GG: Dr Barreiro, thank you very much for agreeing to take part in this initiative, related to the 70th anniversary of WFSA. I am glad to have the opportunity to discuss with you some of the main aspects of your activities in our world federation.

Since many people would like to learn more about your personality and professional start: When and where did you start your medical education?

GB: I studied medicine and also started my first years in anaesthesia in Uruguay.

GG: What was the reason for choosing anaesthesia as your future specialty?

GB: From the very beginning I loved the operating room, the medical issues concerning the pre, intra and postoperative period and resuscitation.  Very early I understood that the anaesthesiologist is in fact a perioperativist.  In brief: I loved being in the trenches!

GG: Who were the people who illuminated and directed your professional career?

GB: I was fortunate to work with mentors and teachers who helped me to become what I am today, among them Gaston Turcatti, Estela Fossemale, Homeo Peri and Martin Marx.

GG: May ask you to try to compare our specialty, as it looks today, to the time you started practicing anaesthesia?

GB: I do not forget the start. A quick look into the everyday activity in the operating room will show you the amazing progress in monitoring, training, and you will notice the whole scope expanding every day.

GG: I can imagine that you had many stations in your professional life. Could you be so kind and mention some of them?

GB: I am an Associate Professor of Anaesthesiology at the Universidad de la República and taught anesthesiology at a postgraduate level for more than 20 years. I also had the Intensive Care specialist degree, as anaesthesiology and intensive care are different specialties in Uruguay.

GG: What were the biggest challenges in your career as an anaesthesiologist?

GB: One of them was the organization of the National Burn Center, the first one in Uruguay. Besides this, for almost 28 years I worked within WFSA in different positions, ending as its President from 2016 to 2018.

GG: So, you are yourself a teacher and a mentor. Can you give us some details on this ?

GB: I will mention some few facts, all related to the technological advancements of our specialty. When I began my work in the OR in 1979, we had no pulse oximeters and few tackmeters or capnographs were available (not just in Uruguay). Once these started to arrive, I had to learn and teach how they work, how important they are for the safety of the surgical patient, not only in the OR, but also in the recovery room. The same for new machines, fiberscopes etc. In brief: I saw anaesthesiology changing from being just clinical to being a combination of clinical and technological/scientific. It was a unique situation, a real revolution in the way we have been able to maintain the patient’s homeostasis.

GG: As far as I understand, you had the opportunity to observe from inside WFSA during all those years when you fulfilled various leading positions in the organization. What do you think are WFSA’s main achievements?

GB: One cannot forget, even for a moment, the fact that WFSA is not a rich organization and its funds are limited. If you take that into consideration, the conclusion must be that WFSA’s achievements are amazing, in every single direction: Training, organisation, etc.

GG: Do you think that WFSA activities are influenced by cultural and resource differences, between one country and another?

GB: In my opinion the differences you are mentioning have one single explanation: the resources our profession can access in each country. Nowadays the so-called cultural gap is less important.

GG: Could you be so kind and mention some of the key moments in the evolution of WFSA?

GB: The creation of this organisation, one of the first such professional bodies in the world, was a crucial moment for the development of our profession and for the image of the anaesthesiologists in the eyes of their colleagues. Besides, I consider WFSA’s activities during David Wilkinson’s time as President, as one of the most prolific periods in its history.

GG: Undoubtedly WFSA’s activities have been very important for our profession. But what about its members? Is WFSA important for each of its Societies?

GB: Indeed. First, it gives everybody the feeling of not being alone on this planet. But no less important is the input and assistance offered by more affluent Societies to those which need support and help.

GG: Did you have any engagement with your own Society?

GB: Yes, I was a member of the Safety Committee between the years 1992-2000, thanks to the recommendation of Professor Martin Marx.

GG: And in WFSA?

GB: I was a Regional Representative from 2000 to 2008, Deputy Secretary from 2008 to 2012, Secretary from 2012 to 2016, President from 2016 to 2018, and Immediate Past President from 2018 to 2020. I am very proud of creating the Gender Committee, currently the DEI Committee.

GG: Dr Barreiro, we are approaching the end of this interview. The time has come to ask you to try and have a look into the future of our world federation. How do you see it?

GB: I think that the main targets of WFSA in the next 25 years include the encouragement of the principle of the anaesthesiologist as a perioperativist, and also enlarging the anaesthesiologist’s input in the domain of pain medicine.

GG: What should be kept?

GB: One country, one national society. Trying to get space for the representation and development of new ideas from everyone. We need every anaesthesiologist in the world to feel represented by he WFSA in order to avoid duplication of efforts. I find this particularly important for those who end their activity in WFSA. In some cases, I saw those people creating their own ‘international’ anaesthetic organizations and of course competing for funding. This is a challenge I tried to solve with an advisory group but it didn´t work (unfortunately).

GG: And what should be changed?

GB: Our task is to convince National Societies that, in spite of any downsides they see with WFSA, it’s better to work inside WFSA than trying to get things alone. Besides, I think that we need a group to study and assess how WFSA can – in the very near future – deal with AI’s impact on all the aspects of our professional life.

GG: Thanks a lot for your answers. I wish you all the best.

GG: Hello, Professor Cheng. Many thanks for accepting our invitation to take part in this on the occasion of the 70th anniversary of WFSA.

I would like to propose that you start with some details regarding your early medical career. Where and when did this start?

DC: In 1977 I graduated (Cum Laude) from the Faculty of Biochemistry at the University of Ottawa, Canada; then I obtained my MD at the University of Toronto in 1983. My career in anaesthesia started the same year, as a resident at the University of Toronto. I then went on to be a research fellow at the same university, and at Toronto Western Hospital, under the supervision of Dr F. Chung. In 1989 I got the position of research fellow at the University of Iowa Hospitals and Clinics, in the Department of Anaesthesia, where I focused on cardiovascular anaesthesia under the supervision of Dr J. Tinker.

GG: Why did you choose anaesthesiology as your specialty?

DC: I was attracted by its various domains of activity, such as acute care and critical care, as well as its technological aspects.

GG: Who are the mentors who inspired your career?

DC: Professor Frances Chung (Toronto), Professor John Tinker (Iowa), Professor Earl Wynand (Ottawa) and Professor Tirone David (Toronto).

GG: Oh, I know Professor David, one of the best cardiac surgeons in the world. By the way, I was operated on by him in 2006.

DC: You’ve been lucky.

GG: Looking back to when you started your career as an anaesthesiologist, how has the specialty changed over the years?

DC: I used to say to my younger fellows: Think beyond the mask!

Our specialty has made enormous progress during all these years. I am thinking of perioperative medicine, of perioperative safety, about the impact principles of evidence-based and value-based practice have had on our daily activity. As well as bedside research, health technology assessments, and not to mention the place of AI in our specialty.

GG: How do you define your own achievements as an anaesthesiologist?

DC: Let me enumerate them:

In the 1990s I pioneered research in fast-track cardiac anaesthesia and surgery which revolutionized conventional practices. I also established a Fast Track Cardiac Anaesthesia & Surgery Pathway: Early Tracheal Extubation, Process of Care and Cost Containment – Setting the Current Standard of Care in Cardiac Surgery Recovery. The postop process of care led to the later development of Enhanced Recovery After Surgery (ERAS).

I also established the MEDICI Centre (Medical Evidence, Decision Integrity, Clinical Impact) in Canada which released several pivotal publications and consensus guidelines to direct evidence-based medical and cardiac surgical practices.

I received cross disciplinary recognition when Co-Chairing the Steering Committee and Expert Consensus Panel for the International Society for Minimally Invasive Cardiac Surgery (ISMICS), the European Association of Cardiothoracic Society (EACTS), as well as at the World Health Organization (WHO) in clinical practice guideline development.

In 2007 I was elected a Fellow of the Canadian Academy of Health Sciences, one of the highest honours for individuals in the Canadian health sciences community and the first anaesthesiologist to have this privilege.

I have been recognised by the anaesthesiology profession nationally and internationally in leadership roles or as a Fellow (e.g. WFSA, IARS, SCA, CSCVTA, CAS, DGAI, HKCA); by Cross disciplinary Profession (e.g. inducted as the Centennial President (2018-19) of the (William) Harvey Medicine Club (the oldest medicine club established in 1919 in Canada);

In 2019, I received the inaugural Distinguished Service Award from the Society of Perioperative Research and Care (this recognizes an individual who has made outstanding contributions to perioperative medicine on a local, national and international scale over an extended time; also have mentored individuals building careers in perioperative care and made a substantial impact on research and education).

In 2019 I was inducted to be Fanshawe College Honorary Diploma (bestowed by the College to recognize an individual’s unique and outstanding impact – anesthesia care team at local, provincial, national and global levels).

GG: And what about the biggest challenges in your career?

DC: I always considered that the work to update perioperative and healthcare system is a very important one. Besides, being accountable to peers and colleagues preoccupied me very much, as did securing the appropriate allocation of resources from hospitals, universities and government.

I am still a mentor and sponsor to medical trainees, many of whom became leaders in medical education, clinical researchers, and healthcare leaders. I also teach undergraduate students, anaesthesia fellows, and have lectured in over 190 cardiac centers, universities and congresses.

GG: You have been involved in many WFSA projects, and we will touch on this subject later on. For now, please enumerate some of the federation’s main achievements.

DC: Gladly. Here they are:

• Safe anaesthesia initiatives, especially in low and middle-income countries (LMIC); such as the WFSA Fellowship Programme, delivery of training workshops (obstetrics, paediatrics, and many more) through courses such as SAFE
• Practice Guidelines and Standards, e.g. work on pulse oximetry guidelines with WHO, setting up Lifebox, wider WHO publications and advocacy around safe anaesthesiology, COVID perioperative guidelines.
• Research and publications promoting global anaesthesiology, e.g. A&A publications.
• Collaboration and Partnership, such as with WHO, Regional Societies, IARS and many others.

GG: Do you think that WFSA activities are influenced by cultural and resource differences?

DC: Yes, indeed.  In some countries we are facing resource limitations. The problem is balancing global standards and local realities. Besides, we see differences regarding the practical topic of the anaesthesiologist versus Anaesthesia Care Team, the way this is practiced in various parts of the world.  And as I already mentioned, there are still problems in LMICs regarding sustainability and unmatched surgery demands.

GG: What are, in your opinion, the key moments of decisions in WFSA’s history?

DC: WFSA’s evolution from a professional society to being a global health leader. Each milestone addressed emerging challenges while staying true to its vision: Safe anaesthesia for all.

But also:

Vision 2030 Strategy (2023): Launched a longer-term plan to eliminate preventable anaesthesia deaths; focus on Workforce training, advocacy, and digital innovation; and a roadmap for closing the global anaesthesia gap.

GG: The next question is connected to the previous one: What value does WFSA bring to its members?

DC: Many, but I will try to give a short answer. Here they are:

*Uniting, educating and empowering anaesthesiologists globally, especially in LMICs; 150+ countries through WCA, Committees, and regional collaborations.

*Fostering collaboration, advancing education, advocating for the profession, and improving patient care worldwide.

*Advocacy and networking: Global influence at WHO, UN, national anaesthesiology societies.

*Education/Training: SAFE, WFSA Fellowship, e-Learning Platform

*Research support and Practice guidelines

*Bridging Resource gaps and humanitarian aid.

*Career and leadership development.

*Crisis response (pandemic, conflict zones)

GG: From your answers up to now, one can understand that you took on some important positions in the WFSA. Did you start with your National Society?

DC: Yes, with the Canadian Anesthesiologists’ Society. Between 2012-2016 I was a member of its Scientific Affairs Committee, but I was also Chair of the Circulation Scientific Subcommittee at the 16th WCA in Hong Kong, China. My personal contribution to cardiac anaesthesiology and the academic mandates in the Scientific Affairs Committee led me to see a position at WFSA.

GG: Thanks for bringing our interview to that topic. So, what position(s) did you serve in WFSA?

DC: Here they are:

2024: Member, Ambassador Group.

2020-24: Treasurer, WFSA Board.

2022-24: Co-Chair, Cardiac Scientific Programme Track, 18th WCA in Singapore.

2017-21: Scientific Programme Planning Committee, 17th WCA in Prague.

2016-20: Chair, Scientific Affairs Committee.

2016-20: Council Member.

2012-16: North American Representative (Elected), Scientific Affairs Committee, WFSA.

GG: So, what is the most important achievement of contribution at WFSA that you are most proud of?

DC: Serving on the Board and Council, working with a talented team from diverse specialty backgrounds to shape and evolve the development of WFSA in its vision and mandates.

GG: Professor Cheng, we are close to the end of this very interesting and important discussion. My next question is: How do you see WFSA in the next – let’s say – 25 years?

DC: My answer is short. WFSA is obliged to look ahead and strive to be THE global authority for ALL anaesthesia, in all the countries of the world. It must fight to close the global gaps in our specialty, to lead sustainable green anaesthesia practices. I also mentioned AI: It is absolutely necessary for WFSA to embrace digital health and AI in eHealth and mHealth. Our federation is obliged to plan for the future the global anaesthesia workforce, for the benefit of all.

• Commitment to Equity: eliminate preventable anaesthesia deaths worldwide, especially in low-resource regions.
• Free/low-cost access to anaesthesia education and training programmes, such as SAFE, Fellowships and e-learning.
• Global standard of anaesthesia practice guidelines, e.g. International Standards for Safe Anaesthesia Practice

GG: And what should be changed?

 DC: Here are my recommendations:

• Reimagine anaesthesia workforce training, AI mentorship and certification across countries.
• Decentralized care delivery utilizing AI healthcare and mHealth, e.g. tele-anaesthesia hubs.
• Become a serious player in Climate-Resilient green anaesthesia.

GG: Thanks a lot, Professor Cheng, for your very important answers.

 DC: Pleasure to meet you.

 

GG: Good morning, Professor Cote. I got your name from the team organising the celebrations for the 70th anniversary of the World Federation of the Societies of Anesthesiologists. I am very glad to have the opportunity to discuss with you some of the points which mark the evolution and activities of this very important world federation. 

CC: I am glad, too. 

GG: Let’s start with some data regarding your early medical career. 

CC: I graduated from the Albany Medical School, NY, in 1972. In 1973 I started my residency in paediatrics and in 1974 I became a resident in anaesthesia at the hospital of the University of Pennsylvania, Philadelphia. Then I had a fellowship in paediatric anaesthesia and paediatric critical care at Children’s Hospital in the same city. 

During the years 1979-1980 I held the position of instructor in Anaesthesia at Harvard Medical School in Boston, where a became an Associate Professor in 1986. My careeer continued at Northwestern Universty Medical School in Chicago where I was appointed as Professor of Anaesthesiology  in 1993, and one year later I became Professor of Paediatrics in the same University. 

In 2007 I was appointed Professor of Anaesthesia at Harvard Medical School, where I became Professor Emeritus in 2017. 

GG: A very impressive and successful career, congratulations! 

CC: Thanks. 

GG:  I think  our readers would be interested to know how you selected anaesthesiology as your future specialty? 

CC: I initially chose paediatrics, but then discovered that I liked critical care so I subsequently changed residency and trained in anaesthesiology and paediatric critical care.  I am board certified in Paediatrics, Anaesthesiology, and Paediatric Anaesthesiology. 

GG: Undoubtedly you benefited from help and encouragement from mentors or seniors during your first steps as an anaesthesiologist? 

CC: You are right. Here are some of them: Brian Marshal at the Hospital of the University of Pennsylvania,  John J Downes at Children’s Hospital of Philadelphia, Richard Kitz at Massachusetts General Hospital, Boston, and I. David Todres at Massachusetts General Hospital, Boston. 

GG: Your first contact with anaesthesia as your future profession took place more than 50 years ago. Looking into the past, how does anaesthesiology as a specialty today compare to when you started out? 

CC: When I began my training we only had a precordial stethoscope, a blood pressure cuff, our eyes and ears, and not every patient had an EKG. Obviously, the most amazing change and improvement in safety is the routine application of non-invasive blood pressure, pulse oximetry and capnography.  Also the development of guidelines that codify equipment, staffing, training, and treatment protocols. Continuous non-invasive cardiac output will be the new norm as well as monitoring the EEG for depth of anaesthesia. 

GG: It is amazing to find out that tens of thousands of miles far away from your practice, I have exactly the same memory about my first days as a resident, ten years earlier!  

And what about your own achievements as an anaesthesiologist? 

CC: I have been very blessed over my life, with the help of many, to have been able to have major long term impact on our specialty.  I performed a convenience sample study of capnography in the paediatric ORs and documented the value in diagnosing a variety of airway events such as kinked ETTs, endobrochial intubation, disconnects, and even two case of malignant hyperthermia. 

I also conducted two randomized blinded studies of pulse oximetry before it was a standard of care and we found twice as many ‘events’ (saturation ≤85% for 30 sec or longer) when the oximeter data were blinded from the anaesthesia providers.  We also demonstrated that we are quite lousy at diagnosing cyanosis: in half the cases where the saturation was ≤72% the anaesthesia team stated that the patient was not cyanotic! Conversely when the saturation was 85%, half the time they said that the patient was cyanotic when clearly this was not possible. These two studies were also used to support in part the development of monitoring guidelines. 

