Covering an SMO as a voluntary locum in the Pacific was not the usual thing that MPS expected to cover. Members of the NZSA’s Global Health Committee have had many discussions with them explaining exactly what your role will be. The following information shares some key details from these discussions.
In 2022, after a review of their policy, they confirmed that:
Members will still be able to request humanitarian indemnity if they are not travelling with a specific organisation, provided they will not receive any employer or state indemnity for their voluntary work.
There was some concern that we could be involved with the care of tourists. However, after describing the environment we will work in, providing emergency and elective care to anyone who presents to the hospital, their decision was:
Treatment of people who are not from that country (e.g. tourists) who are involved in an accident or similar unplanned situation would be acceptable. Treatment of anyone who has travelled to that country specifically for treatment would not be included.
For those practising in Suva, there may be non-Fijians who are admitted for treatment as part of planned care. Often these are from Kiribati or one of the other Micronesia states. It has been very difficult to explain this to MPS, and I suggest that when these patients present, we ‘assist’ a local Anaesthetist with their care rather than be the lead SMO.
Pregnant patients are one of the key exclusions on the policy. However, the underwriting team at MPS made a decision which allows us to look after the anaesthetic care of the pregnant patient, as this is not directly related to the routine care of the pregnancy itself. This is based on the following scenarios:
General Anaesthesia duties
- Preoperative assessment of acute and elective patients
- Anaesthesia for acute and elective cases presenting at secondary and tertiary facilities within the Pacific
- Assisting visiting teams where needed to optimise care but primary role is to routine care of local populations
- Teaching and supervising junior staff working within these roles
- Post-operative care within HDU/ICU environments
Obstetric Anaesthesia
- Pre-operative assessment of acute (common) and elective (uncommon) obstetric cases
- Provide advice and support for pre-operative management of Obstetric emergencies such as Pre-eclampsia
- Provide General or Regional Anaesthesia for acute/elective Caesarean section
- Provide regional anaesthesia/sedation for assisted delivery
- Teaching and supporting junior anaesthetists in this field
Other
- Support High-dependency / Intensive Care units where needed
- Provide support to hospital trauma teams and cardiac arrest teams (all within the hospital)
The precise statement from the underwriting team was:
Anaesthetist providing anaesthesia to pregnant patients
This would be allowed [on humanitarian membership] as this isn’t associated with the management of a pregnancy. The anaesthetist should only be providing anaesthesia to the patient, which is within their scope and area of expertise.
This should be viewed the same as an anaesthetist providing anaesthesia to a patient who needs surgery for a broken leg; they aren’t performing surgery on the leg, they are providing anaesthesia to the patient to ensure the surgery can performed by a Trauma surgeon.
In this scenario, the anaesthetist’s role is not associated with the management of a pregnancy, as an Obstetrician / Gynaecologist would be managing the pregnancy.
