NYSORA NEWSLETTER, MARCH 2011

A Note from Your Editor

Focus On: Tsotne Samadashvili, MD, NWAC Rome 2011 Scholarship Recipient

Focus On Faculty

Underserved Communities: A Plentiful Harvest

By Michael McTigue

They say that March comes in like a lion and goes out like a lamb; at least that’s what they say here in North America. The proverb is meant to deal with the weather, but here both the NWAC and NYSORA staffs are definitely moving ahead rapidly as March begins! The NYSORA Pan Asian Symposium was another success for the team and reflected well on their efforts. We look forward to having more news from Bangalore, India in the future. Meanwhile the NWAC staff are putting the final touches on the next big event; NWAC Rome 2011.

This month is our last chance to remind you of the NWAC Rome 2011 event this April. You’ve read about it in previous issues and we have one more article this month about NWAC Rome 2011, an interview with NWAC NAP scholarship winner Doctor Tsotne Samadashvili from the Republic of Georgia. It’s the second profile we’ve done on the two NAP recipients and the first two in a series as we learn from their experiences learning from us.

The rest of our Newsletter focuses on NYSORA with interviews of seminar attendees and faculty; notably attendee Travis Smith, CRNA and 9th symposium faculty member Andre Boezaart, MD, PhD. It was interesting for us to get a perspective from both sides of the symposium and we hope it will be for you as well. In addition we have a feature from new writer Eddie Hrslak about how NYSORA philanthropy extends outside of medicine into the neighborhoods of their home city, New York.

We’ll stay with you through the month and bring you more news and events to watch for in the future. Meanwhile we again urge you to consider attending NWAC Rome 2011. As we’ve said before, there are many delights in Rome, many opportunities for engagement with peers and many wonderful experiences awaiting your arrival.

By Andrea Ralya, MBA

In the past 5 months, I began working as an instructor to train residents from the Medical University of Georgia. I emphasize that I do it with great pleasure. It is remarkable for me when I see the interest in the eyes of my young colleagues. This leads me to try to obtain more and more information and to share it with them. Frankly speaking, this is a great responsibility. - Tsotne Samadashvili, MD

The Republic of Georgia

People call the country Georgia; however, Georgians call it Sakartvelo and themselves, Kartvelebi. The terms Georgia and Georgians come from medieval days when French and English visitors to the country wrote that the people there particularly revered Saint George, a Christian figure. To this day, the country flag uses the symbol of the cross of Saint George on its flag. Currently, Georgia is organized as a democracy; however, during the last century, the country underwent many political and social upheavals, including both World Wars and occupation by the Soviet Union. The post-communist era brought economic challenges until recently, when new political leadership introduced democratic reforms and actively encouraged foreign investment. About 4.5 million people live there and 53% of them live in urban areas (2007, www.data.un.org.; accessed 2/4/11.).

The capital city of Georgia, Tbilisi.

Healthcare Challenges

As an evolving democratic nation, the Georgian government sought ways to redesign the health care system. At this time, the Ministry of Labour, Health and Social Affairs is the key strategic decision maker, however, most of the responsibility for decision making at the local level is delegated to twelve regional health departments. The State United Social Insurance Fund and the Ministry of Finance are the funding sources for the health care infrastructure and payment for services. The Ministry confirmed a commitment to the decentralization of health services in the 2000–2009 strategic health plan. Although health care providers and nearly all dental clinics and pharmacies are privatized, the plan to privatize hospitals is in progress. As of 2004, government expenditures in the health sector are increasing.

Among the public health issues are communicable diseases and diseases related to a high incidence of tobacco use. The leading communicable diseases are TB, malaria, sexually transmitted diseases, and HIV/AIDS. Georgia saw a rise in TB morbidity in 1992–1996, reaching almost the highest level in the WHO European Region. The incidence of TB has risen among both children and adults. In spite of progress made in the past few years, the levels are still high at 98.1 per 100,000 people (2005 – Health and Health Care Statistics, Ministry of Labour, Health and Social Affairs, National Centre for Disease Control and Medical Statistics). The leading causes of mortality among the Georgian population are not these communicable diseases but diseases related to lifestyle choices including an increase in the number of cardiovascular-related deaths (639.6 per 100 000 population, 2001), cancer, (98.7 per 100 000 population), and respiratory diseases, related to tobacco use; and accidental deaths due to automobile accidents.