I had the opportunity to study massive blood transfusions in paediatric patients at the Shriners Burns Institute in Boston. I published one paper clarifying that the fall in platelet counts in children follow the same kinetics as adults found by Ron Miller in Vietnam, i.e., they loose ~40% of baseline after 1 BV loss, another 20% with the second blood volume and then 10% with the third blood volume loss – so ~70% of baseline decrease.  So if you start with a high count, even after 4-5 blood volumes shed, there may be no need to transfuse platelets since the counts remain >100,000/mm3 but if one starts with a low count (~100,000/mm3) then clinical bleeding is associated with counts <50,000/mm3 and this may occur after losing one blood volume. I also examined citrate toxicity with FFP transfusions and found that clinically important reductions in ionized calcium occur when the rate of administration is > 1mL/kg/min.  I also clarified that the citrate is rapidly metabolized in the liver such that ionized calcium starts to return towards normal after the transfusion stops (if there is adequate liver blood flow).  Thus one needs to give calcium during, not after, rapid FFP transfusions.  I further studied the interaction between halothane anaesthesia and citrate toxicity demonstrating that with a deper plane of anaesthesia there was reduced citrate metabolism and greater cardiac depression, i.e., the calcium channel blocking activity of inhation agents is more than additive to cardiac depression from hypocalcemia. Inhalation agent anaesthesia + rapid FFP transfusion = cardiac arrest in infants and toddlers. 

In the early 1980’s there were several paediatric patients who died while undergoing dental procedures in private offices due to sedation mishaps.  I was the co-author of the very first sedation guideline for the American Academy of Pediatrics (1985) and since then the primary editor of six additional sedation guideline updates.  These guidelines have been implemented both nationally and internationally.   

I have also had the good fortune to be the primary editor of A Practice of Anesthesia for Infants and Children, now in its 7th edition.  This is a huge project involving over 100 contributing authors from five continents.  This 1100 page textbook is used as a reference source by the American Board of Anesthesiology.  I also have assisted with editing handbooks in paediatric anaeshesia from both India and South Africa. 

GG: Once again, a very impressive list. And now the next question: What have been the biggest challenges in your career as anaesthesiologist? 

CC: Obtaining funding for research and having adequate non-clinical time to conduct the research.  This is an even more difficult problem for the current generation. 

GG: You are right. The so called ‘production pressure’ leaves almost no time for research, and this is a problem for all medical domains, including our specialty. Professor Cote, I would like to ask you to share some details about your activity as a teacher and mentor. 

CC: I have had the good fortune to mentor a number of fellows and many dozens, if not hundreds, of residents in anaesthesiology over my 40+ years in academic medicine; I have also been a mentor to many junior faculty. I have been rewarded by the fact that many have become department chairs and/or leaders in academic anaesthesiology. 

GG: The time has come to discuss the various activities of WFSA. I am sure that you have many impressions of its main achievements over the years? 

CC: Indeed. I think that the amazing growth in educational materials, individual focused teaching modules and courses is the most important achievement.  Coincident with this is the many fellowships now available worldwide (see further). 

GG: I can imagine that you have had contacts with colleagues and peers from many countries. Do you think that WFSA’s activities are influenced by cultural and resource differences? 

CC: It has always impressed me that, regardless of the country or their culture, we all face the same problems in providing anaesthesia care but in some, these challenges are enormous due to equipment, drug, and personnel shortages.  WFSA is actively improving anaesthesia care through projects such as Lifebox which is distributing pulse oximeters and capnographs to operating rooms in medically less fortunate countries and educating providers in how to use and interpret the data provided. This has and continues to make a huge difference. 

GG: And what about the key moments in WFSA’s history? 

CC: For me it was when Kester Brown was WFSA President and determined that paediatric fellowship training programmes were needed.  I was at a CLASA meeting in Santiago, Chile (1997) and with Kester Brown, Haydn Perndt (Tasmania) and David Hatch (London) visited the Luis Calvo Mackenna Children’s hosital and met with Sylvana Calvieri.  Sylvana was totally receptive to the idea of WFSA-sponsored felowships. This was the birth of the WFSA paediatric anaesthesia fellowship programme.  The plan was to take fully trained anaesthesiologists from less medically advantaged countries in Central and South America, who spoke the same language, and were approved by their country’s anaesthesia societies, and then train them as paediatric anaesthesia subspecialists for 6-12 months.  They would then return home to become the local specialist who could also teach others – spread the knowledge. Over the years Sylvana travelled throughout Central and South America to personally interview potential candidates and her dedication has resulted in many dozens of paediatric anaesthesia trainees educated by the combined WFSA/Calvo Mackenna agreement.  

The next step in the fellowship development occurred at the 2nd All Africa Anaesthesia Congress when our paediatric anaesthesia committee discussed the need to expand the fellowships.  We had a commitment from the Red Cross Children’s Hospital in Cape Town but needed additonal funding.  I approached the largest commercial sponser (Draeger International) and met with their lead representative (Mr. Koen Paradis).  He loved the idea of the fellowship in Santiago and suggested sponsoring a programme in both Saharan and sub-Saharan Africa. They sponsored Cape Town and Tunis, Tunesia to include a francophone region.. So this resulted in two new programmes.   

The Cape Town programme was particularly notable since Adrian Bosenberg took Zipporah Gathuya from Kenya under his wing and she performed over 1000 regional anaesthesia blocks in paediatric patients during her fellowship.  She then returned to Nairobi and for the first time a baby with tracheoesophageal fistula survived! Kenya is now the nidus of a fantastic paediatric fellowship programme (more to follow).  

In 2004, at the WCA in Paris, the paediatric anaesthesia committee discussed further expanding the  fellowship programmes and Dr Rebecca Jacob stepped up to begin a programme at the Christian Medical College in Vellore, India as the fourth pediatric fellowship location.  Since that time other programmes have started in Singapore, Belgrade, Lagos, Mexico City, Marrakech, and the now fantastic programme in Nairobi, Kenya.  

With the support of WFSA along with the Society for Pediatric Anesthesia and a large grant from ELMA Foundation, the Pediatric Anesthesia Training in Africa (PATA) programme, under the direction of Mark Newton and Faye Evans, is now educating fellows from Uganda, Ghana, Zambia, Nigeria and West Africa.   

In summary, this entire series of WFSA-sponsored events led to the development of a very sophisticated educational programme designed to improve paediatric anaesthesia care throughout West Africa.  

I feel quite blessed to have played a small part in this and to have been a partner with WFSA to help begin this wonderful journey that has now trained well over 125 paediatric anaesthesia specialists. At great sacrifice, they gave up their adult anaesthesia practice, left their families behind and trained to be specialists before returning to their country of origin, just as the original goal set in the late 1990s by WFSA and Kester Brown’s vision intended.   

GG: This is a wonderful example of the crucial place of pediatric anaesthesia subspecialists in  every single anaesthesia department.  

Professor Cote, the last questions are about your personal involvement in WFSA activities. What is – in your opinion – the value this organisation brings to its members, both Societies and individuals? 

CC: Clearly the value of this organisation extends from the teaching opportunities around the world, to the composition of educational materials, and hands on care. 

GG: Speaking about your involvement in WFSA activities, did you start out in your own Society? 

CC: Yes. Here are some of the details of my US engagement (not an exhaustive list!):  

• Member, Ad Hoc Committee to Establish Guidelines for Conscious Sedation in Dental Practice and Outpatients, American Academy of Pediatrics, Food and Drug Administration 

• Vice-Chairman and Treasurer, Section on Anesthesiology, American Academy of Pediatrics 

• Chairman, Committee on Drugs, Section on Anesthesiology, American Academy of Pediatrics ad hoc 

• Chairman, Section on Anesthesiology, American Academy of Pediatrics 

• Lead Author, Revision of Guidelines for Conscious Sedation, American Academy of Pediatrics 

• Member, Subcommittee on Pediatric Resuscitation, American Heart Association  

• Member, Subcommittee on Pediatric Anesthesia, American Society of Anesthesiologists 

• Member, American Heart Association, Emergency Cardiac Care Committee, Subcommittee on Pediatric Resuscitation 

• Representative for North America to Committee on Pediatric Anesthesia, World Federation of Societies of Anesthesiologists 

• Member, Task Force on Sedation by non-Anesthesiologists, American Society of Anesthesiologists 

• Member, Committee on Pediatric Anesthesia (Annual Meeting), American Society of Anesthesiologist 

• Member, Anesthesia Patient Safety Committee, American Society of Anesthesiologists 

• Member, Task Force on Sedation by Non-anesthesiologists, American Society of Anesthesiologists 

• Member, Committee on Patient Safety and Risk Management, American Society of Anesthesiologists 

• Member, Committee on Overseas Anesthesia Teaching Programs, American Society of Anesthesiologists 

• Member, Committee on Government Affairs, Society for Pediatric Anesthesia 

• Member, Task Force on Perioperative Management of Patients with Obstructive Sleep Apnea, American Society of Anesthesiologists 

• Committee member, American Society of Anesthesiologists Committee on Global Humanitarian Outreach 

• American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Obstructive Sleep Apnea 

• American Society of Anesthesiologists Committee on Standards and Practice Parameters 

• American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia 

GG: Once again, a very impressive list! After such fruitful activity in the framework of your own Society, what led you to seek a position with WFSA? 

CC: A colleague of mine at the Massachusetts General Hospital, Nishon Goudsouzian, was a member of the WFSA Paediatric Anaesthesia Committee and he suggested that I join. It turned out to be one of the most rewarding pieces of advice I ever received because it provided me an international opportunity for education. I got to know and become friends with so many international leaders in our specialty. I may have never achieved so many goals otherwise.  It has been a wonderful journey. 

GG: What positions did you hold at WFSA? 

CC: Once again a list! 

1996-2000 Chair, Paediatric Anaesthesia Committee 

2000-2008 Member, Executive Committee 

2004-2008 Liaison from the Executive Committee to the Paediatric Anaesthesia Committee 

2008 Vice-Chairman, World Federation of Societies of Anesthesiologists

2008 Co-opted member Paediatric Anaesthesia Committee 

2008 Co-opted member Patient Safety Committee

2008-2012 Member, Foundation Committee

2008 -2010 Global Pulse Oximetry Project, First International Consultation Meeting WHO Headquarters, Geneva, Switzerland 

2008-2012 Credentialing Committee

GG: My next question is connected to the previous one. What is the achievement or contribution at WFSA you are most proud of? 

CC: The initiation and evolution of the paediatric anaesthesia fellowships throughout the world.  Currently I provide copies of my textbook to all paediatric anaesthesia fellows when their programme directors request them. 

GG: Dr. Cote, as you are approaching the end of the interview, let’s have a look into WFSA’s future. How do you see it in the next –let’s say- 25 years? 

CC: I think the most important direction is the expansion of the Life Box program and the evolution of educational materials.  Just think about how many lives have been and will be saved when every OR in the world meets up to date current monitoring standards. 

GG: Out of these important WFSA activities, what should be kept? 

CC: Obviously I am biased towards the paediatric fellowship programmes but certainly the others regarding obstetrics, pain management, regional anaesthesia, critical care, and trauma should all be kept and expanded.  Also the development of educational materials both online and as printed material should be kept and expanded. 

GG: And what should be changed? 

CC: As with any international organisation, politics can creep in, and interfere with the core mission.  It is essential to get rid of all politics and focus on the goal of improving anaesthesia care throughout the world regardless of the local political issues. 

GG: What should be the main WFSA focus in the next quarter of century? 

CC: Continue it growth, expand the fundraising activities, attempt to obtain funding from large organisations such as Bill Gates, George Soros, and other billionares, as well as partnering with in country governments. 

GG: Professor Cote, this was a very instructive interview. On behalf of our readers I would like to thank for your time and cooperation. 

CC: My pleasure, Professor Gurman. 

GG: Hello, Dr Eltringham. I am very glad to have the chance to interview you on the occasion of the 70th anniversary of WFSA, an organisation to which you have contributed so much. Our readers are very interested to know more about their ‘heroes’, those who worked so hard for the success of our specialty all over the world. This is why I would start this interview with a question related to your own history as a physician. Can you tell us where and when you started your medical career? 

RE: I graduated MB ChB from St Andrew’s University, Scotland in 1964.  

I spent a lot of time at medical school playing rugby, which was very helpful as many of the examiners and Professors were also keen rugby fans. As someone who never did very well in my examinations, this as undoubtedly an advantage.  

I then did my pre-registration jobs in Dundee and at the Royal East Sussex Hospital in Hastings.  

After this, I was an obstetric resident (SHO) in Dublin, Ireland at the Rotunda Hospital where I continued to play a great deal of rugby. Following this my wife and I moved to Bath where I did six months orthopedics before spending another six months as a casualty officer in the accident and emergency department of the Royal Infirmary. It was during this final period that I decided to investigate anaesthesia as a career. 

GG: What an interesting combination: medicine and  rugby. Indeed, I remember that some of my colleagues at medical school used to play rugby during their leisure time. So, why did you choose anaesthesiology as your future specialty? 

RE: I was encouraged by the expanding scope of the specialty, especially the involvement in intensive care. As I mentioned in my book ‘Laughing Gas’, I was also encouraged into anaesthesia by the fact that the trainee anaesthetists I encountered in Bath were uncommonly good-humoured and all seemed to actually enjoy their work!  

GG: I have no doubt that during the first year as an anaesthesiologist you had mentors, seniors who inspired your career. Can you give some names? 

RE: Dr Peter Basket encouraged me to become an anaesthesiologist and also nominated me for my first National Society position. Like me, Peter was a fervent rugby enthusiast and no doubt was partly convinced of my suitability to join his specialty by my rugby-playing abilities.  

Professor John Zorab encouraged me to get involved with WFSA.  

GG: You started your professional way as an anaesthesiologist more than half a century ago. Looking back to your early practice, how is aneasthesiology today compared to when you started out? 

RE: Anaesthesiology covers a much wider field now, e.g. intensive care, pain clinics, high-dependency units. When I started out, anaesthesia had only recently been recognised as a separate specialty and anaesthetists had no responsibilities outside the operating room. Today there is much more teaching involved and I believe also more encouragement to get engaged in research. 

When I started anaesthesia, the only type of anaesthetic machine we had was the Boyles Machine. This was a trolley on wheels with cylinders of oxygen, nitrous oxide and cyclopropane. The gas flow rates were controlled by rotameters and directed to glass jars with either chloroform or ether, the two volatile agents commonly in use. The mixture was inhaled by the patient but so much escaped into the room that each night when I arrived home, my wife could identify which agent I had been using during the day.  In my early years we only administered general anaesthesia; regional techniques and epidurals were totally unheard of in my hospital and spinals unpopular due to reports of ensuing neurological damage. 

What a tremendous change we have seen! 

GG: We would be interested to get an idea about your own achievements as an anaesthesiologist. 

RE: I joined Gloucestershire Royal Hospital in 1974 as a Consultant Anaesthetist and later set up the intensive care unit there. I am proud to have been involved in daily teaching sessions for both medical and nursing staff.  

Not mentioned but key:

Dr Elringham is the originator of the Glostavent, which he developed in the mid 1990s combining components from the Manley Multivent ventilator, the oxygen concentrator and the draw-over vaporiser. He was inspired to do develop this after travelling across many low-resource countries where he saw totally unsuitable pieces of machinery languishing from want of uninterrupted electricity and oxygen supplies. The Glostavent is today manufactured by a UK company and can be found in hundreds of operating rooms across Africa in particular.  

GG: I can imagine that you had your own challenges in your career. Can you give us an example? 

RE: Passing the FFARCS exam (now FRCA). I needed four attempts before persuading the examiners that I was suitable! 

GG: Isn’t this rather unusual for a successful physician like you?! OK, so let me ask a question about your activity as a teacher and mentor. 

RE: Just two examples: I introduced daily teaching sessions at Gloucestershire Royal Hospital and regular exchange visits with US centres such as Yale, Colorado and Wisconsin.  

GG: Moving from your personal career to more general subjects, this is something we ask every single interviewee: What do you think are WFSA’s main achievements? 

RE: I can think about two: Introduction of regular refresher courses for low-resource countries and engagement of exchange visits, especially for countries in Africa, Asia and South America. 

GG: Speaking about low-resource countries, how do you think WFSA activities and projects are influenced by cultural and resource differences? 

RE: Poorer countries often lack the facilities to organize visiting lectures and training courses. Courses organised by WFSA have been shown to be effective, greatly appreciated, and important in encouraging recruitment into the specialty. 

GG: During your activities as a WFSA Officer you had many opportunities to observe its activity. Can you give as some examples of key moments of decision for the federation? 

RE: Here they are: Introduction of refresher courses in low-resource countries greatly increased our understanding of the problems faced by colleagues in these poorer and often isolated countries.  All WFSA’s projects demonstrated that improvements can be made. 

GG: And what value does WFSA bring to is members; National Societies and individuals? 

RE: I can mention three: 

1. Improved education, especially in low-resource countries.  
2. Involvement in intensive care, recovery units and research. 
3. Encouragement of anaesthesiology as a career 

GG: I just mentioned the fact that you have been closely invloved with WFSA activities. Did you start with your National Society? 

RE: Yes, on joining the Council of the Association of Anaesthetists (Great Britain and Ireland) I became part of its International Relations Committee (IRC). Alongside this, I coordinated refresher courses in Africa, Asia and South America and arranged regular exchange visits.  

GG: The professional life of an anaesthesiologist is hard; too many long hours in the operating room, too many night on-call, too many difficult cases in the ICU. How did you find time and energy to deliver these important educational activities in the framework of WFSA? 

