Essay 01 – Safe Anaesthesia: Right of Every Mother and Child

Dr. Priya Sadawarte

MD DNB
Consultant Anaesthesiologist, Nagpur

Meena lies on the operating table, heart pounding, eyes searching for reassurance. Her baby is minutes from being born—by scalpel. In that sterile room filled with machines and masked faces, there is one person whose presence stands between fear and comfort, between risk and safety: her anaesthesiologist: the unseen guardian of operating room!

Childbirth is often portrayed as a moment of beauty—but for millions of women and newborns in India, it is a moment shadowed by danger. Obstetricians and neonatologists often take the spotlight during every caesarean section, high-risk labour, and neonatal surgery. But anaesthesiologists also play an equally important role in not just making it possible—but safe. In many parts of our country, this safety is not guaranteed. Many a times, it is compromised or even absent!

India has made commendable strides in reducing maternal and child mortality. But behind the national averages lie stark inequality. Rural areas, remote districts and states with weaker infrastructure often lag behind. Unsafe or absent anaesthesia is a silent contributor to this tragic statistics.

The World Health Organization has identified universal access to safe anaesthesia as a cornerstone of essential healthcare. Safe anaesthesia includes skilled professionals, functioning equipment, reliable oxygen, and essential medications.

In many community health centres, surgeries are delayed or denied because no trained anaesthesiologist is available. Many district hospitals lack essential monitoring equipment and reliable supply of anaesthetic drugs. For mothers and newborns, this access can mean the difference between life and death.

India currently has about 1.27 anaesthetists per 100,000 people, against the WFSA recommendation of at least 5! In rural districts, this shortage is more acute. As anaesthesiologists, our work is not only in the operating room, we can be pivotal change agents, driving policy, training and advocacy.

We can train non-physician anaesthesia providers by developing certified training programs for nurse-anaesthetists or paramedics, supervised by qualified anaesthesiologists. We can have short-term skill enhancement courses for MBBS doctors or medical officers in rural areas to manage basic anaesthesia for low-risk procedures. Telemedicine systems can be set up allowing remote supervision by qualified anaesthesiologists. Real-time video communication for pre-op assessment, intra-op guidance, and post-op care can be used. Government hospitals or professional bodies (e.g. ISA) can offer CME sessions, workshops, and hands-on training in district/rural hospitals. Rural Anaesthesia Champion Program can be started by selecting anaesthesiologists from each district to act as nodal mentors and troubleshooters for 5–10 rural centers. Organizing rotational postings of anaesthesiologists from district hospitals or medical colleges to rural PHCs/CHCs and deploying mobile surgical units with anaesthesiology staff for elective procedures in underserved areas can help. Postings in rural government hospitals can be incentivized by providing financial bonuses and housing support.

Low-cost, portable standardized anaesthesia kits tailored to rural settings can be developed and distributed. It may contain oxygen concentrator instead of oxygen cylinders, pulse oximeter, BP monitor, portable suction, manual ventilation systems (e.g., Ambu bags) where electric power is not reliable, spinal anaesthesia kits etc. Partnering with NGOs or medical device manufacturers for donation or subsidy can make equipment available. Maintenance program with local biomedical engineers or tele-assistance from district-level centers can keep the equipment functioning. We can work with local health authorities to ensure that ‘essential anaesthesia drugs’ are included in state procurement lists.

We can take up leadership role to make resources available. Let us be the reason mothers return home smiling, and children thrive safely. Instead of remaining the silent force in the background, we need to raise our voices for safer systems in every corner of India. Because safe anaesthesia is not a luxury, it is a human right!