Doctor Samadashvili as a Physician and Use of the Professional Opportunities Offered at NWAC 2011

Doctor Samadashvili practices at the Hospital of Traumatology and Orthopedics “JSC “Traumatologi” in Tbilisi, Georgia, where he is Chief of Anesthesiology and the Intensive Care Unit. Working 76 hours per week, he provides general, spinal, epidural and regional anesthesia to patients with acute trauma and in the ICU. He has a special interest in children with osteogenesis imperfecta who are undergoing orthopedic surgery because of their bone defects and require special anesthesia support. He describes his work as, “primarily in orthopedics and traumatology, for adults as well as for children. In my point of view, my important achievement is my experience in the rare disease, osteogenesis imperfecta. The hospital’s orthopedic surgeons make orthopedic corrections in these patients and I provide anesthetic support.” Prior to completing his degrees, he worked as an anesthesiologist assistant and as a nurse in the emergency department. He stated, “When I was an undergraduate student, I was interested in pathology, clinical pharmacology, therapy, hematology, and nephrology. What attracted me most were the circumstances of an operation. I wanted to take part in surgical assistance, as well as in managing the processes of urgent treatment. All of these skills are needed to be a part of one of the best professions - anesthesiology. To be successful, the practitioner requires a lot of experience, considerable knowledge of the medical areas of my interest, and is given a lot of responsibility. Anesthesiology requires the highest attention to quality and consideration of patients’ safety first.”
The doctor was a self-directed student of regional anesthesia, which he says is not popular in Georgia. In 2008, he attended the Akademisches Lehrkrankenhaus der Universitat des Saarlandes, Klinikum Saarbrucken, Germany. He returned with “a lot of theoretical material as well as video material.” Dr. Samadashvili launched and established methods of regional anesthesia and post-operative pain management in his institution. “Currently, I am extremely interested in succeeding in regional anesthesia by using ultrasound methods. The clinic has the equipment and ability to perform it. I am trying to perfect this method by using a lot of material from the NYSORA web page as well as using other related literature. I believe that sharing the advice and the practical experience of my colleagues is very beneficial.” He notes an increasing interest among his colleagues to learn more about regional anesthesia as a result of his efforts.

We asked Dr. Samadashvili what influenced him in his career choice. He was born into a family of medical professional but he stated that, “In spite of the fact that my mother and my elder sister are my colleagues, they thought that my choice to be an anesthesiology was not solid. I knew that it was a field where I could achieve what I aimed for, and even now that is the way I develop myself.”

Symbol of the Georgia Help Association for "Glassy Children," a term used by people affected by osteogenesis imperfecta.

In the written application for a scholarship, all applicants were asked to describe what about attending NWAC would be beneficial to them in their practice. Dr. Samadashvili said that, in his opinion, “sharing experience is very important. There is not great interest in regional anaesthesia in my country, due to the reason that we are not faced with it very often, consequently, there is a lack of information and trust for our patients. I think sharing experience and maintaining close contacts with my foreign colleagues is very important. Mostly, a push is needed to activate a chain reaction.”
Doctor Samadashvili’s CV shows that he is well-prepared to be a teacher and to share the knowledge gained from attendance at NWAC Rome. He completed a Trainer of Trainers program at a Medical Academy of Tbilisi in 2009. This certificate allows a physician to formally share his experience with colleagues and residents. “At this stage, together with support from the pharmaceutical company, AstraZeneca, I have prepared a short course of training in regional anesthesia that includes a review of the subject and definitions of the areas of anatomy and usage, to make regional anesthesia a well-known, alternative method and most contemporary method of pain management. I am confident that the programs at NWAC Rome will have an influence on me as well as on my colleagues and residents who I train at the clinic.”

The Future

“This is a century of advanced technology, and our job becomes more difficult, however, more interesting. Consequently, because of the improving technological factors, the result will be greater intra and post-operative safety for the patient. I think that next ten years will prove it. I see myself in my career path where my job, practical anesthesiology, increasingly will become a very interesting, high technology, safe, and intelligent treatment option. Regional anaesthesia is a very important part of this great science and it is also improving and increasingly used.”

More about Doctor Samadashvili

Tsotne Samadashvili received a physician diploma in general practice at the Institute of Family Doctors. He then studied at the State Medical Academy of Georgia, Postgraduate Education, Department of Anesthesiology and Intensive Care.

He received additional training at the Department of Anesthesiology and Intensive Care, Izmir, Turkey, and in emergency care, including parenteral feeding, artificial respiration, treatment of penetrating thoracic wounds, and toxicology; pediatric anesthesia and critical care; and regional anesthesia. An avid participant in continuing medical education, he holds a certificate in hospital management related to grants, research, and business plans; financial and human resources management; and strategic planning.