RE: I was encouraged by the then WFSA leadership, especially Anneke Meursing (Netherlands), John Zorab (UK) and Kester Brown (Australia). 

GG: What position(s) did you hold at WFSA? 

RE: I was Chair of the WFSA Education Committee and Vice-President under Anneke Meursing.  

GG: What is the achievement or contribution at WFSA you are most proud of? 

RE: I introduced refresher courses in low-resource countries and chaired and organised many of these in Africa, South America and Asia.  

GG: Dr Eltringham, we are close to the end of this very interesting interview. Let’s speak about WFSA future. How do you see the federation in the next – let’s say – 25 years? 

RE: Keeping what it is doing now: Maintaining a strong focus on education and support for initiatives such as Fellowships, refresher courses and professional exchanges. 

GG: Finally, what should be, in your opinion, the main WFSA focus in the next quarter of century? 

RE: Education must take priority. 

GG: Dr Eltringham, many thanks for your answers. I wish you all the best. 

RE: Thanks. 

 

GG: Dear Dr Enright, we have known each other for many years and have worked together on WFSA educational projects. I had many opportunities to follow your activities in the framework of this federation. Nevertheless, I think that I don’t know too many details from your life and career. Please let me know, how did your way to medicine start?

AE: My professional start may seem simple and clear, but you as you can imagine, things did not go as smoothly as may appear. I graduated in medicine in 1970 at University College Dublin in Ireland. Then I emigrated to Canada in 1972 where I finished my residency in anaesthesia at the University of Calgary in 1978.

My academic activity took place at the University of Saskatchewan, when I became a Professor of Anaethesia, then I moved to the University of British Columbia between the years 2003-2021, and since 2021 I have been Emeritus Professor of Anaesthesia at University of British Columbia.

GG: Interesting that you selected anaesthesia among many other fields of medicine. What brought you to our specialty?

AE: The answer is simple: During my medical studies I enjoyed physiology and pharmacology, and I found that in anaesthesia I could apply what I learned in medical school.

GG: Did you have a particular mentor during your professional life? Somebody who inspired you in your career?

AE: Yes, indeed, and they are two: Prof Roger Maltby at the University of Calgary and Dr. John Parker at City Hospital in Saskatoon.

GG: More than 50 years have passed since you started your residency in anaesthesia. May I ask how you view anaesthesiology as a specialty today compared to when you started to practice?

AE: It’s very different. We had no pulse oximeters or capnographs when I started. We got fiberoptic bronchoscopy during my residency. Enflurane was a new agent then. We were only starting to get Guidelines to Practice. And many other new things which showed up during this long period of time.

GG: Can you describe, in short, your own achievements and contributions to our specialty?

AE: Let’s put them in order: I was Examiner in Anaesthesia for Royal College of Physicians and Surgeons of Canada from 1980 to 1986. Then I served as President of the Canadian Anesthesiologists’ Society during 1994/95. I was Chair of the Congress Organising Committee for the 12^th World Congress of Anaesthesiologists which took place in Montreal in 2000 before becoming Chair of the WFSA Education Committee from 2000 to 2008 and finally WFSA President from 2008 to 2012.

GG: Indeed, I remember vividly your prolific activity as chair of the WFSA Education Committee, especially the initiatives related to education projects for Eastern Europe.

AE: Those were years of intense activity, with the aim of helping our colleagues from the former Soviet bloc to reach the needed professional level, after so many years of restrictions.

GG: As one can easily understand, you had a lot of challenges during all your professional activity. Can you tell me what was the biggest one?

AE: Very simple. Running a big Department of Anaesthesia which encompassed all of Vancouver Island with 2 tertiary care hospitals, 5 secondary care hospitals and a population of just under one million.

GG: You have always been a teacher, not only a clinical practitioner. How can you describe your participation in the training and teaching of your younger colleagues?

AE: I have always loved teaching. I was Residency Programme Director at University of Saskatchewan from 1978-1980.  I have taught medical students and residents in Canada and in many places around the world.

GG: I cannot forget the impact of your lecture at the 1^st International Congress of the Moldavian Society of Anaesthesiologists, in 2007 in Kishinev. The participants were very impressed by the way you presented the future of our profession, a very optimistic one.

GG: WFSA activities are on a very large scale and covers many domains. How do you see its achievements during all those years you were an active WFSA Officer?

AE: I first became involved with WFSA in 1996. I became more involved when appointed to Chair the Federation’s Education Committee in 2000. WFSA’s focus on education is the right one. I continued the work begun by Kester Brown and Haydn Perndt; people after me have gone on to do even more. Education is the most important things that WFSA can support.

GG: WFSA is active on five continents, and our specialty is practiced somehow differently from one side to the other of the world. Are WFSA activities influenced by cultural and resource differences?

AE: WFSA includes all areas and most societies around the world. However, it is most important to those in low- and middle-income countries (LMICs) which have more limited resources than those in high income countries. We need to continue the focus on those most in need. The other issue that has been very important is patient safety.

GG: Dr. Enright, you have been involved in WFSA projects and activities for so many years. Please, let us know what are – in your opinion – the key moments of decisions in WFSA history?

AE: It is hard to say. I think Professor Kester Brown put the emphasis squarely on education. The Executive Committee was very supportive of my efforts when I was Chair of Education. The decision to support the Global Oximetry Project, proposed by Alan Merry and the Scientific Committee at Paris 2004, was very prescient and resulted in the launch of Lifebox Foundation which has done enormous work in getting a low-cost pulse oximeter to over 40,000 ORs around the world. Other very strong areas are Update in Anaesthesia and Anaesthesia Tutorial of the Week which Iain Wilson started, and which have gone on to thrive and be very important in education.

GG: WFSA was created many years ago, in the year 1955. Since then, the number of National Societies which are affiliated to this federation continues to increase. In your opinion, what value does WFSA bring to its members?

AE: ‘Ask not what your country can do for you but what you can do for your country.’ Those words of President John Kennedy have much meaning to people who support the objectives of WFSA. To those who do not think like that, WFSA is not so important.

GG: We are close to the end of this interview. I would like to ask you what is the achievement or contribution at WFSA you are most proud of?

AE: I think they are too many, but I will try to select the most important ones:

• Continuing and starting education programmes all over the world
• Seeking out other organizations who would support our work, eg. Society for Pediatric Anesthesia (Fellowships in Pediatric Anaesthesia), International Association for the Study of Pain (IASP) (Fellowship in Pain Bangkok)
• Starting the work for the development of the Paediatric Anaesthesia Fellowship Programme in Nairobi. It took a long time, but we got there in the end. It was the first University-recognized subspecialty training programme in East Africa. Now it has produced 24 Paediatric Anaesthesiologists from 12 different countries, all of whom have returned to practice in their own countries.
• Running courses on teaching skills. This was particularly successful in Eastern Europe and developed a cadre of young teachers who have become leaders in anaesthesia education.
• The other area which has made a big difference is the Global Health Section of Anesthesia & Analgesia (A&A) in collaboration with WFSA. Having a Global Health section in A&A has greatly increased publications from LMICs. Young researchers from less resourced areas now have some hope of getting their work published. In addition, there are tutorials on how to write a manuscript, how to review a manuscript. IARS has now introduced free membership for trainees in LMICs, tiered memberships for colleagues from LMICs, travel grants if presenting posters at IARS meetings, editorial Fellowships at A&A with some specifically retained for colleagues from LMICs and mentored research grants for LMICs.

GG: Dr. Enright, the time came for a look into the future of WFSA. How do you see WFSA in – let’s say – in the next 25 years?

AE: It should continue its work in supporting anaesthesia programmes in LMICs with a special focus on sub-specialty training programmes. Many countries have progressed their anaesthesia services and education to the point where they desperately need to develop sub-specialists.

The liaison with IARS is very important and should be further developed. As mentioned above, IARS has made huge efforts to support the work of WFSA. More can be accomplished.

GG: What should be kept?

AE: My focus is always on education so that work should continue. WFSA should look for new ideas and ways of doing things but not get caught up in the ‘flavour of the month’!!

GG: And what should be changed?

AE: It is not an easy organisation to run because of the breadth of its membership.  Sometimes appointments to positions are made because of political pressure. It is important to get the enthusiasts who will do the work in the right positions. Committees should be made up of ‘Champions’ who will both inspire and lead. It is important not to get caught up in the day to day but to have a vision for the WFSA to which everyone can aspire.

GG: And, finally, what has to be the main WFSA focus in the next quarter of a century?

AE: Education, education and once again education!

GG: Dear Dr Enright, it was my pleasure to have a new occasion to listen to your very important and inspiring thoughts about our federation. I wish you all the best.

GG: Hello Professor Gelb. I am very glad to have a chance to speak to you today and to discuss some aspects related to WFSA which is so well known to you

AG: Indeed. And one cannot forget the fact that we are celebrating this year, the 70^th year of this important global organisation.

GG: I am glad that you remember this fact. So, let’s start with the beginning. Where and when did you start your medical career?

AG: I grew up in Cape Town, South Africa, where I graduated from medical school in the year of 1972. My internship was spent at Groote Schuur Hospital, in the same city.

GG: What special aspects of anaesthesiology attracted you enough to decide that this would be your future specialty?

AG: I can imagine it was exactly the same aspects which attracted many others of my peers: acute care and intensive care. While working in the surgical department I really liked the operating room, the atmosphere, and the spirit of cooperation. Besides, it took me a very short time to realize that applied pharmacology and physiology are two of the most important pylons of anaesthesia, and this was another point of attraction.

GG: Did you have mentors, or seniors, who inspired your career?

AG: Yes, indeed, and here I mention only a few: Gay Harrison (Cape Town); Wolf Spoerel (London, Canada. He was a German refugee and a committed humanitarian); Richard Knill and Kai Rehder (research); Ron Miller and Wolf Spoerel (department leadership).

GG: So, you started anaesthesia more than 50 years ago. In your opinion, what is the specialty like today, compared to when you started to practice?

AG: Much safer thanks to the huge increase in technology, standards, better medications, and better understanding of physiology. It is enough to look to an anaesthetized patient today and see the multitude of monitors surrounding them, and to check the anaesthesia drugs used these days to understand the huge advances anaesthesia has seen as a medical specialty.

GG: How could you describe the biggest achievements in your career as an anaesthesiologist?

AG: Here they are: Leadership of two anaesthesia departments and five international organisations, 300+ invited lectures and publications, named lectures and other honors.  And one more detail: Only being sued once in 40 years!

GG: I can imagine that you encountered some big challenges in your career?

AG: Yes, and some of them cannot be underestimated: Dealing with difficult, egotistical surgeons, and hospital administrations that seemed more interested in budgets than patients. I can imagine that I am not the only one who has similar memories….

GG: You are well known as a teacher and mentor. Can you elaborate?

AG: I’ve won awards for teaching and for mentorship. My teaching style is Socratic in that I believe students can be taught to work out the answers for themselves. I believe mentorship is a bottom-up process where the mentee sets the agenda and we help them achieve it.

GG: For many years you have been involved in WFSA activities, and we will soon come back to this topic. But now can you tell us what you think are the organisation’s main achievements?

AG: I think one of the biggest achievements is changing WFSA from an organisation mainly focused on education in poor countries into one whose education is relevant to all income categories and a greater, more prominent role as a global advocate for anaesthesia, especially at world congresses.

GG: Since you mentioned this, how do you think WFSA activities are influenced by cultural and resource differences?

AG: In my opinion, both require WFSA to be malleable in its approaches and meeting the needs of different constituents.

GG: And what value does WFSA bring to its members?

AG: Relevant education and global advocacy, including its influence on WHO activities.

GG: You did not start as an Officer of your own National Society, but you have had many positions in other professional organizations, before becoming active at WFSA.

AG: Correct. I was a Board Member and President of SNACC, ISAP, IARS, WFSA. Board of Global Surgery Foundation, California Anesthesiologists’ Society.

GG: What was the incentive for seeking a position as an Officer at WFSA?

AG: Very simple! Alan Merry discussed it with me in 2010 and then co-opted me onto his Patient Safety & Quality Committee.

GG: What positions did you hold at WFSA?

AG: I was Chair of the Patient Safety & Quality Committee (2012-2016), Council representative on the Board (2015/6), Board Secretary (2016-2020), President (2020-2022) and then Immediate Past President (2022-2024).

GG: Impressive. What is the most important achievement or contribution at WFSA you are proud of?

AG: Leading the development, publication and promotion of the WHO-WFSA International Standards for a Safe Practice of Anesthesia. And one more: leading WFSA through the COVID-19 pandemic.

GG: The time has come to end this very interesting conversation. We would like to get your opinion about the future of WFSA. How do you see the organisation in, let’s say, the next 25 years?

AG: The future will be heavily influenced by the ability to find funding in addition to National Society dues. Education and advocacy will remain the dominant focus. To secure funding, WFSA needs to be very nimble in adapting to needs that may be different in different regions of the world and also to the requirements set by funders. Every initiative will need, as part of the planning, not just the ‘package to be delivered’, but also pre-planned monitoring and explicit outcome evaluation.

WFSA could be a ‘think tank’ or convening organisation, but that will require leadership and infrastructure support.

GG: What should be kept?

AG: Education and advocacy. WFSA is not a research organization, so any grant applications put forward by WFSA need to be appropriately focused on education and advocacy. Education and advocacy should be the main WFSA focus areas in the next quarter century.

GG: What should be changed?

AG: Many of the Committees are not as active as one would want. This is common to many organisations, but it does hamper productivity. Consideration should be given to more active use of taskforces or workgroups of energetic people who can pull Committees along.

GG: Dear Adrian, it was a pleasure meeting you today and getting such interesting answers to our questions. Thanks a lot, and all the best.

AG: My pleasure, Gaby.

GG: Hello, Dr Goucke. We have never met, but I am glad to have the opportunity to discuss with you some aspects related to your activity as a WFSA leader.

RG: And this comes in the framework of 70th anniversary of the federation.

GG: Indeed. So, let’s begin. Please let us know when and where you started your medical career?

RG: I started tropical medicine in Sydney, Australia, and then in Papua New Guinea and South Korea.

GG: What convinced you to select anaesthesiology as your future specialty?

RG: Very simply I wanted a cognitive and technical specialty, and anaesthesia is a perfect combination of both.

GG: Did you have any mentors or seniors who inspired your career?

RG: Yes, the senior staff at the hospital in Perth, Australia.

GG: I am sure that our readers will be interested to know your opinion about anaesthesiology today compared to when you started to practice.

RG: You take one look at today’s operating room, and you will see a multitude of monitors, one for almost each of the vital functions, which, together with the physician’s vigilance, assures patient safety during delivery of anaesthesia and surgical procedures.

GG: Did you have any special domains of interest in your career?

RG: Yes, cardiac and liver transplant.

GG: And what about the biggest challenges in your career?

RG: Moving into pain medicine and running/setting up a department of pain medicine.

GG: And any challenges as a teacher and a mentor?

RG: The real difficulty was to teach in a language other than English.

GG: Speaking about WFSA, what do you think are its main achievements?

RG: The fact that it created a system of global education, using the ability of the internet to reach every person.

GG: Do you think WFSA’s activities are influenced by cultural and resource differences?

RG: Hard to say. Maybe it should place more emphasis on providing safe anaesthesia with less or minimal resources. I can imagine that this is a very difficult task.

GG: You had the opportunity to observe from the inside WFSA’s activities and decisions. What are, in your opinion, its key moments?

RG: Among many other things: The increased energy on global advocacy, cooperation with WHO and bodies like the World Medical Association.

GG: And its special, peculiar values?

RG: Hard to say, but I think it is advocacy and creating a better awareness of the importance of anaesthesia.

GG: Coming back to your own career as an anaesthesiologist, did you start your activity within the framework of your own Society?

RG: No.

GG: What led you to seek a position with WFSA?

RG: I thought that it was important to promote the field of pain management among anaesthesiologists all over the world. This would explain why at WFSA I filled the position of Chair of the Pain Management Committee. And this is exactly my contribution at WFSA: Promoting Essential Pain Management, by using all the tools the federation had available.

GG: Finally, just a couple of questions regarding the future of the federation. How do you see WFSA in the next 25 years?

RG: Investing energy, money and events in education and global advocacy. By the way, these are the issues WFSA has to focus its activity on in the future.

GG: Is there anything which should be changed?

RG: WFSA needs more engagement with its members, because this is what makes up the Federation

GG: Thanks a lot, Dr Goucke, for finding the time to answer our questions. I wish you all the best, 

RG: Thanks a lot.

Please share with us some recollections of your time with WFSA.

Working for the WFSA was a great privilege. I was hired in 2001 to assist the newly formed Foundation Committee, chaired by the late Prof. Michael Rosen.

The London Office was created in 1997 after the World Congress in Sydney in 1996 and was based at the Royal College of Anaesthetists in London, with two part-time staff.  By the time I joined, it had moved to new premises with a newly appointed Office Manager, various temping secretaries at different times, as well as a part-time bookkeeper. Only three months later the Office Manager was fired and I was invited to take over her post, running the day-to-day administration. 

Due to budget constraints, the Office moved again to a smaller room in the same building and I became the sole employee.  A year later it moved into the premises of the Association of Anaesthetists of Great Britain and Ireland in London.

