#61 – How to do Anesthesia for Global Outreach, Part 1 – Mason McDowell, DNAP, CRNA

This podcast and the one to follow are pure gems.  You’re gonna hear from Dr. Mason McDowell who in 2014, sold everything he, his wife and 2 young daughters 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.  He’ll talk a little about that in this show.   I just want to frame how massive of a change this was for Dr McDowell and his family.  They lived in a planned community of beautiful residential homes and businesses nestled in the mountains of Asheville, North Carolina.  The community housed a satellite campus for WCU and our anesthesia program.  Mason could walk to work from his home, step across the street to a number of stellar restaurants or high end shops or even stroll to the end of the block to the grand movie theater to watch a show with some fresh popcorn.  He was well-respected in the local community and maintained an anesthesia practice at the local 800-bed trauma center with all the technology and resources you could imagine.  And they decided to leave all of that and move full time to Bere, Chad.  The hospital where Mason went to work didn’t have a functional anesthesia machine.  Mason flew to Europe to buy a draw-over vaporizer so that he could bring inhalational anesthesia to the Bere.  Before Mason and that machine showed up, the options were either ketamine or spinals.  That’s it.    The stories Mason shares here 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.