He speaks four languages including Georgian, English, German, and Russian and is a published professional author on the topics of DIC in trauma, problematic questions in the treatment of compound fractures, and management of gastroduodenal bleeding with trauma. In addition to his role as a member of the Osteogenesis Imperfecta Federation of Europe and the Help Association “Glassy Children” for People Affected by Osteogenesis Imperfecta, he holds membership in the Georgian Association Traumatologists and Orthopaedics.

By Michael McTigue

 During the Ninth Annual NYOSRA Symposium we had a chance to talk with faculty member Andre p. Boezart, MD, PhD. Dotor Boezaart a prfoffesor of Anesthesiology and Orthopaedic Surgery and Director of Acute Pain and Regional Anesthesia at the University of Florida College of Medicine in Gainesville, Florida. We interviewed Doctor Boezaart after his presentation.

Doctor Boezart, where do you think the main focus for training should be in anesthesiology?

Training should focus on high yield blocks; there are eight single shot blocks and 6 continuous blocks that every anesthesiologist should know and that will take care of almost every need. One of the problems I see now is an emphasis on lots of weird and wonderful little blocks that seem to be more about saying, “Look how good I am, look how clever I am”, and that aren’t really being done for the best outcome.

What do you mean?

I think that we must remember Hilton’s Law that every muscle moves a joint and the nerve that enervates that muscle also enervates the joint. I mean, that’s from 1884. Find that nerve and block it to get the desired effect. There’s no need to keep probing for smaller and smaller targets. It’s great that we can block the ulnar nerve, but it numbs just two fingers, it’s a useless block.

So you feel there is more to the equation of pain management?

We need to look at pain management vs. pain medicine. If I overdose a patient on opiates, their pain is managed, but that’s not very good medicine. Pain medicine looks to do what is best for the patient, not what most expedient. The doctor is the caring part of the equation. The patient is most interested in how much I care, not how much I know. If I really care about the patient, then whatever I do for that patient will be beneficial. The pain medicine needs to start there.

It’s everything. Evidence based medicine is ruining our profession. Algorithms can’t substitute for good old fashioned doctoring. Algorithms and flow charts are the tech piece, but as I said the doctor is the caring part of the equation. The tech is the sexy part and the easy part, but the caring part is the important part. Again, if I really care about the patient whatever I do for them will be beneficial to them. And that is always what a patient really wants to know; do I care about them? How much do I care about them? They don’t ask how many blocks I know, or what flow chart I’m using. They want to know if I have their best interests at heart.

By Eddie Hrslak

From its very inception in 1994, NYSORA (The New York School of Regional Anesthesia) has exhibited a marked resolve to use its acclaim and reputation in the domain of Regional Anesthesia and Perioperative care as a way to move beyond the ambit of medical, academic discourse and instruction and provide much-needed financial assistance to local communities beset by economic challenges. In point of fact, the School’s existence and operation have become inextricably bound with its enduring commitment to humanitarianism.

In a recent interview with Ms. Stacy Atkinson, NYSORA’s Manager, I inquired about the organization’s outreach to inner-city communities, i.e., NYC neighborhoods beleaguered by untoward economic circumstances. She pointed out, with sprightliness and unmistakable pride in her voice, that, in the past two years alone, NYSORA has greatly escalated the scope of its philanthropic involvement, primarily locally, but also globally.

When Harry S. Truman public high school in the Bronx stood in dire need of a new gymnasium-one to replace its rundown, dilapidated space littered with antiquated equipment-NYSORA summarily answered the call, ensuring that its donation go toward restoration of the facility and continuance of athletic programs.

Further, NYSORA has had a wide-ranging impact on a few local nursing homes. The lack of resources, shorthandedness, and a resultant substandard patient care are a common scourge at great too many nursing homes. The School’s ongoing funding to such institutions has proven to be a remarkable countervailing force, producing tangible, lasting results.

The Harlem All-Starz cheerleading squad is a competitive group of jaunty, wide-eyed 6-to 13-year old girls whose dogged persistence and devotion to cheerleading are reflected in their enviable success: Last April they got to compete in the U.S. Finals Cheerleading National Championship in Orlando. It is highly doubtful that any of this would be possible without NYSORA’s generous and continuous charitable aid.

Ms. Atkinson apprised me of the School’s recent expansion of humanitarian efforts; over and above the aid distributed locally, some overseas communities are anxiously awaiting materials and resources instrumental in providing greater medical care. Both Kenya and Indonesia are expected to receive 500 medical textbooks each by the end of February, 2011.

Allotment of monetary aid to domestic and global underserved communities is warp and woof of NYSORA, a clarion expression of its underlying commitment to humanity. The School’s acclaim and wide success in the field of medicine give it the wherewithal to help the communities toiling under economic strain.