Initially my immediate contacts were with Prof. Anneke Meursing from the Netherlands (Honorary Secretary), who was working in Malawi at that time; Prof. Michael Rosen from the United Kingdom (Chair, Foundation Committee); Dr. Kester Brown from Australia (President); Prof. Michael Vickers from the United Kingdom (Past President) and Dr. Richard Walsh from Australia (Treasurer), all of whom were very supportive and trusted me to bring stability to the Office, organise its administration and bring its budget under control.

Apart from the Office duties, I worked at the WFSA stand at various regional and world congresses, a good opportunity to meet some of the officers of the national societies and committee members in person, as well as networking with industry.

After 12 years it was time to enjoy retirement in 2013.  I always felt that the Office should to be able to help the Committee Chairs achieve their aims, but for that we needed to hire more staff, as it was not possible for just one person to do it all.  Unfortunately funds were not made available, so I am very pleased to see that the Office structure has changed since then, by expanding its activities and members of staff.

GG: Hello, Dr Kempthorne. We have never met, but I am very glad to have this opportunity to get some information about your career and your thoughts regarding our common profession and WFSA, this world federation celebrating 70 years of existence this year.

PK: Ready to answer your questions, Dr Gurman.

GG: Excellent, let’s start with the first question. Why did you choose anaesthesiology as your specialty?

PK: I wanted to become a paediatrician but could not get a training position for more than 2 years. My father was head of the anaesthesia department so I asked him for a job and fell into anaesthesia by serendipity. In retrospect I think I had always been fascinated by anaesthesia. As a 12 year old I was noting down tomorrow’s operating list for my father when the house surgeon phoned. Even then I was asking for electrolytes if they were on diuretics.

GG: Very interesting, the son selects the same specialty as his father! It does not happen very often in our field.

PK: Correct, you are right.

GG: So my next question would be where and when did you start your training as an anaesthesiologist?

PK: My early training was at the Waikato Hospital in New Zealand (1975-1977). Then off I went to Scotland, the Netherlands and The Royal Children’s Hospital in Melbourne, Australia.

GG: I can imagine that your father was also your mentor. But did you have any other seniors who inspired your career?

PK: Kester Brown, and Frank Shann (Intensivist) at The Royal Children’s Hospital in Melbourne.

GG: Once again Kester Brown! It seems that he was responsible for the creation of an entire generation of successful anesthesiologists, not only in Australia and New Zealand, but all over the world, especially in the domain of paediatric anaesthesia. I am so happy that I had the opportunity to meet Kester Brown many times at congresses and conventions.

PK: Indeed, a special man and teacher.

GG: Starting anaesthesia so many years ago, I am sure you might have an objective view on the evolution of our common specialty. How is anaesthesiology, in your opinion, today compared to the time you started to practice it?

PK: My father instilled me the discipline of monitoring the patient by clinical means.  As a young boy I remember my father bringing home the first Teledyne pulse monitor. He said that would transform anaesthesia, because at last he could free up his second hand which up until then had been on the pulse. Montoring and TPN are the two massive changes I have been witness to. The downside has been a loss of clinical monitoring skill and a resulting dependence on technology and if this fails there is nothing to fall back on. 

GG: Indeed, you will find many ups and downs in every single domain. Dr Kempthorne, can you describe in short your own achievements as an anaesthesiologist?

PK: I became a paediatric anaesthetist after training at The Royal Children’s Hospital. I returned to New Zealand in 1982 where Paediatric Anaesthesia was not yet a sub-specialty. Auckland had the brand new Starship Children’s Hospital, but in the rest of the country every anaesthetist in each department was doing neonates, infants and young children; the outcome was not always as good as it could be.

I set about trying to improve this, setting up a sub-specialty unit in Waikato Hospital and then in Christchurch Hospital. Others started to follow.

Then came the battle to sell the idea of referral to regional paediatric surgical specialist units around the country. Eventually we got there and now it is well established.

I set up a National Meeting of Intensive Care specialists from around New Zealand and invited Frank Shann from Melbourne to officiate, and we produced a national guideline for referral of children needing intensive care. This was both to the regional centres and to the Children’s Hospital in Auckland.

GG: And what were the biggest challenges in your career?

PK: Convincing anaesthetic colleagues that not every anaesthetist should be doing neonates, infants and small children.

GG: I am sure that you, like many others of our peers, have been involved in the education of new generations of anaesthesiologists. Could you be so kind and elaborate on this subject?

PK: I focused on teaching the skills that are needed in looking after small children. The simple things. Managing an infant airway with your hands. Intubation.  I encouraged the early use of intraosseous needles when venous access was proving difficult both with anaesthetists and paediatric trainees

GG: Let’s move now to another subject: WFSA.  What do you think are its main achievements?

PK: Improving the care of all patients requiring anaesthesia, analgesia and resuscitation on a global scale, especially in low-income countries. Setting up of Lifebox was probably the greatest achievement during my time.

GG: Do you think that WFSA’s activities are influenced by cultural and resource differences between one country and another?

PK: I think it is sometimes hard for anaesthetists who are keen to teach in low-income countries to understand the cultural diffences and the hurdles the locals face. A paediatric surgeon and I regularly worked in Tonga, an island in Polynesia. I was helped with cultural differences because my surgeon was a respected Cook Islander. I remember ventilating a child in intensive care using an oxygen-driven ventilator. I could tell something was amiss. It turns out that there was a risk I would exceed the oxygen concentrator’s ability to fill cylinders. The result of that would be that Tonga would have to buy oxygen from  Samoa; this was a problem because of a longstanding cultural issue going back many generations.

GG: A very instructive story. Tell me please, what are – in your opinion – the key moments of decisions in WFSA’s history?

PK: Correcting the dire financial situation of the organisation in 2000, and launching Lifebox in 2011. And, finally, getting the World Health Organization to recognise lack of safe anaesthesia and surgery as a major deficiency in global health.

GG: The next question is about the value WFSA brings to its individual and Society members.

PK: I have already mentioned those that WFSA helps with teaching and advocacy. However, people like me received huge benefits as well. It is being part of a global network of colleagues and friends. There is a risk that without WFSA, we finish up isolated in our own little worlds under the illusion that the way we do things is the best way. This isolationism is very problematic.

GG: Now, speaking about your own activities. I understand that you never had an official position in your own national Society. So how did you get involved with WFSA?

PK: There is one guilty person: Kester Brown!

Through him I got to know some of WFSA’s activities and then I became a representative for the Pacific, Australia and New Zealand. I redesigned the Federation’s website and maintained it at the time when we could not afford a professional web master. Finally, I set up and chaired the original Global Workforce Survey  Committee.

GG: And what do you consider your most important achievement or contribution to WFSA?

PK: Leading the work for The Global Workforce Survey. [Note: First published under Dr Kempthorne’s leadership in 2017, this was subsequently updated in 2024.]

GG: Dr Kempthorne, we are approaching the end of this interview which provided such interesting data and insights. Let’s have a look into the future: How do you see WFSA in the next 25 years?

PK: I think it will be much the same. There will still be a need for improved access to safe surgery, anaesthesia, analgesia and trauma care around the world and we will still be the only group in a position to make significant improvements.

GG: What should be kept?

PK: Some very important projects:

• The training centres where people can receive sub-specialist input, and then return to be the focus of improvement in their own facilities.
• Sending teachers to hospitals in low-income countries. When you go there you see all sorts of things you can change quite quickly which the the outside training model may miss.
• The Global Workforce Survey must be repeated every decade.
• The World Congresses of Anaesthesiology.
• The apolitical nature of WFSA. This is one of its strengths.

GG: This is, in my eyes, a very important list! And what should be changed?

PK: I think WFSA should be inviting non-physician providers of anaesthesia to join the Federation in some way. The Global Workforce Survey continues to show that they are vital providers in some regions. We must embrace them and teach them. At the moment they are learning from each other. It would be much better if we step up and include them in our training programmes.

GG: A final question: What should be the main WFSA focus in the next quarter of a century?

PK: Increased awareness at all levels of the glaring lack of access to safe surgery globally.

GG:Thank you very much for your time and cooperation.

PK: All the best.

GG: Hello, Professor Lema. Thank you for accepting our invitation to be one of the leading past WFSA Officers who will answer some questions related to our federation’s activities and projects.

ML: My pleasure. I know that this initiative is connected to the 70th anniversary of WFSA.

GG: Indeed. Professor Lema, let’s begin with a question about your medical career. When and where did you start ?

ML: I graduated from the State University of New York and started my activity as an MD at Downstate Medical Center, in Brooklyn, NY (1978-1982).

GG: What was the factor which brought you to anesthesiology as your future specialty?

ML: I had a PhD in physiology (1978), and the pharmacologic management of the patient appealed to me.

GG: Some of what attracted me to our common specialty was also that part of applied pharmacology. By the way, did you have mentors or seniors who had an influence on your career?

ML: Yes, indeed. I am giving you just a few names: Drs James Cottrell, Alexander Gotta, Leroy Vandam, Gerald Ostheimer, Ben Covino.

GG: Amazing! All these names are well known to me from the literature. Since you spent so many years in anaesthesia, what is your overall opinion about our specialty today in comparison with when you started to practice?

LM: Good question. I think that today anaesthesia is much safer and in many ways also easier.

Today we have much safer drugs, and our techniques and technology assure a very low mortality rate in those countries where hospitals and operating rooms are properly equipped.

GG: Speaking about progress, can you tell us about some of your own achievements as an anaesthesiologist?

LM: Let’s try. I think I had the opportunity to be a leader and help transform several societies to keep up with the changes in healthcare.

GG: And what about the biggest challenges in your career?

ML: I can say that the permanent need for educating new administrators on the critical role we play in preventing crises from occurring and trying to treat them when our help and expertise is crucial.

GG: I can imagine that part of your professional activity was directed towards teaching. Can you give some examples?

ML: For 38 years I occupied the position of Chair at Roswell Park Comprehensive Cancer Center. I spent 24 years as programme director/chair at the University of Buffalo Anaesthesiology Department. Besides, I helped the careers of hundreds of physicians and administrators advance to greater positions.

GG: Professor Lema, let’s speak about the WFSA activities. What do you think about its main achievements?

ML: Two very important topics: The Pulse Oximeter project and the permanent efforts to educate nations to raise the standard of anaesthesia care and its safety.

GG: Do you think that WFSA activities are influenced by cultural and resource differences between regions and countries?

ML: WFSA always tried to make every OR in the world as safe as seen in advanced countries – limited by money to send advisors and purchase equipment, we managed to partner with a diverse group of organisations and individuals.

GG: And what about some key moments of decisions in the federation’s history?

ML: Changing the Officer tenures to make the position less draining on their time.  It reinvigorates the mission and enthusiasm of those who are elected.

GG: There is no doubt that WFSA brought and is still bringing value to its members, National Societies and individuals, too. Can you think of specific contributions?

ML: Yes. I think that it brought medical education through mentorship, educational/scientific meetings and periodicals. But one of the most important values was, once again, the safety of anaesthesia practice in some countries with limited resources.

GG: Speaking about your own activities at WFSA, I understand that these started after you held a position in your own Society?

ML: Yes indeed, I was the involved in the ASA Newsletter and then served as President of the American Society of Anesthesiologists.

GG: What led you to seek a position in WFSA?

ML: The American Society was using delegate spots as an opportunity for directors and officers to visit the world.  There was a decision to cut off WFSA funding to support US efforts.  As a senior officer, I joined WFSA to reshape and re-establish ASA’s commitment to assist in world anaesthesia education and support for underserved countries.

GG: And what position(s) did you hold at WFSA?

ML: Treasurer – ASA felt I would help oversee their investment, and I did help to bring finances under control and balance the books with a little belt tightening.  Actually, I unofficially still serve as Treasurer Emeritus because the American banking institution that holds one of WFSA’s account is five minutes from my office and I can facilitate international transfers or resolve any issues without a lot of travel, time and expense involved.

GG: Very impressive! So, after fulfilling such important tasks, can you tell us what have been your own achievements at WFSA that you are most proud of?

ML: Keeping WFSA solvent during a time when revenue was decreasing. Overseeing two successful World Congresses, except for the fact that the Argentinian profits were stolen by the professional congress organising company!

GG: Professor Lema, we are approaching the end of this interview. The last question will be directed towards WFSA’s future. How do you see our federation in the next 25 years?

ML: In short, these are the main points:

• Continue serving as the world’s source for anaesthesia trends and medical education and trainings.
• Support access to basic technology/protocols worldwide.
• Continue to be the world’s anaesthesia ambassador with international organisations like WHO

GG: What should WFSA keep doing?

ML: Four main directions:

• Medical training in underserved areas.
• Provision/distribution of basic monitoring
• Online education
• Advocacy for anaesthesia

GG: And, in your opinion, what should be changed?

ML: I am of the opinion that the future organisation and content of the next World Congresses have to be discussed. For instance, is it cost-effective or profitable to continue these? Or can they be delivered virtually?

GG: Finally, what do you think should be the main WFSA focus in the next quarter of a century?

ML: Financial stability.

GG: Professor Lema, many thanks for your very instructive answers. I wish you all the best.

ML: Same to you.

GG: Hello, Professor Merry. Many thanks for accepting our invitation to take part in this WSFSA oral history interview on the occasion of our 70th anniversary. Let’s start with a question related to your first steps in medicine. Where and when did you start it?

AM: I started in Zimbabwe and qualified in the year 1976. Then I was requalified in London (licentiate at Royal College of Physicians and a member of the Royal College of Surgeons). I did house jobs in 1977 and Senior House Jobs in 1978 at Harare Hospital and worked as a locum GMO for 2 weeks at Karoi, Sinoia and Chipinga hospitals (Zimbabwe).

GG: Why did you choose anaesthesia as your future specialty?

AM: I was inspired to consider anaesthesia by Dr Mike James (later Professor at Cape Town) and Professor Ashley Duthie who had established an exceptional department at Harare. After moving to New Zealand and spending one year as a surgical registrar in Rotorua, I was offered a place on the Auckland Anaesthesia training scheme and took it with a view to becoming a GP (general practitioner) anaesthetist.

GG: Beside Prof. Mike James, who you do consider as your mentors or seniors?

AM: Profs. Ashley Duthie, Bill Runciman and Kester Brown.

GG: Indeed, in the past I had the privilege and the honor to meet Professor Brown, and to hear some of his pearls of wisdom related to pediatric anaesthesia and education. Now, I would like to ask: When you look back to the time you started your career as an anaesthesiologist, how do you see our specialty today?

AM: In New Zealand anaesthesiology has become a highly organised, highly respected and highly sought-after specialty which provides the highest standards of care to patients with a strongly patient-centric focus. The specialty is also very gender equitable in relation to opportunities for its members.

GG: We are still in the domain of the past. Can you present here, in short, your own achievements as anaesthesiologist?

AM: Currently, I am semi-retired. I was vocationally registered as a specialist anaesthesiologist and specialist in pain medicine. I was a cardiac anaesthesiologist, Professor of Anaesthesiology at Auckland University, then Head of the School of Medicine, and finally Deputy Dean of the Faculty of Medical and Health Sciences. I was Head of Department of Cardiac and Thoracic Anaesthesia at one stage. I am a Fellow of the Royal Society of New Zealand and was made an Officer of the New Zealand Order of Merit. I have published over 200 papers and co-authored 4 books, three published by CUP or OUP. 

Importantly, I have a wonderful family that is very close, and I see that as our most valued achievement together.

GG: A very impressive record, congratulations! And now about the biggest challenges in your career?

AM: In the 1990s, some ten health professionals were convicted of manslaughter after tragic deaths arising from simple errors in practice. This risk to a cardiac anaesthesiologist was very frightening.  I co-chaired the New Zealand Medical Law Reform group, which brought about the Crimes Amendment Act of 1997 that changed the threshold for negligent manslaughter in New Zealand and introduced a requirement for (in effect) gross negligence. At the time this law change was considered unachievable.

GG: I have never heard about this tragic event. I can imagine that it shattered the medical community in New Zeeland. And what about your contribution as a teacher and mentor in our common specialty?

AM: I have contributed to teaching medical students, anaesthesia trainees, and have supervised about 16 PhD students to completion.

GG: The next part of this interview refers to the WFSA activities and projects during your time. What are, in your opinion, its main achievements?

AM: The fact that WFSA speaks for all the anaesthesiologists around the world and has a voice at WHO is very impressive. The Standards for a Safe Practice of Anaesthesia are very valuable. Lifebox is one of WFSA’s greatest achievements which has, I believe, led to many lives being saved. The World Congresses are a hugely important contribution to advancing the standards of anaesthesia everywhere.  The courses and training that WFSA provides are all very important.

GG: During all your career as an anaesthesiologist, you worked in different countries, one different from the other regarding their national wealth. Do you think that WFSA activities are influenced by cultural and resource differences?

AM: Yes, I worked in different parts of the world, and I noticed this aspect.  These differences are very substantial. The need to function at a very high level in English to participate in WFSA Committees is a major barrier to which I do not see an easy solution. Similarly, differences in resources markedly limit participation.

GG: You are right, but one cannot forget that today English is the language which makes us understand each other, and it does not matter if one’s command of English is worse or better than the other one. Now, the next question: what are – in your opinion – the key moments of decisions in WFSA history?

AM: The decision to professionalise its staff and appoint a CEO transformed and accelerated its contributions and effectiveness.

GG: As you know, WFSA brought, and is still bringing, very significant professional and ethical values. Could you be so kind and refer to this important aspect?

