Some observations about anesthesia in South America: the changing Peruvian context

Lema¹ alleged on page 38 of the chapter titled "International Scope, Practice, and Legal Aspects of Anesthesia," in Miller's Anesthesia (eighth edition) that in South America only Colombia and Chile have laws for regulating the expertise and care's standard in anesthesia. In addition, he mentioned that physicians, surgeons and paramedical personnel with a low level of anesthesia training have practiced it for many years in several countries of the region. He claimed that the situation persists in some countries, included Peru, even with government authorization. Nonetheless, current peruvian context is different, thus I wish to clarify his observations about the practice of anesthesia in Peru.

In the not-so-distant past, these situations before described, were common in Peru. However, since 2005 when the first anesthesia norm was approved by Peruvian Health Ministry, they had a decreasing trend because were not allowed anymore by law.² As a consequence, the number of physicians with an anesthesiology formal training as is required by norm, has increased for working in most of the operating rooms and related areas. Moreover, the peruvian residency programs last a minimum of three years (Anesthesiology) and a maximum of five (subspecialties in Cardiovascular and Obstetric Anesthesiology).

Currently, there are two government norms which describe all aspects and requirements (such as facilities, trained personnel, monitoring, medical equipment, drugs, perioperative assessment) for working with quality in the anesthesiology field.^2,3 These norms are mandatory for public and private hospitals with operating rooms and must be obeyed in the whole country. Furthermore, Peruvian Medical College has begun a certification process of medical knowledge requiring a number of credits obtained in medical education courses for all physicians (general practitioners and specialists) each five years.⁴

On same chapter, Dr. Maria Carmona mentioned a situation that happens in Brazil, but is common to Peru too. This situation refers to the fact that Brazilian and Peruvian Constitutions declare health as a right for every citizen and health care as government duty. Nevertheless, total expenditure on health is 8.4% of gross domestic product in Brazil y only 5.1% in Perú.⁵ As a consequence, the health care systems have heterogeneity in quality amongst different regions of both countries, in concordance with the economic development and inequality of these regions.

In conclusion, although there are many issues in the work of peruvian anesthesiologists yet, today the working environment is changing and the government is enforcing the law for aspiring to have better standards of patient's care in the whole country. Consequently, nowadays our patients receive safer anesthesia than previous decades.

References

• ¹
  Miller RD. International scope, practice, and legal aspects of anesthesia. In: Miller RD, Cohen NH, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL, editors. Miller's anesthesia. 8th ed. Canada: Elsevier Saunders; 2015.
• ²
  Ministerio de Salud del Perú. Sección de Normas Legales. "Norma Técnica de los Servicios de Anestesiología". Lima: Oficina General de Comunicaciones del Ministerio de Saludd el Perú; 2005. Retrieved from:http://www.minsa.gob.pe/ and ftp://ftp2.minsa.gob.pe/normaslegales/2005/RM486_2005_MINSA_ok.pdf [accessed 19.01.15].
  » http://www.minsa.gob.pe/» ftp://ftp2.minsa.gob.pe/normaslegales/2005/RM486_2005_MINSA_ok.pdf
• ³
  Ministerio de Salud del Perú. Sección de Normas Legales. "Norma Técnica de Salud para la Atención Anestesiológica". Lima: Oficina General de Comunicaciones del Ministerio de Saludd el Perú; 2005. Retrieved from: http://www.minsa.gob.pe/ and ftp://ftp2.minsa.gob.pe/normaslegales/2011/RM022-2011-MINSA(A).PDF [accessed 19.01.15].
  » http://www.minsa.gob.pe/» ftp://ftp2.minsa.gob.pe/normaslegales/2011/RM022-2011-MINSA(A).PDF
• ⁴
  Colegio Médico del Perú. Sistema de Certificación y Recertificación del Médico Cirujano y del Médico Especialista. "Reglamento del Sistema Nacional de Certificación y Recertificación del Médico Cirujano y Médico Especialista. Lima: Webmaster Colegio Médico del Perú; 2011. Retrieved from: http://www.cmp.org.pe/ and http://www.cmp.org.pe/sistcere/8880-CN-CMP-011%20Manual%20y%20Reglamento%20SISTCERE%202011.pdf [accessed 12.01.15].
  » http://www.cmp.org.pe/» http://www.cmp.org.pe/sistcere/8880-CN-CMP-011%20Manual%20y%20Reglamento%20SISTCERE%202011.pdf
• ⁵
  World Health Organization. Global Health Observatory Data Repository. "Peru Statistics Summary (2002-present)". Geneva: Global Health Observatory; 2012. Retrieved from: http://www.who.int/en/ and http://apps.who.int/gho/data/node.country.country-PER?lang=en [accessed 20.02.15].
  » http://www.who.int/en/» http://apps.who.int/gho/data/node.country.country-PER?lang=en

Publication Dates

• Publication in this collection
  Mar-Apr 2017