Global Health Diaries
Our work doesn’t stop at the walls of the medical center. Across the globe, members of Columbia Anesthesiology partner with colleagues to care for patients, teach, learn, and contribute to health systems in diverse and challenging settings.
Our brief dispatches offer perspective on global health in practice.
Sierra Leone...Dr. Anjan Saha
Neonate with tetanus in a hospital on a remote island off of the coast of Sierra Leone. Baby rigid, periodic relaxation from spasms, only on nasal cannula. No amnestic agents, muscle relaxants, laryngoscopes, ETTs, ventilators, BVMs, or antitoxin available. The hospital is 40 mins from mainland, and 6 hours total transit time at minimum from nearest hospital with its last vial of antitoxin. Baby still gets antitoxin, and supplying hospital has its stock replenished. How? Talk to a global anesthesiologist near you.
Building Sustainable Cleft Care in Guyana...Dr. Richard Raker
In 2018, I traveled with representatives from Smile Train a leading global charity supporting comprehensive cleft care to Georgetown, Guyana, where we assessed whether the Georgetown Public Hospital Corporation (GPHC) was ready to move beyond visiting surgical missions and develop a sustainable, locally led cleft program. From the outset, our goal was not to provide episodic care, but to help build durable systems that would remain long after we left.
We began with a comprehensive safety and infrastructure review aligned with international surgical and anesthesia standards. We met with hospital leadership, the Ministry of Health, surgeons, anesthesiologists, pediatricians, and nurses and local business leaders to understand their strengths, challenges, and vision. It was clear that the clinical talent and institutional, governmental and local commitments were already present; what was needed was structured mentorship, standardized systems, and ongoing quality oversight.
My primary role focused on anesthesia systems strengthening. During mentoring visits, I worked side-by-side with the Guyanese anesthesia team to enhance pediatric airway management, refine intraoperative monitoring, strengthen postoperative recovery protocols, and reinforce safety checklists. The emphasis was always on partnership and skills transfer, not substitution.
We also helped implement structured intake pathways and digital patient tracking through the Smile Train Express (STX) platform to ensure continuity and long-term follow-up. Case review and complication monitoring were embedded early to support continuous improvement.
By 2023, cleft surgeries were being performed independently by the local team. Between 2019 and 2025, 113 patients underwent surgery for 161 cleft-related conditions, delivered under standardized safety protocols and supported by multidisciplinary follow-up. Overtime, speech therapy, nutritional support, orthodontia and dental care will be added.
For me, this experience reaffirmed that sustainable global surgery is not about short-term missions—it is about trust, training, safety alignment, and building systems that empower local clinicians to lead.
Lessons in Anesthesia Education: Reflections from Vietnam...Dr. Jordan Francke
In January 2024, I had the honor of being one of five nationally recognized residents to receive the Society for Education in Anesthesia’s “Health Volunteers Overseas Traveling Fellowship.” This opportunity supported a four-week medical education rotation at Huế University of Medicine and Pharmacy (HUMP) in Huế, Vietnam.
As I prepared for the trip, I was faced with a mixture of excitement but also apprehension about teaching in this resource-limited setting: I feared I was not adequately prepared to teach complex topics to my peers abroad, or that incorrect assumptions about what medications, equipment, and resources they might have could potentially offend them. Upon arrival, any concerns I had quickly melted away. I was warmly welcomed by 24 anesthesiology residents whose clinical practices, medications, and monitoring standards in many ways mirrored those of my home institution. Twice weekly, I delivered lectures (often on obstetric anesthesia and systems of perioperative care in the U.S.) while HUMP faculty interpreted. The cross-cultural cooperation transformed sessions into dynamic, case-based, and highly interactive assemblies that underscored the truly bi-directional nature of this exchange.
Despite meaningful differences in the availability of resources like medical air and infusion pumps, what struck me most was HUMP’s remarkable strength in regional anesthesia. With only a single ultrasound machine, residents routinely performed a wide range of single-shot nerve blocks and spinal anesthetics for awake patients. Their level of technical versatility in many ways exceeded my own residency experience in the United States. Outside the lecture hall and operating rooms, I was deeply influenced by the team’s humility, ingenuity, and disciplined stewardship of medications and supplies, particularly in the context of drug shortages and limited equipment. I returned home with a renewed appreciation for the technologies I take for granted, a commitment to more judicious resource use, and a desire to build future partnerships so HUMP residents can visit my institution and experience our approach to anesthetic care firsthand.