AM: WFSA has elevated the status of anaesthesiologists, primarily by demonstrating a concern for the safety and quality of care received by patients around the world.

GG: It would be interesting to know some details about your own activities in the WFSA framework. Did you start your engagement in your own Society?

AM: No, but thanks to Professor Kester Brown‘s guidance I was involved with the Asian Australian section, then WFSA’s Quality and Safety of Practice Committee (becoming Chair) before joining the Board.

GG: And what are the most important achievements or contribution at WFSA you are most proud of?

AM: The Global Oximetry Project and the birth of Lifebox. Notwithstanding that Lifebox was begun collaboratively by several organisations, and became independent, WFSA played a major role in its establishment and should be very proud of what it has achieved.

GG: And now, just a couple of questions related to WFSA’s future. You had a lot of experience on the Board, so I am sure you can give us your input about how you would see our world federation in the – let’s say – 25 years from now and what should be kept in the future?

AM: WFSA will need to focus on the needs of patients globally through advocacy and training. And what has to be kept? The World Congresses and the global nature of the organisation.

GG: And a rather tricky question: What should be changed?

AM: The role of non-anaesthesiologist anaesthesia providers has to be acknowledged and embraced, not as a threat to anaesthesiologists, but as essential to meeting the needs of patients in low-income areas of the world. The emphasis should be on the anaesthesia team led by anaesthesiologists. This is the opportunity to retain the influence of anaesthesiologists. It is counterproductive to say that only anaesthesiologists should give anaesthetics, although fine to say that it would be ideal for that to be the case.

WFSA should establish a World Journal of Anaesthesia. To some extent this need has been supported by A&A’s Global Health Section under the editorship of Angela Enright, but an independent journal focused on international issues related to anaesthesia and the needs of patients undergoing surgery everywhere could have great political influence if well led. It could possibly also be a source of income for WFSA, but that is probably a secondary consideration.

GG: And the last one: What should be the main WFSA focus in the next quarter of a century?

AM: As I already said, the need to provide safe anaesthesia to the 5 billion people in the world who currently cannot access it.  I think some consideration should also be given to supporting patients in war zones, although this is a big ask. The future may well have a greater need for this.

GG: Professor Merry, thank you very much for your special contribution to this project. I wish you all the best, and hope that we will meet in the future.

AM: I hope so, too.

GG: Hello Mio, I am glad to ‘meet’ you once again, this time in my position as an amateur journalist, and you as a personality among past WFSA leaders.

This interview takes place on the occasion of the 70th anniversary of the federation, a fitting opportunity to present your own role in the development of WFSA’ activities. My first question is: Where and when did you start your medical career?

MM: I started as a general practitioner in 1998, in Belgrade, Serbia. I made my way to anaesthesia purely by chance, and the person ‘responsible’ for this was Professor Sever Kovacev, the founding father of Serbian anaesthesiology.

GG: As a professional with a lot of experience through so many years, can you tell us how you feel anaesthesiology today compares to when you started your practice?

MM: In my opinion, the most important event during all these years was the development of the various sub-specialties. This successful trend not only contributed to the development of the profession, but it improved the specialty image in the eyes of all, including our peers.

GG: How can you define your own achievements as an anaesthesiologist?

MM: During all my years of practice I developed my professional and scientific capabilities, from the theoretical and practical point of view, being able to learn from my tutors (one of whom was you!) Eventually I obtained the position of associate professor at my University and Head of Anaesthesia section in the OR.

GG: And the biggest challenge in your career?

MM: I fought and obtained the necessary support from the local academic department, but one of the most difficult tasks was to cope with the enormous demands – professional and personal – during the recent COVID-19 pandemic.

GG: Let’s discuss the main WFSA activities during these years, and your personal involvement in these. What do you think are WFSA’s main achievements?

MM: WFSA made a lot of efforts to improve global recognition for the specialty, and also to find solutions for the perennial shortage of anaesthesiologists all over the world.

GG: How do you think WFSA activities are influenced by cultural and resource differences?

MM: I am of the opinion that what influenced and still influences our activities in the framework of WFSA is the individual effort done by each of us, more than any cultural or resource influences.

GG: In your opinion, what were some of the key moments in WFSA’s history?

MM: Putting in place a full-time CEO and a professional Secretariat was critical.

GG: One last question about WFSA general activities: what value do you think the federation has brought to its members?

MM: Educational resources, facilities and volunteers, development of regional fellowship capabilities (Critical Care, Pain, Pediatric anesthesia, Cardiac anesthesia, Patient safety, Research etc.)

GG: And now, back to your own activities at WFSA.  Did you start in your own Society?

MM: Yes.

GG: In what position?

MM: After graduating from the International School of Instructors in 2008, I started being involved in the projects of WFSA. First, I was elected as a member of the NASC Board (then the European Regional Section of WFSA), and then I occupied various positions in WFSA itself.

GG: Could you please offer us some examples?

MM: Yes, of course: I have been Deputy Chair of the Workforce Well-being Committee, a member of the Diversity Equity Inclusion (DEI) Committee, and also Chair of the WFSA Education Committee.

GG: Very impressive. And what is the contribution to WFSA you are most proud of?

MM: I was very active in the continuous campaign to expand into new educational projects, looking for new resources, for volunteers, and to establish the regional fellowship capabilities, globally.

GG: We are reaching the last part of the interview, which deals with the future of our organisation. How do you see WFSA in the next 25 years?

MM: As a strong professional association

GG: What should WFSA keep doing?

MM: Advocacy, Education and Patient Safety.

GG: Should WFSA change anything?

MM: Yes.  We have to start a proper alumni network and work hard in order to develop global research capabilities in our specialty.

GG: If you were asked what should be the main WFSA focus in the next quarter of a century, what would you answer?

MM: Workforce and well-being in anaesthesiology.

GG: Thanks a lot, Dr Milenovic. I wish you all the best.

MM: Thank you, Gaby.

GG: Welcome, Dr Morriss, to this new project, which includes interviews with personalities with an important role in the development of WFSA, whose 70th anniversary we are celebrating this year. 

WM: I am glad to bring my own contribution to this project. 

GG: Thanks. Let’s start with a question related to the first steps in your career. 

WM: I was born and raised in Christchurch, New Zealand (NZ), and graduated with a MBChB (Bachelor of Medicine, Bachelor of Surgery) in 1988. I worked in NZ for two and a half years as a junior doctor and then my wife and I went on a working holiday for another two and a half years, including seven months in Asia and also in the United Kingdom (UK). I worked briefly as an Anaesthetic Senior House officer (SHO) in the UK and, during this time, fell in love with the specialty of anaesthesiology. 

We returned to NZ in 1993, and I undertook specialty training in Christchurch and Melbourne, graduating with a fellowship in 1999. After some time working as a specialist at The Alfred Hospital in Melbourne, I worked for two years in Suva, Fiji. 

My family and I returned to Christchurch in 2002, but I remained closely involved in education and development work in the Pacific region and further afield. 

GG: I can imagine that during all those early years you had the possibility to get data about many medical fields. How come you chose anaesthesiology as your specialty? 

WM: I had originally planned to be a general practitioner, but anaesthesiology captivated me with its mix of intellectual rigour and hands-on patient care. I liked the fact that we could remain generalists with an excellent overview of patient care but also had the opportunity to develop expertise in subspecialist areas of practice. I also enjoy the non-technical aspects of the job, such as teamwork and communication skills. 

GG: All of those already interviewed took the opportunity to mention important personalities who inspired their career. Do you also have such examples? 

WM: Indeed. My decision to work in Fiji (from 2000-2002) was a turning point in my career and laid the foundation for my involvement with WFSA. I was encouraged and supported by Dr Haydn Perndt, a past Chair of WFSA’s Education Committee, and he has remained an amazing mentor over many years. 

I have been inspired and supported by many WFSA leaders, including Dr Angela Enright and the late Dr Jannicke Mellin-Olsen. I have always been grateful for their vision and wisdom. 

GG: Dr Morriss, a long career is behind you. Having such a tremendous experience, how do you see the anaesthesiology as a specialty today, in comparison to the time you started to practice it? 

WM: As a specialty, anaesthesiology has grown and matured over the last 30 years. In Australia and New Zealand, training and standards have steadily improved, and the standing of our specialty is high compared to other specialties.  

Globally, our specialty is more connected now than ever before, and WFSA has played a vital role in connecting us all. 

I think there is now greater understanding that anaesthesiologists have multiple roles inside and outside the operating room – we don’t just ‘pass gas’. This was particularly evident during the COVID-19 pandemic, when we worked in planning rooms, emergency departments, and intensive care units, as well as operating rooms 

GG: You are right. The COVID cataclysm had a positive aspect, that of emphasising the anaesthesiologists’ role outside the operating room. My next question refers to the biggest challenges you have met in your career. Can you elaborate? 

WM: With pleasure. I feel like I have been very fortunate during my career as an anaesthesiologist (to date!) and have worked with many amazing and supportive colleagues. However, looking back, there have been challenges. Soon after my family and I arrived in Fiji, there was a military coup – the government was held hostage for almost two months, martial law was declared, and there was a lot of instability over six months, including a military mutiny. The health system was put under huge pressure, and it was a challenging place to work. 

We also faced challenges at work and home in my city Christchurch. In 2010-2011, the city suffered a series of devastating earthquakes which had a dramatic effect on our hospital, and in 2019, we had to deal with a terrible terrorist attack at two mosques in the city. 

GG: There is no doubt that during your long career as an anaesthesiologist you have been involved in the education and mentoring of younger generations. Can you offer us some details regarding this activity? 

WM: Teaching has always been a big part of my career. I have lectured or taught in over 60 countries around the world, as well as teaching medical students, anaesthesiology trainees, and other healthcare workers in Christchurch. 

My mentorship roles have sometimes been formal, but mostly informal. I am now getting to the stage in my career when colleagues (anaesthesiologists and non-anaesthesiologists) often remind me about some teaching or ‘life advice’ I gave them, often many years previously. It’s always gratifying to find out that your teaching or advice has been remembered – and it has had a positive impact.  

GG: Question: For sure, your former trainees remember a lot of the advice you offered them all your long career. But do you remember everything you taught them?! 

WM: A lot! 

GG: Now is the time to switch to the aspects related to WFSA’s activities and projects. For instance, what do you think are the organisation’s main achievements? 

WM: WFSA’s main achievement is to be a unifying organisation for our global specialty. This has become particularly apparent during the last decade. 

WFSA played a key role in creating awareness about the vital role of anaesthesia and surgical care play in universal healthcare delivery. WFSA continues to be a strong and essential advocate for our specialty. We have also consistently provided high-quality educational resources for colleagues all around the world. WFSA has played an essential role in developing leaders and teachers, especially in countries with limited resources. 

GG: Since you mentioned the WFSA role in countries with limited resources, do you think that some of its activities are influenced by cultural and resource differences? 

WM: There are huge disparities in resourcing for our specialty around the world. The Lancet Commission on Global Surgery found that 5 out of 7 billion worldwide do not have access to safe affordable surgical care and anaesthesia when needed.  This lack of access mainly occurs in countries with limited resources. The WFSA Global Anaesthesia Workforce Survey also showed massive disparities in workforce numbers. However, in my experience, despite these differences, anaesthesiologists from different cultures living in different countries and different regions share similar concerns – such as workforce shortages, scope of practice issues, workforce wellbeing, and how to provide the best care for patients when the money is limited. Overall, resourcing differences seem to be a more important factor than cultural differences. However, we all share many of the same fundamental concerns. Massive disparities in resourcing remain, but effective advocacy and improved training are making a difference. 

GG: During all this time when you were involved in the WFSA activities, what were its key moments of decisions? 

WM: Probably the most important moment was the decision to form WFSA in 1955, seventy years ago. This was a farsighted and progressive moment that has had far-reaching benefits for our specialty over subsequent decades. 

Since 2008, when I became directly involved in WFSA, there have also been key moments and decisions. These include the decision to appoint our first CEO in 2013 and the subsequent restructuring of WFSA, and our involvement with the Lancet Commission on Global Surgery. We also played a key role in ensuring that Resolution 68.15 on strengthening surgical care and anaesthesia was passed by the World Health Assembly in 2015. 

There were many key decisions during the COVID-19 pandemic that allowed us to ‘weather the storm’ and helped WFSA to become a more flexible, modern organization. 

GG: Can you be so kind as to explain what value our world organisation is bringing to its members? 

WM: WFSA offers multiple benefits for Member Societies and individual anaesthesiologists, and we need to continue to remind our members of these benefits. In the year of 2023, we wrote and circulated a document entitled: The Value of Your Federation. Just a few examples of benefits include: 

For Member Societies: 

• Advocacy at WHO and government level 

• Connection with a global network of Member Societies and other organisations 

• Promotion of Member Society conferences and other activities 

 For individuals: 

• WFSA Fellowships and Scholarships 

• Training courses, such as SAFE and EPM. 

• Anaesthesia Tutorial of the Week, Update in Anaesthesia 

• WFSA Mentorship Programme 

GG: Indeed, this is a very impressive list, and I am sure that both Member Societies and individuals are aware of these benefits and permanent help. By the way, did you start your activity with your own Society? 

WM: Yes, I am a longstanding member of the New Zealand Society of Anaesthetists (NZSA). I am also a member of the Pacific Society of Anaesthetists, a Fellow of ANZCA, and a past member of the Australian Society of Anaesthetists.  

Here is a summary of my activities at the level of my Society: I was the inaugural Chair of the NZSA’s Overseas Aid Subcommittee (now Global Health Committee) and the inaugural Chair of ANZCA’s Overseas Aid Committee (now Global Development Committee). 

GG: What was the incentive that lead you to seek a position at WFSA? 

WM: After returning to Christchurch from Fiji, I remained heavily involved in educational work in the Pacific region and further afield. I was encouraged to apply for membership of the Education Committee and was appointed in 2008. 

I was a member of this Committee till 2012, and then I chaired it (2012-2016). 

GG: Any other leading activity? 

WM: Here is the list: 

• Member of WFSA Board, WFSA Council (2012-2024) 

• Director of Programmes (2016-2020) 

• President-Elect (2020-2022) 

• President (2022-2024) 

GG: Indeed, you fulfilled very important positions and tasks in the framework of the federation. Can you tell us what is the most important achievement or contribution at WFSA you are proud of? 

WM: It’s difficult to identify and single achievement or contribution, so will list several: 

• Restructuring and modernisation of WFSA during the period 2012-2024 (included the decision to recruit a CEO and grow the Secretariat, development of a clear vision and mission for the organization, development of comprehensive strategic plan, and revision of the Constitution) 

• Expanding WFSA’s Fellowship Programme during my time as Chair of the Education Committee. 

• Improved engagement with Member Societies during my time in the WFSA leadership, including face-to-face and virtual meetings with societies, and a strengthening of online resources. 

• Becoming a more effective advocacy voice for our specialty at the global level. WFSA’s position statement on Universal Health Coverage (which I presented at the WCA in Hong Kong in 2016) was a key part of this. We also played a vital role in work related to WHA (World Health Academy) Resolution 68.15 on strengthening surgical care and anaesthesia, and the Lancet Commission on Global Surgery. 

• Co-authoring two key papers – the WFSA Global Anaesthesia Workforce Survey and the WHO-WFSA International Standards for a Safe Practice of Anaesthesia. 

GG: Dr Morriss, we are approaching the end of our interview. Please take a look into WFSA’s future and tell us how do you see the federation in the next, let’s say, 25 years? 

WM: We have a strong foundation to develop and strengthen our 3 key work areas – advocacy, education and working together. The role of anaesthesiologists is not always well understood, and WFSA needs to continue to advocate strongly for our specialty – for colleagues everywhere. Despite differences in geography and resourcing, anaesthesiologists around the world share many of the same concerns, and it vital that we continue to be united by WFSA. 

WFSA needs to be seen as the ‘go to organization’ for educational resources – where colleagues around the world can find high-quality, free and comprehensive resources. Finally, WFSA needs to continue to develop a true global community where colleagues everywhere share, learn and grow together. The World Congress will continue to be the premier global meeting of our specialty. 

GG: What should be kept? 

WM: I think that the most important items to be continued are: 

• Fundamental structure, vision and mission of WFSA – a professional membership organisation, the global voice of our specialty. 

• Freely available educational resources, with a focus on colleagues working in countries with limited resources. 

• Fellowships and other programmes which help develop leaders and teachers. 

GG: And should be changed? 

WM: Here is, in my opinion, the short list of things which are to be re-assessed and re-discussed by our future leaders: 

• Greater resourcing to run a more inclusive, predictable, two-yearly World Congress. 

• Increased funding, especially unrestricted funding from donors, to allow development of key projects. 

• Possible changes to the Secretariat structure so WFSA has regional hubs 

GG: And now my last question: Whats hould be the main WFSA focus in the next quarter of a century? 

WM: I really like WFSA’s mission: To empower anaesthesiologists around the world to improve patient care. From talking with anaesthesiologists in different parts of the world, the mission also resonates with them. 

It is essential that WFSA always focuses on how anaesthesiologists can provide the best possible care for patients. Leadership and workforce development are central to this. WFSA will continue to play vital in developing and supporting leaders, especially in low-resource countries, but anaesthesiologists everywhere need to work together to ensure that we are leaders in healthcare delivery. 

In short, WFSA needs to continue to work with Member Societies to strengthen leadership of our specialty and ensure a well-trained and resilient workforce. 

