out”.

I barely finished the sentence before Danae cut down and retrieved a baby girl. Good pulse but not breathing. After an extended period of manual ventilation and stimulation the baby perked up and breathed on her own! The unmistakeable scent of Arabic perfume lingered in the air as it radiated from the cloth I used to wrap the baby in. The fabric had been part of her mothers clothing. Blood covered the OR table, floor, and the surgeon. We cleaned up the baby’s mother and brought in the family for a final viewing. Tears and prayer filled the OR. The family left to find a truck to carry the body away and I walked home alone under a brilliant night sky, still replaying the events of the day and looking for lessons to learn.

I returned home to find suitcases filled with treasures from the US. Our friends brought items purchased or donated for us and our hospital– it was like an early Christmas. After 30minutes of sorting goodies and eating junk food another call came: stat C-section. Seriously?!

A very young mother with complicated labor was already in preop when I arrived. Unfortunately the dead body from an hour ago was still in the OR (still waiting for family) and we had to find a way to move it out and bring in the new patient without making a big scene. If it wasn’t so sad it would have been comical. We pushed the dead woman into our tiny preop room after angling the new patient’s stretcher in a way that she had to twist around to see the body. And that’s exactly what she tried to do. We built a human wall with the 4 of us as we shuffled along pulling the new patient past the body (just 2 feet away).

Now in the OR: IV fluid, monitors, spinal anesthetic administered easily–cut down and baby retrieved in textbook fashion. Except…Silent baby. Floppy baby. Apneic baby. After stimulating, warming, and ventilating with oxygen…nothing. Pulse rate 160:perfect. But he’s not breathing.

Ventilate. Stimulate. Spank…again and again. The sound of surgery continued behind me. NDilbe attended to the mother as I worked on the baby boy. After maybe 40 minutes that baby boy had a perfect heart rate, perfect color, perfect body temperature… but he wouldn’t breath. Not even a sputter. I told Danae I was stopping. We have no ventilator here and no other option. Chad is harsh. Only the strongest survive. I kept my hand draped over his chest and I stroked his hair as I felt the warmth of his body slip away while I whispered words of prayer. It think it took about 10 minutes to see his heart rate slow and then finally stop. I stayed with him and I finally glanced over my shoulder at his young momma: She knew. She saw my eyes and heard the silence. It took 10 minutes to watch a baby die once I quit breathing for him. How long will it take to forget this day?

4 resuscitations

3 babies in peril

2 babies beat the odds

1 husband/father/friend who is beyond thankful for faith and daily blessings. Life is good even when it’s hard.

-Mason

A young patient assess Mason McDowell, DNAP, CRNA.

You can find that and so many other stories in Mason’s writing.

Mason and his family moved to Chad with the intention of living there for years. Unfortunately, a couple of years into their new journey, the political and security situation deteriorated rapidly in Chad and the US State Department issued a warning that all US Citizens should evacuate immediately. Mason talks about the decision to leave with a day’s notice and the culture shock he and his family experienced upon their return to the US. Not long after that, in May of 2017, I caught up with him to record these interviews.