GG: Dear Dr Morriss, thanks a lot for your very interesting answers and for your important advice regarding the future of the WFSA. I wish you all the best and hope to meet you sometime at a future World Congress. 

WM: Thank you, Dr Gurman, for this opportunity to present some of my views about our specialty and the future of our federation. All the best. 

GG: Hello, Dr Nuevo. I am very glad to have this opportunity to speak to you, this time with the aim of discussing some aspects related to the 70th anniversary of WFSA.

FN: Good morning, Dr Gurman.

GG: First of all, let us know where and when you got your MD diploma?

FN: I graduated in 1981 from the University of Santa Tomas Faculty of Medicine and Surgery in Manila, the Philippines, by the way with Latin honours “Magna cum laude”.

GG: Congratulations. And what brought you the decision to select anaesthesiology as your future specialty?

FN: I would say that what made me interested to take up anaesthesiology is my realization that I finished my medical school career WITHOUT having a full understanding of what anaesthesiology is all about. Hence, it is the ‘search for further knowledge and skills’.

This was triggered by my personal experience during our mandatory one-year service to aid the underprivileged Filipinos way back in 1982. At that time, President Ferdinand Marcos Sr. mandated that all medical graduates must first serve the country after they quality from the Philippine Medical Licensure Examinations. No public service, no granting of license to practice medicine. So, I went back to my hometown, 50 km north of Manila city and served in the Municipal District Hospital.

I was on duty and evaluated a 6-year-old boy with abdominal pain and gave a clinical diagnosis of ‘acute appendicitis’. I was so glad to be able to give the right diagnosis, for which the Senior Municipal Officer commended me. He was scheduled for emergency appendectomy, and another doctor was called to give anaesthesia. Sadly, this doctor refused to handle the case, since he claimed he could only administer anaesthesia to adults, particularly spinal anaesthesia, and he had no competence to give anaesthesia to a child because he had only had 6-months training in anaesthesia. Hence, this child was moved by ambulance to another town, 15km away, for proper surgical management in the Bulacan Provincial Hospital. It dawned on me that my medical training was incomplete, because I could not deliver anaesthesia care, even if I could do a normal spontaneous delivery, or recognize and manage patients in heart failure, or give good differential diagnosis for cases that come my way.

But with anaesthesiology, I only knew the drugs, anesthetics, and how local infiltration anesthesia worked. I never really got to know and understand, nor appreciate, the work of an anaesthesiologist, a much needed specialist in the surgical team. So after my one-year service, I applied for a residency in anaesthesiology at the University of Santo Tomas Hospital, for a full three year course. My professors were astonished that I chose this when they wanted me in Internal Medicine, in Obstetrics, in Paediatrics, and other disciplines. I was even told that I am wasting my time and career opportunities by going into anaesthesiology.

These comments further challenged me and convinced me that many professionals did not appreciate the value of an anaesthesiologist. So, I never looked back, nor did I regret being in the anaesthesiology residency programme. I graduated from my residency in 1986 and did further subspecialty training in thoracic and cardiovascular anaesthesia through preceptorship/ observership programmes abroad.

Currently, I am still in active clinical anaesthesia practice at the Philippine Heart Center (PHC) and at the University of Santo Tomas Hospital (USTH).

GG: I can imagine that you had some mentors and seniors, who inspired you to become a specialist in anaesthesiology.

FN: During my residency training, I was inspired by Dr Romarico D Suarez, who was part of the historical first open heart surgery (ASD Repair) done by Dr Denton Cooley. Despite being locally trained, he engaged himself in continuing professional development by attending conferences and personally subscribing to journals and books in anaesthesiology. He was also good as an administrator and as a teacher/mentor. After qualifying as a Diplomate in Anaesthesiology in 1988 from the Philippine Board of Anaesthesiology, where I needed to pass three phases of examinations (a comprehensive written examination, an oral examination and a practical examination), I was invited by another professor from the University of the Philippines to become a member of the National CME Committee of the Philippine Society of Anesthesiologists (PSA). It is at PSA, where I met Prof Quintin J Gomez, who has been a WFSA President. He has been called the Father of Anesthesiology in the Philippines.

There are many other pioneering Filipino anesthesiologists who inspired me as well. As early as my first-year residency in 1983/84, I participated in the oral free paper presentation at the 1981 World Congress of Anesthesiologists hosted by our national society – the PSA. After my residency, I pursued presenting my research papers at the ASEAN Congress of Anesthesiologists that is regularly organized by CASA (Confederation of ASEAN Societies of Anesthesiologists) and other international anaesthesia congresses hosted within the Asia Pacific region. In these various anaesthesia congresses, I got more inspired by many other pioneers in anesthesiology. I personally got acquainted with Dr TC Kester Brown, Dr Carlos Parsloe, Dr Saywan Lim, and Prof Ronald Miller, and other leading personalities.

GG: By the way, many years ago I had the opportunity to meet Professor Quintin Gomez during his visit to Israel. I was deeply impressed by his cleverness and enthusiasm regarding our common specialty.

Dr Nuevo, it is a long time since you started your career as an anaesthesiologist. Can you share with us your feelings and impressions about the advancements or shifts in current practice during these years?

FN: My personal appreciation of anaesthesiology as a specialty or discipline is that anaesthesiology is the application of my knowledge in internal medicine, obstetrics, paediatrics and surgery during a surgical /obstetrical procedure. It is like the practice of clinical medicine during a specific surgical environment – whether elective or emergency in nature. And most of all, the anaesthesiologist TODAY must assume another role, which is as a perioperative physician.

During my training and my early years of clinical practice, the anaesthesiologists needed to rely on their personal vigilance and clinical acumen when it came to patient monitoring. The most sophisticated monitor we had in the 1980s was an ECG monitor and it would rarely be available separately from a cardiac defibrillator. So, it is the introduction of basic monitoring standards – particularly the pulse oximeter – that improved the delivery of anesthesia care. The emphasis placed by WFSA on patient safety through better patient monitoring, particularly oximetry, paved the way to safer care during anaesthesia. I became part of this WFSA Global Oximetry Project.

In addition to patient monitoring, the advancement in anaesthesia machines that allow low-flow or close circuit general anaesthesia techniques, use of mixed air and oxygen, and the availability of Target Controlled Infusion (TCI) pumps that allowed Total Intravenous Anesthesia (TIVA) techniques. And lately, with the introduction of ultrasonography in regional anaesthesia procedures, which I used to perform using surface landmarks +/- nerve stimulators, and even the use of ultrasound in vascular access, anaesthesia management have improved by leaps and bounds, coupled with the availability of better anaesthetic agents and essential cardiovascular or support drugs to tie over the sickest surgical patient at hand. Today, I would never proceed with any sedation or anaesthesia care, without a pulse oximeter, at least, attached to the patient.

GG: The next question is an important one: What challenges have you faced in our professional career and how did you address these?

FN: Very early in my career, I faced the challenge of NOT being able to make an independent decision on the anaesthesia plan for a patient. Oftentimes, you heard a surgeon suggesting that the intervention should be done with spinal anesthesia or general anaesthesia, and for the internist to make notations on the patient chart on how to proceed with your premedication or sedation or anaesthetic care. I realized that surgeons did not treat anaesthesiologists with the equal respect that they would render to other disciplines.

My term of office with the Philippine Society of Anaesthesiologists lasted for ten years, rising from the ranks until I assumed the presidency in 1999. I was also Chair of the National CME Committee for four years, and this gave me the opportunity to re-introduce “anaesthesiology as a distinct specialty” amongst the various medical disciplines. This, I would say, was the best strategy. I had to turn the table in order for anaesthesiologists to earn the respect of other specialties in medicine. I organized regular ‘joint forum’ or joint CME activities with other specialties – surgeons, obstetricians, paediatricians, and family medicine practitioners – at various regions of the country, using the existing structure of the chapters of the Philippine Medical Association and other national specialty organizations, and tied this up with our existing anaesthesia regional chapters as well.

This led to face-to-face interactions, conversations, debates, and more importantly camaraderie and fellowship activities. Through consistent anaesthesia CME activities, we, as a Society, gained the respect of our specialty, and it became clear how essential the role of a competent anaesthesiologist is in ascertaining good patient outcomes.

We also launched collaborative programmes in health care delivery where challenges are met. The Department of Health (DOH) and the Philippine Regulations Commission (PRC) started to engage with our Society in many important matters related to patient safety, healthcare delivery and professional regulatory concerns.

GG: I completely agree with you. These kind of things have been part of our professional reality for many years, in countries all over the world. I should congratulate you on the successful campaign in this direction.

And since WFSA played, and still plays, an important role in the perennial activity of improving the image of the anaesthesiologist in the eyes of our peers, could tell us about the main achievements related to your own activity at WFSA and which you are most proud of?

FN: One of my defining moments as an anaesthesiologist and as a leader was when I was elected as Chair of the WFSA Executive Committee (EXCO) in 2008. However, the more momentous event was when I bid farewell to my colleagues, at the end of my term and after losing the election for the WFSA Presidency. I was so moved when all the EXCO members present at that time gave me a standing ovation. I felt their love for me and the deep appreciation for the hard work and dedication I had shared with each one of them in their respective projects, and with WFSA in general. My greatest achievement at WFSA was to see success, not for my personal gains, but success in the advancement of various WFSA projects and the palpable engagement and cohesiveness amongst the 22 EXCO members, as I ended my term as Chair of EXCO.

GG: Dr Nuevo, I am sure you been involved in teaching or mentoring the next generation of anaesthesiologists. What has that experience been like, and what advice do you have for young professionals entering the field?

FN: Yes, I have been involved in teaching and mentoring the next generation of anaesthesiologists. I have been a Training Officer (2005) and served as Department Chair (2012-2020) at UST Hospital. I also served as Division Chief of Cardiovascular Anaesthesia Division of the Philippine Heart Center (2019- 2021) It has been a very rewarding experience, seeing that the trainees who I was privileged to have taught, mentored and worked with, all have turned out to be successful in their chosen anaesthesia subspecialties. A good majority of them have become anaesthesia leaders themselves in their respective workplaces.

Now, in my seventies, I still get the chance to meet the new generation, from millennials to gen Z, and find conversations with them to be interesting, seeing their different perspectives of work and life, very much apart from the baby boomers. Communication is key, and being attuned with digital technology helped me cherish those opportunities of learning and teaching across generations.

GG: Given your international experience, what have you learned about the practice of anaesthesiology in different cultural or resource contexts?

FN: The first lesson is the value of sincere communication and respect for individual and cultural differences. During my stint as Chair of the WFSA Executive Committee, I was able to engage representatives of the various national societies into open communication. WFSA is the great equalizer across all national anaesthesia societies. We freely engaged in debates and found common ground to move the organisation forward. This led to revisiting the WFSA Statues and Bylaws, formulating the WFSA Mission and Vision Statements, recognising additional regional sections such as SAARC, looking seriously into succession planning by having a President-Elect position, and elevating a number of working groups into WFSA Standing Committees. This included the Safety and Quality of Practice Committee and the Professional Wellbeing Committee.

GG: We would like to get more information about how you got engaged in anaesthesiology professional activities. Can you elaborate?

FN: I was fortunate to have had several opportunities to meet many outstanding anaesthesiologists and participate in carious anaesthesia activities, because of the positions I held in the past, as follows:

• 1999 – 2001: Chair, Confederation of ASEAN Societies of Anaesthesiologists
• 1998 – 2002: Board Member, WFSA Asian Australasian Regional Section 2002 – 2006: Chair, Asian Australasian Regional Section
• 2004 – 2008: Deputy Chair, WFSA Executive Committee
• 2008 – 2012: Chair, WFSA Executive Committee

While working on WFSA education activities in the Pacific, I was able to encourage anaesthesia care providers across the six islands in the Pacific region to coordinate as one group under the Micronesia Anaesthesia Society.  

My engagements with other societies such as the Association of Anaesthetists of Great Britain and Ireland mostly centered on WFSA activities which were led by their members. I have fond memories working with Roger Eltringham (on publications and anaesthesia equipment), David Wilkinson (Statutes & Bylaws, WFSA EXCO), Iain Wilson (Publications, ATOTW), Isabeau Walker, Ellen O Sullivan, David Whitaker and Gavin Thoms (all as part of the global oximetry programme).

GG: Now, a personal question. Why did you want to get involved in the WFSA activities?

FN: I got involved in WFSA not by intention, but through an opportunity given to me.

My initiation into WFSA came in 1998 when I was nominated by Dr Manuel V Silao to the Asian Australasian Regional Section and was elected as Board Member of that for 1998-2002. At that time, I was Vice-President of the Philippine Society of Anaesthesiologists (PSA) and Chair of our National CME Committee. I stayed with WFSA from 1998 to 2012, fourteen years of commitment and joyful dedication to the mission of the Federation. I found WFSA to be a progressive organisation and sincere in its concern to advance the specialty as well as improve patient outcomes through improvement in anaesthesia services across all nations.

Sadly, I lost the election to WFSA Presidency in 2012 to Dr David Wilkinson (the then WFSA Secretary).

While many had advised me not to run and simply ‘toe the line’ so I could become president in time, I declined and wanted to prove my point that the current state of affairs needed change, so that WFSA could keep the engagement of committed members with equal opportunities. I have no regrets, because it was time for me to go back and serve my colleagues in the country.

GG: I really appreciate your ‘stubbornness’, it significantly contributed to the Federation’s achievements and I am sure that it gave you a lot of satisfaction. Now, coming back to your own involvement with WFSA, what has been the most valuable part of your engagement?

FN: I would consider this to be my term as Deputy Chair (2004-2008) when Anneke Meursing was President and when I was Chair of the WFSA Executive Committee with Angela Enright and with Jannicke Mellin-Olsen. We were the only three female officials at that time (2008-2012).

Even as a Deputy Chair, I was actively engaged since our Chair, Dr Mohammed Takrouri, found it challenging to be physically around in the conduct of our roles and responsibilities. Then, during my term as Chair of WFSA EXCO, the organisation embarked on many ground-breaking initiatives like the ‘global oximetry project’, engaging with WHO, advancing the ‘training the trainees’ programme across all regional sections, and also revisiting our statues and bylaws.  

GG: Are there any particular experiences or memories that stand out from your work with global health and WFSA?

FN: I would say that the most outstanding work we had during the time I was with WFSA is the Global Oximetry project, whereby we need to conduct research and also educational activities at various points where anaesthesia delivery was not yet so well-developed. At that point, there was yet no proof that pulse oximetry could save lives. And that was very challenging to prove.

GG: Dr Nuevo, looking back to WFSA history, can you recall any key moments or decisions in the history of WFSA that you believe were particularly impactful for the organisation or the field of anaesthesiology?

FN: A key moment in the history of WFSA is when we took on leadership in the creation and development of the WHO Surgical Safety Checklist which was introduced in 2008. WHO recognized the value that WFSA brought in the realisation of its ‘Safe Surgery Save Lives’ programme.  Hereon, WFSA participated in the World Health Assembly and we became one of the bona fide leaders in global health

GG: A final question. What do you think is the value that WFSA brings to members?

FN: As I have mentioned earlier, WFSA is the great equalizer amongst all the world’s national societies of anesthesiologists. In WFSA, we stand equal, shoulder-to-shoulder, with the most advanced societies, and with those who have barely started to organise themselves. The WFSA mission of ‘Uniting and empowering anaesthesiologists around the world to improve patient care’ must be made known to every anaesthesiologist and made alive in each one’s heart, so that ultimately the WFSA vision of ‘Universal access to safe anaesthesia’ can be realized.

GG: Dr Nuevo, it was a real pleasure to talk to you. You brought to our readers some important thoughts and data about your and WFSA achievements during this long period of time.

FN: Thank you, Dr Gurman, for this opportunity to share my thoughts with you.

GG: Good morning, Dr Onajin-Obembe. I am very glad to have the opportunity to interview you on the occasion of the 70th anniversary of WFSA, an organisation in which you have invested so much energy and initiative. 

BO: Thank you for contacting me. 

GG: The aim of this interview, I would say, is to get some data about your career and contribution to the success of WFSA. So, let’s start with the beginning: Tell us about your early medical career, where and when did you start? 

BO: I earned my medical degree (MBBS) from Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria in 1988. I later pursued residency training in anaesthesia at Lagos University Teaching Hospital (LUTH), Lagos State, from 1995 to 2002, culminating in board certification as a Fellow of the West African College of Surgeons (FWACS) in Anaesthesia. 

In July 2002, I joined the University of Port Harcourt Teaching Hospital and the University of Port Harcourt as an Honorary Consultant Anaesthesiologist and Lecturer—marking the beginning of a new chapter in both clinical service and academic mentorship. 

GG: Here it is a question which might interest our younger colleagues: Why did you choose anaesthesiology as your future specialty? 

BO: I initially chose anaesthesiology under the impression that it was a relatively easy specialty—but I soon discovered its depth, intensity, and complexity. That realization transformed my curiosity into a deep respect for the discipline and a lifelong commitment to mastering its challenges. 

GG: Have you been influenced in your professional career by any mentors? 

BO: This question demands a long answer! 

 I’ve been fortunate to have many mentors throughout my career, but two stand out as foundational influences: The late Professor Dorothy ffoulkes-Crabbe and Professor Olushola Kushimo, both of whom I had the privilege of learning from at LUTH.   

Professor ffoulkes-Crabbe inspired me through her remarkable leadership in both academia and professional societies. As President of the West African College of Surgeons (1991–1993), and later as the driving force behind the creation of WFSA’s African Regional Section in Harare, Zimbabwe in 1997, she served as Chair of the inaugural ARS Board from 1997 to 2001. Her visionary dual engagement left a lasting impression on me.   

Professor Kushimo, my guide in paediatric anaesthesia, was also chief supervisor for my fellowship thesis under the West African College of Surgeons. Her rigorous teaching and personal investment in my growth were instrumental in shaping my clinical and academic journey.   

Both women made a deep and enduring impact on me—not just professionally, but personally. 

One of the defining moments in my medical career came in 1997, when I discovered I was expecting my third child while preparing for the Part 1 examination of the West African College of Surgeons. Overwhelmed, I found myself in tears in Professor Kushimo’s office, unsure how I would navigate the demands of motherhood and rigorous professional exams. She looked at me and said, ‘God gives grace.’ That phrase became my anchor. 

Five days after sitting for the exam in May 1998, I gave birth. That season taught me that excellence does not always come from perfect circumstances—it often rises from quiet endurance, faith, and the support of mentors who speak strength into our moments of doubt. Professor Kushimo’s affirmation stayed with me, and today I carry that grace into every mentoring relationship I hold. 

GG: You have almost 30 years daily involvement in anaesthesia practice. This means that you have accumulated a lot of experience. Can you tell us how you judge the present status of our common specialty in comparison to the time when you started practicing it? 

BO: For me, anaesthesiology has always been shaped by personal vision and purpose—what you put into it is what you gain.  

Residency training in the early 1990s was rigorous; my colleagues and I approached it with deep focus and a strong commitment to self-directed study. At LUTH, the culture of learning was immersive. We engaged in disciplined reading, research, and presented regularly at clinical meetings—where we were rigorously cross-examined and challenged to sharpen our thinking. In the operating room, learning was hands-on and immediate. We relied on peer guidance and worked diligently to become confident and competent enough to manage surgical lists independently. 

I vividly recall volunteering for complex and rare procedures, like the separation of conjoined twins, even when I wasn’t scheduled—driven purely by the desire to learn. Workload was never a complaint; it was simply part of the commitment to mastery. 

Today, learning is more accessible than ever. Advances in technology and digital content allow us to acquire knowledge and skills online, without being physically present in a seminar room or operating theatre. Hands-on training can now be simulated on mannequins, a significant shift from my earlier days when practical experience meant working directly with live patients. 

The COVID-19 pandemic accelerated the shift to virtual learning, making webinars and remote participation the norm. Today, we’ve transcended geographic boundaries—connecting to meetings, webinars, and conferences from anywhere across the globe. 

While remote learning offers incredible opportunities, anaesthesia and the perioperative care of surgical patients remain inherently hands-on. These critical practices cannot be performed virtually—they demand physical presence and real-time experience in clinical settings such as the operating room and intensive care unit. 

GG: I completely agree with you. Today simulation occupies an important place in the residency training, and not only. This is a very effective method of keeping one’s manual ability and clinical judgement. Dr Onajin-Obembe, can you describe your own achievements as an anaesthesiologist? 

BO: I have earned recognition as a prominent leader and advocate for anaesthesia in Nigeria, across Africa, and on the global stage. Within the Nigerian Society of Anaesthetists, I progressed through key leadership roles—including Public Relations Officer, General Secretary, Vice President, and ultimately President. I also led the WFSA African Regional Section (ARS) as its President and proudly hosted the 6th All Africa Anaesthesia Congress in Abuja, Nigeria, in November 2017. 

I served as a WFSA Council Member from 2016 to 2024 and held a Board position for three years during that period. Since 2015, I have been the permanent representative of the Nigerian Society of Anaesthetists to the G4 Alliance, where I have held various leadership roles—including Permanent Council Secretary and, most recently, Permanent Council President from 2022 to 2024. 

My academic journey includes over 70+ publications in both national and international journals, alongside more than 80+ conference presentations. I had the distinguished honor of delivering the Sir Robert Macintosh Lecture at the Euroanaesthesia Congress in Munich, Germany, in December 2021. More recently, I was named the Kester Brown Lecturer at the Australian Society of Anaesthetists’ National Scientific Congress (ASANSC) held in Darwin, Australia in September 2024. 

My focus in anaesthesiology has evolved over the years in response to emerging areas of need and development.  

At UPTH (University of Port Harcourt Teaching Hospital) I pioneered the Paediatric Anaesthesia Unit and established specialized services for head and neck procedures—including maxillofacial, ENT, and ophthalmology. I also co-designed the Smile Train–sponsored Basic Pediatrics and Cleft Lip Programme under the West African College of Surgeons. 

My advocacy journey was sparked by the findings of the Lancet Commission on Global Surgery in 2015. Recognizing the critical knowledge gap surrounding anaesthesiology within the broader healthcare system motivated me to pursue leadership in management and implementation-focused initiatives. 

It was a privilege to pioneer anaesthesia training programme at the Federal Medical Center, Abuja in 2016; a model built on implementation action research methodology. Beginning with a modest diploma in anaesthesia, the programme has steadily evolved into a fully accredited residency training programme. I look forward with pride and anticipation to celebrating its tenth anniversary in 2026. 

From 2017 to 2023, I served as Workforce Lead at the Federal Ministry of Health in Nigeria, where I partnered with clinical and research experts to design strategic frameworks that shaped surgical care nationwide. This included the development of Nigeria’s five-year National Surgical, Obstetric, Anaesthesia, and Nursing Plan (NSOANP), as well as the Strategic Priorities for Surgical Care (StraPS) and implementation plans for 2019–2023. 

I am proud to have founded Global Anesthesia Initiatives, based in Texas, USA—an organisation dedicated to addressing the global anaesthesia workforce shortage by fostering collaborative partnerships and establishing training programmes in underserved regions. 

GG: Indeed, avery impressive list of activity! Having been involved in so many projects, can you tell us something about the biggest challanges in your career? 

BO: One of the most profound challenges I have faced in my career is the widespread lack of understanding around health systems and how this affects the delivery of anaesthesia. A functional anaesthesia service relies on timely access to essential drugs, appropriate equipment, reliable maintenance, supply chain logistics, and ongoing biomedical support. The absence of these critical components often renders anaesthesia practice frustratingly difficult. 

Another major obstacle is the absence of a structured workforce pipeline. Addressing the anaesthesia workforce crisis requires a consistent influx of trainees to sustain and replenish the field as seasoned providers retire. Unfortunately, anaesthesia training programmes have struggled to attract young doctors, leaving significant gaps in service capacity. 

Workplace culture and geography present further barriers. Anaesthesiologists working in isolated or toxic environments often face professional stagnation and feel undervalued, regardless of their accomplishments. This persistent lack of recognition contributes to emigration and intensifies the brain drain affecting Nigeria’s healthcare sector. These interconnected challenges—systemic, cultural, and structural—create considerable difficulty in scaling up anaesthesia services in underserved regions. 

GG: I can imagine that you had many trainees working near you and being educated by you. Can you elaborate about this important task? 

BO: Throughout my career, I have had the profound privilege of serving as a role model and source of inspiration to medical students, residents, and colleagues alike. My teaching philosophy is rooted in student-centered learning. I strive to help learners internalise and consolidate knowledge, guiding them toward their ‘sweet spot’ where understanding becomes personally meaningful and professionally empowering. I make it a priority to connect with my students within the first ten minutes of a lecture, cultivating a warm and engaging  environment. This sets the tone for active participation, curiosity, and deeper learning. 

Inspired by Gardner’s theory of multiple intelligences, I deliberately employ diverse instructional methods to reach a broad spectrum of learners. My goal is not just course completion, but joyful, memorable, and lasting comprehension. I encourage students to take ownership of their learning—searching for answers, sharing discoveries, and exploring new ideas together. Mentorship is profoundly personal to me. I consider each mentee a divine responsibility—an opportunity to nurture the whole person: body, mind, spirit, and soul. I speak life into them, celebrate their victories, and stand by them through every season. I pray for them and treasure their growth, both professionally and personally. 

I am especially grateful to my four stellar academic mentees, who completed their anaesthesia residency at UPTH: Dr Emem Abang Ating, Dr Chimaobi Nnaji, Dr Eze Okubuiro, and Dr Benson Ezeobika. Our collaboration on their WACS theses was deeply rewarding; they allowed me into their lives and learning processes in ways that truly shaped our shared experience. 

I deeply appreciate my life mentee, Dr Durotoluwa Adeleke, now based in Canada. Since our first meeting in South Africa in 2020, I’ve been a part of her journey—as a female anaesthesiologist, a wife, and a mother. She also serves on the Board of Global Anesthesia Initiatives, a testament to her continued growth and leadership. 

Several of my mentees began their journeys as medical students, many of whom have now graduated. I’m proud of Dr Israel Itodo, a medical graduate from the University of Port Harcourt, who earned a distinction in Preventive and Social Medicine. In 2021, he led the initiative that brought 11 final-year medical students to the World Congress of Anaesthesiologists (WCA)—a powerful act of peer-led advocacy.  

Equally inspiring is Dr Ekene Ahaneku who in 2022 launched a leadership mentorship programme for medical students across Nigeria. From that cohort, my star mentee, Michael Erhayannem, continues to chart his career journey with promise and purpose. And now, in a beautiful turn of events, many of these young doctors are reverse mentoring me. It is the ultimate honor. 

While I am deeply invested in the success of every student and resident, I hold firm to the values of integrity and professionalism. I do not tolerate shortcuts, malpractice, or dishonesty. Excellence must be grounded in ethical practice. I recognize that setbacks, like failing professional exams, are painful yet invaluable moments in the journey. They offer opportunities to reassess, learn deeply, and grow stronger. As a mentor, I remain committed until my mentees succeed. 

Ultimately, I believe every individual is intelligent. The key is discovering one’s unique learning style and harnessing it. 

GG: No question, your longtime activity at the WFSA  offers you a chance to have a good idea – based on facts – about the achievements of this world organisation. 

BO: WFSA has grown remarkably stronger over the years, with adaptability and innovation at the heart of its evolution. Whether by design or circumstance, WFSA has continually transformed its operations—including the historic move to elect two Presidents serving concurrently, exemplifying shared leadership. Another bold stride is the reimagining of the World Congress, now held biennially and alternating between high-income and low- and middle-income countries to foster inclusivity and global engagement. 

It is truly inspiring to witness WFSA’s resilience and unity over 70 years. Its governance structure has matured over time, responding thoughtfully to changing contexts. I am especially proud of the Federation’s decisive action during the COVID-19 pandemic—organising the first-ever virtual World Congress, a powerful demonstration of strategic risk management and commitment to continuity in challenging times. 

GG: Looking back on WFSA projects and activities, do you think that they are influenced by cultural and resource differences? 

BO: WFSA has made deliberate efforts to mitigate socioeconomic and resource disparities across the global anaesthesia community; offering conference fee discounts, providing scholarships, and sponsoring trainees to foster inclusivity. Its commitment to diversity, equity, and inclusion has encouraged broader participation and engagement from anaesthesiologists worldwide. 

Despite these commendable strides, growing resource gaps continue to present challenges. For many national societies in low- and middle-income countries, meeting membership obligations has become increasingly difficult—exacerbated by currency devaluations and unfavorable exchange rates. This widening financial divide underscores the urgency for more adaptive, equitable solutions, especially as economic pressures intensify in already vulnerable regions. 

GG: Let’s go further. What are – in your opinion – the key moments of decision in WFSA’s history? 

BO: The COVID-19 period and the reorganisation of the World Congress was historical. The use of technology to achieve this was amazing. Now WFSA is able to host virtual meetings and to keep the collaboration active. 

GG: And what value does WFSA bring to its members, Societies and individuals? 

BO: Having a unified umbrella like WFSA is truly invaluable for national anaesthesia societies. It offers a global platform to harness collective expertise, foster cross-border collaboration, and amplify the voices of individual member societies. By leveraging shared knowledge and best practices, WFSA has become a powerful catalyst for professional growth, advocacy, and innovation—bringing lasting benefits to anaesthesiologists around the world. 

GG: Coming back to your own activities at WFSA, here is an interesting point: Did you start your public activity with your own Society? 

BO: Indeed. In 2008, I represented the Nigerian Society of Anaesthetists (NSA) as an official delegate to the WFSA General Assembly during the World Congress in South Africa. Attending meetings alongside NSA President Dr Olaniyi Oladapo provided me with invaluable insight into WFSA’s governance and global impact.   

 I have also had the distinct privilege of serving as a speaker at every World Congress since 2004; an enduring commitment that reflects my passion for advancing anesthesia education, advocacy, and international collaboration. 

GG: What led you to seek a position at WFSA? 

BO: My entry into WFSA leadership was entirely unplanned; it felt divinely orchestrated. During the African Regional Section (ARS) meeting at the WCA held in Buenos Aires in 2012, I was nominated to serve as interim Secretary/Treasurer due to the absence of the sitting officers. We were tasked with planning the 2013 All-Africa Anaesthesia Congress in Egypt, and I was entrusted with organizing the ARS General Assembly and overseeing the election of new board members.   

Although I had joined the ARS board in 2009, I had little prior knowledge of its workings. With generous guidance from Professor Arthur Rantloane of South Africa, we successfully revived the ARS and I was elected President in 2013. 

Later, while preparing for WCA 2016 in Hong Kong, Dr Gonzalo Barreiro reached out and encouraged me to apply for a WFSA Council Member position, even providing the application requirements.   

Were it not for the unexpected responsibility I took on in 2012 and the timely support in 2016, I may never have envisioned myself as part of WFSA’s leadership. These moments—both serendipitous and purposeful—shaped my trajectory in global anaesthesia advocacy. 

GG: What positions did you hold at WFSA? 

BO: Here is the list: 

• WFSA Board Member (2017, 2021 & 2022). 

• Member, DEI Committee (2020-2026). 

• Member, Professional Wellbeing Committee (2020-2024).  

• Council Member (2016-2024). 

• President, Africa Regional Section (2013-2017). 

GG: A very impressive list. What is the achievement or contribution to WFSA activities you are most proud of? 

BO: One of my proudest achievements at WFSA was the revitalisation of the African Regional Section (ARS) in 2013 and my commitment to ensuring its continuity. It took persistent outreach and coordination to engage national societies, but I was inspired by a memorable moment with the late Professor Kester Brown, who urged me to ‘hold Africa together’ and envisioned ‘one big African party.’ That vision became a driving force. I  am deeply gratified to see African anaesthesiologists now more actively participating in WFSA activities. A particularly meaningful milestone was Nigeria’s recognition as a fellowship training center for Paediatric and Obstetric Anaesthesia—an achievement that speaks to our growing influence and commitment to capacity-building. 

I am also proud to have encouraged Nigerian anaesthesiologists to pursue leadership by applying for committee memberships during the 2024 elections. And after a period of dormancy, the return of the South African Society of Anaesthesiologists to the ARS marks a renewed sense of unity and momentum for the region. 

GG: Dr. Onajin-Obembe, the time has come to end this interview, but not before discussing the future of our world organisation. Where do you see WFSA in the next – let’s say – 25 years? 

BO: In the next 25 years, I envision WFSA as a key driver of innovation in anaesthesia education—particularly in reimagining fellowship training. Rather than requiring fellows to spend an entire year abroad, WFSA could adopt hybrid models that blend 4 to 6 months of in-person training in the host country with virtual mentorship and clinical support back in the fellow’s home institution. As James Webb Young aptly said in 1940, ‘Innovative ideas happen when you develop new combinations of old elements.’ 

I see WFSA boldly breaking boundaries through tools like ‘fishbowl windows’—enabling real-time, virtual participation across continents. Picture a colleague in Canada observing or even collaborating in an operating room in Nigeria, and vice versa. As the landscape of medicine evolves, WFSA must also explore the transformative role of artificial intelligence in anaesthesia practice, training, and system design. Harnessing AI responsibly can help bridge gaps in care and create more personalized, efficient, and scalable anaesthesia solutions globally. 

GG: What should be kept? 

BO: The WFSA regional structure is a valuable asset. It functions well and serves as a strong foundation—but there’s room for thoughtful improvement 

GG: And what should be changed? 

BO: I would like to see WFSA’s African Regional Section (ARS) take greater ownership of its growth and operations, reducing its reliance on WFSA for financial and human resources. Strengthening internal capacity and leadership will be key. I would be delighted to see ARS evolve into a well-organized and self-sustaining entity. Although it took decades for national societies like the ones in the USA and Australia to mature, setting the growth and development of ARS as an aspirational goal is both timely and worthwhile. 

GG: Imagine that we will meet in a quarter of century from now (just a supposition, I am too old to stay alive for another 25 years!). What do you think should be the main WFSA focus in the future? 

BO: In the next quarter-century, WFSA must remain vigilant and responsive to global trends —political, economic, social, and technological – ensuring it evolves in step with the changing landscape of healthcare.  

Agility will be essential; the Federation must be willing to pivot boldly and timely to remain relevant and resilient—not unlike avoiding the fate of the dinosaurs. 

A key frontier will be the integration of artificial intelligence into anaesthesia practice, education, and systems. As AI technologies mature, WFSA has an opportunity to lead the conversation around their ethical, equitable, and effective application—particularly in settings where human expertise and digital innovation must co-exist to close care gaps. 

GG: Thanks a lot, Dr Onajin-Obembe, for this very comprehensive interview. I wish you all the best and ongoing success in your career. 

BO: My pleasure, Dr Gurman. 

GG:  Haydn, I am so glad to have once again the chance to contact you, after so many years of “no see, no hear, no speak…”. Today I would like to talk to you about WFSA, our common organisation, which recently celebrated its 70th anniversary.

HP: With pleasure. Go ahead.

GG: First, let me ask you about your early medical career, where and when did you get started?

HP: I graduated in 1977 from the University of Sydney School of Medicine. My career as a physician specialist in anaesthesia included a lot of places: Internship and residency at Canberra Community Hospital and at the Wooden Valley Hospital in Canberra, Australian Capital Territory (ACT), anaesthesia training in London, UK, with a Fellowship year in paediatric anaesthesia in Montreal, Canada. Finally, I spent two years as a volunteer with CUSO (Canadian University Service Overseas) on the island of Espiritu Santo in the South Pacific.

GG: Why did you decide to become an anaesthesiologist?

HP: For me that was a rather easy decision. Anaesthesia was the most appealing specialty after 24 months of rotating through a variety of different medical and surgical terms in Australia. The UK offered ready access to training opportunities in anaesthesia for Australian medical graduates. As you might know, Australia is a founding member of the modern Commonwealth.

GG: I can imagine that during your first years, there were many older colleagues who influenced your career. Could you be so kind as to name some of them?

HP: Dr. JVI Young, the London Hospital doctor (inventor of the Halox vaporizer) who was a true ‘Renaissance Man’, Dr RAF Linton at St Thomas’ Hospital who was a deep thinker about the physiology underpinning anaesthesia, Dr Michael Dobson at John Radcliff Infirmary in Oxford who was responsible for creating the Anaesthesia in Developing Countries (ADC) course. Also, Professor John Sandison at McGill University in Montreal Canada who was involved in the University of Calgary programme developing a DA and MMED anaesthesia training programme in Kathmandu, Nepal.

GG: I started my residency in anaesthesia 15 years before you. So, some 50 years have passed since your first contact with our specialty. How is, in your opinion, anaesthesiology today in comparison to the time when you started to practice it? Can you call it a revolution in everything we know and do today?

HP: Yes, indeed. I can offer a long list of examples. Anaesthesia today is safer and in some respects easier, despite the sicker, older patients we are dealing with. Perioperative monitoring and preoperative testing and assessment have helped make anaesthesia an extremely safe process.  The introduction of propofol and the laryngeal mask completely transformed anaesthesia practice, as did pulse oximetry and capnography. TIVA (total i-v anaesthesia) is beginning to eclipse inhalational techniques.

When I started anaesthesia, many cases were undertaken holding a black rubber anesthetic facemask using inhalational drugs such as cyclopropane, trilene, ether, halothane and nitrous oxide. Training and education have much improved. The training case load, however, has significantly reduced. Training in the 1980’s involved over 5,000 cases, albeit many of lesser complexity than today.

The baby boomers in the UK usually expected to train for at least 10 years post-qualification, including a one-year, non-anesthetic Senior House Officer post before starting anaesthetics and at least three years spent as a Senior Registrar – the later years characterized by a heavy service workload, nominally supervised but largely autonomous – before taking up a consultant post.

GG: And what about your own achievements as an anaesthesiologist?

HP: The fact that I had, for thirty years, the privilege to learn and teach in many different countries around the world.

GG: And if you will allow you, the tremendous activity and success of the WFSA Education Committee during your time as Chair of that Committee. It is clear that your career is a combination between clinical activity and that of teaching.

HP: Indeed. Teaching was the most rewarding part of my career. This was especially so in other countries where culture, language and resources are so very different. Trying to simplify and explain concepts inevitably led to my better understanding of them. There is enormous vicarious satisfaction from the success and achievements of mentees and students.

GG: Let’s speak about WFSA activities, as you witnessed during a long period of time. What do you think about its main achievements?

HP: The formation of WFSA established a global ‘fellowship’ of anaesthesiologists whose shared professional endeavours foster learning, friendships and the exchange of experiences. As an organisation, WFSA has played a crucial global role in education, training, and advocacy.

GG: You mentioned the fact that you had the opportunity to teach in many countries. Do you think that WFSA activities are influenced by cultural and resource differences?

HP: Despite having the same physiology and pharmacology, the practice (and politics) of anaesthesia in different countries is heavily influenced by history, culture and resources. The WFSA must attune to its activities and offerings to meet the very diverse needs and expectations of its 142 Member Societies.

GG: And what values does WFSA bring to its members?

HP: WFSA brings the opportunity to learn from other anaesthetists through lectures, tutorials, courses or indeed at coffee breaks, and the chance to share life experiences with people from countries and cultures very different to one’s own.  Together we can address the challenge of improving anaesthesia throughout the world to provide the best possible circumstances for safe surgery.

GG: I think you are right, teaching and sharing experience. Coming back to your own career, before becoming a WFSA Officer, did you start in your National Society?

HP: Yes, I was a member of the Australian Society of Anaesthetists’ Overseas Aid Sub-Committee.

GG: What led you to seek a position at WFSA?

HP: At the World Congress in the Hague in 1992, I was (unknowingly) nominated to serve on the WFSA Education Committee by Dr Kester Brown who was then its Chair.

GG: It is amazing to see that the late Kester Brown brought to the organisation so many gifted members and future officers. What position(s) did you hold at WFSA?

HP: Gaby, as you know, I was a member of the Education Committee (1992-1996) and then its Chair (1996-2000), and in this quality I supported your projects in Eastern Europe.

GG: How could I forget?! This was the first major step towards closing the gap between the two parts of the old continent. So, what is the most important achievement or contribution to WFSA that you are most proud of?

HP: Development of the idea that WFSA could practically support training anaesthetists from low- and middle-income countries (LMICs) in subspecialty disciplines such as paediatrics and obstetrics, through the establishment of WFSA Training Centers. These Training Centers would serve to train anaesthetists from neighboring countries where opportunities for further training were limited.

GG: Let’s finish by speaking about WFSA’s future as you see it. How do you see this very valuable world organisation in the next 25 years?

HP: As a dynamic global leader in the development of anaesthesia; a champion for anaesthesia providers in the less affluent countries of the world; and as an articulate and effective advocate for the right to safe anaesthesia worldwide, no matter what the affluence or nationality of the patient.

GG: What should be kept and what should be changed?

HP: We have to keep the regional and world meetings, which are the ‘lifeblood’ of the organization. I think that effective Committees are WFSA’s ‘bone marrow’.

GG: And the last question: What should be the main WFSA focus in the next quarter of a century?

HP: Increasing the numbers of anaesthesia providers in the less affluent countries of the world. In the 21st century, no one should die from lack of anaesthesia and surgery.

GG: I liked this answer! Thanks a lot, Haydn, for your time and readiness to answer all the questions.

HP: All the best, Gaby.

GG: Bonjour Philippe. Long time no see. I am so glad to have the opportunity to talk to you, and discuss WFSA, and your special contribution to the activity of this very important world body. 

PS: Bonjour Gaby. 

GG: For a long period of time, I followed your teaching activity, and admired your special organisational spirit, but I never had the opportunity to know about your early years in the specialty. Can you tell us where and when you started your medical career? 

PS: Except for one year spent at the Pitie Salpetriere Medical Centre Department of Anaesthesiology in Paris, I spent the main parts of my career in the Lille University Department of Anaesthesia & Intensive Care. 

GG: Why did you choose anaesthesia as your future specialty? 

PS: After practising intensive care and reanimation for several years, I moved into anaesthesiology as Professor when a vacancy came up at Lille University. 

GG: I am sure that you owe some of your early success to your mentors. Can you give an example? 

PS: Professor Pierre Viars, the former chief of the Department of Anaesthesia-Critical Care at Pitie-Salpetriere Medical Centre in Paris. 

GG: I can imagine that you have a good view of our common specialty and its development over the years. So, my question is: How do you see the specialty of anaesthesiology in comparison to the time when you started to practice? 

PS: I can answer in one sentence: Great evolution in the drugs and techniques, but also a strong increase in the number of staff members.  

GG: Philippe, it would be interesting to get some information about your own achievements as an anaesthesiologist. 

PS: I soon became Head of a great University Department. I developed anaesthesia in the operating theatres, recovery rooms, intensive care and within emergency medicine (SAMU), pain consultation and treatment. With some European colleagues I developed a worldwide programme of teaching in anaesthesiology and I took part in WFSA’s activities. 

GG: What about the biggest challenges in your professional career? 

PS: Teaching and training. One example? I initiated more than 800 MD and PhD theses during my more than 30 years of teaching. 

GG: The next part of our chat will be dedicated to WFSA activities. What do you think are the main achievements of this world federation? 

PS: Sucessfully fighting great difficulties due to insufficient links between the National Society members. 

GG: Do you think WFSA’s activities are influenced by cultural and resource differences?  

PS: Yes, WFSA is deeply characterised by an Anglo-Saxon predominance. 

GG: And what about the key moments of decisions in the WFSA history? 

PS: Two words: Too conservative. 

GG: What value does WFSA bring to its members; National Societies and  individuals? 

PS: Largely insufficient. There is no feeling of membership or ownership of WFSA within the National Societies. There are no direct individual members of WFSA, since members are declared (more or less) by the National Societies paying the minimal fees. 

GG: As far as I remember, you started your public activity with your own National Society, n’est pas? 

PS: Yes, I was President of the French Society of Anesthesiology (SFAR), and actively supported  the participation of the Society within WFSA’s activities. 

GG: What made you interested in seeking a position at WFSA? 

PS: I was interested by international relationships and designated by the SFAR to represent the Society at WFSA. 

GG: What functions did you hold at WFSA? 

PS: I was a member of the WFSA Council and of Several committees during my 12 years with the Federation. Also, I was the founding Chair of WFSA’s Scientific Committee 

GG: What is the achievement or contribution at WFSA you are most proud of? 

PS: Serving as President of the World Congress of Anaesthesiologist in 2004 in Paris, France. 

GG: I was there and I vividly remember it as one of the most successful congresses organiszed by WFSA. Phillipe, this last part of our interview is dedicated to the future of WFSA. How do you see our federation in the next 25 years? 

PS: An immense amount of things to be done. 

GG: What should be kept and what should be changed? 

PS: To keep: Strength and diversity of the committees. To change: More frequent meetings,  especially in low-resource countries between the World Congresses if maintained every four years. 

GG: Finally, what should be, in your opinion, the main WFSA focus in the next, let’s say, 25 years? 

PS: Developing links between National Societies, and especially restoring  contacts with colleagues in distant countries suffering from wars or political conflicts. 

GG: Philippe, merci beaucoup for your patience and very important answers. 

PS: A bientot, Gaby. 

GG: Dr Trenkler, Stefan, I am very glad to have the opportunity to talk with you today, when we are in the 70th anniversary year of the World Federation of the Societies of Anesthesiologists, We know each other for many years, and I followed your successful activities and projects during all this time. However, I know nothing about your first period as an anaesthesiologist. Where and when did you select anaesthesiology as your future specialty?

ST: My first contact with the specialty took place in 1973 at Presov Hospital in Slovakia. I was impressed by the place technology had in the daily practice of anaesthesiologiy, especially in the domain of intensive care, and had the chance to work under Professor Lucansky, the then ICU director at Presov Hospital and the founder of the second ICU in all Czechoslovakia. From that point to my final decision to become an anaesthesiologist, the road was a very short one. During the first years of my career, I was lucky to meet and work with some of the best professionals my country had, among them J. Matinsky in Bratislava and J. Drabkova in Prague.

GG: I am old enough to have my own answer to the following question. But I would like to hear your opinion on the present versus the past. When you look back at your first years as a dedicated anaesthesiologist, how do you see the specialty of today compared to those times?

ST: In 1973 we still used ether as a principal volatile drug, and I vividly remember the fact that we did not have any up-to-date equipment for monitoring the patient in the operating room or in the intensive care unit. Today, the modern anaesthesiologist enjoys superb work conditions, modern equipment, newer and safer drugs, but above everything they have the chance to pass through a full system of educational programmes.

GG: As I already mentioned, I have known you for many years and we cooperated on some projects initiated by WFSA. But please be so kind and highlight your own achievements as an officer of various national and international professional organisations.

ST: As a Slovakian anaesthesiologist, I represented my Society at WFSA, in the European Society’s Council, at NASC, EDAIC, EBA, EAA, and ITACCS. I also organised national congresses in my country, to which we invited speakers from many countries (you have been one of them!).

I was also the Slovak coordinator and co-author of IMPACT (a project under the auspices of NEJM), CRASH (Lancet) and EuReCa 1-3 (Resuscitation).

My professional life was not easy. For example, for many years I had to change workplaces for political reasons. But I was lucky enough to get a good education, to be influenced by the new trends in my profession and this is why I was able to bring to my country the world spirit (efficiency, quality, a new vision) for the sake of the Slovak reality.

GG: You are very well known for your educational abilities. Tell us about your activity as a teacher and as a mentor.

ST: During my professional career I had the opportunity to teach anaesthesia and related fields in no less than four Slovak universities and at all levels: pre- and postgraduate, nurses, paramedics. For many years I held the position of ESAIC examiner, and also took part in various WFSA educational projects, such as the WFSA-Egypt Assiut course.

GG: From all of the above, it is clear that you have had a lot of opportunities to observe WFSA’s activities over many years. What do you think have been WFSA’s main achievements so far?

ST: In my eyes, WFSA started as a global educational organisation and almost everything which has been done since aimed to improve the quality of our profession, all over the world, by continuously initiating educational projects.

One of the most important aspects of its activity was the creation of various initiatives which took into consideration the cultural and resource differences among countries and geographical regions. As we say, one size does not fit all!

The World Congresses organized by WFSA are a good opportunity to notice these perennial differences. At the same time, a lot of things have been done throughout WFSA’s history to minimise these differences and to assist everybody in need to bring our specialty to a high level, all over the world.

But one cannot forget the spirit of solidarity, of cooperation, which illuminates WFSA projects and initiatives throughout its years of existence.

GG: Dr Trenkler, let’s speak about your own activities in the framework of your own Society, and then WFSA. How did you engagement with the Slovak Society start?

ST: In 1975 I joined the Slovak Society and subsequently became a member of its Board where I have served continuously since 1990. During the period 1994-2014 I served in the position of Vice-President. For some time, I was also Chair of the Society’s Safety Committee.

I was always interested to put Slovak anaesthesiology on the world map, and this is why I organised so many congresses in Slovakia, bringing experts in various domains of our specialty, among them many personalities from ESAIC.

During all those years I was inspired and helped by the unique personality of Drs M. Janecsko and G. Hempelmann.

My official positions at WFSA included being Chair of the Equipment Committee for one term (2000-2004) and member of the Executive Committee for two terms (2004-2008 and 2008-2012).

GG: We are approaching the end of this very interesting chat looking at your personal contribution to the development of anaesthesia as a specialty, in your country as well as abroad. Looking into the future, how do you see WFSA in – let’s say – the next 25 years?

ST: It is my hope that this very efficient and important organisation will continue its efforts to maintain the spirit of solidarity among its members, to prevent futile disagreements and to try to implement and respect the principles of DEI (diversity, equity and inclusion), in order to promote a healthier environment for all the anaesthesiologists, all over the world.

It is very important to keep alive and successful the World Congresses, and also the short courses with training-of-trainers components which, as far as I remember, you were one of the initiators.

GG: Stefan, many thanks for this important interview. I wish you all the best in the future and hope to meet you, once again, sometime in the future.

ST: Thanks a lot, Gaby.

GG: Good morning, David. I am so glad to have a new opportunity to contact you, this time asking you to answer some questions related to your well known and appreciated activity in the framework of WFSA whose 70th anniversary we are celebrating this year.

DW: My pleasure, Gaby.

GG: Thanks. So, let’s start with the first question: When and where did you start your medical career?

DW: I qualified from St Bartholomew’s Hospital in London, UK in 1971, then did a medical house job at Connaught Hospital, East London, and a surgical house job at Crawly Hospital, in Surrey. This was followed by obstetrics and gynecology job at Whipps Cross Hospital, also in East London. After this I was a Senior House Officer and Registrar in anaesthesia at Whipps Cross Hospital, and later on held Registrar and Senior Registrar post back at Barts. I spent a year in Perth Western Australia and then returned to a Consultant position at Barts for next 30 years.

GG: An interesting question: Why did you choose anaesthesiology as your future specialty?

DW: It was not my first choice. I started wanting to be an obstetrician, but did not enjoy it, and so switched to anaesthesia just to see what it was like. Anaesthesia just suited me, and I really enjoyed it all. And it helped by having known George Ellis from Barts while I was a student.

GG: Who are the mentors/seniors who inspired your career?

DW: A rather long list. Let’s start with Bill Chew at Whipps Cross, Tom Boulton from Barts and Reading. Then all my senior colleagues at Barts, in particular Richard Ellis, Bob Ballantine, Ian Jackson and Ronnie Bowen. Last but not least: Peter Baskett and Leslie Baird at the Association of Anaesthetists (Great Britain & Ireland) and Kester Brown from a global perspective.

GG.I do envy you! I met some of them…. How can you summarize your own achievements as an anaesthesiologist?

DW: Let’s put them in order:

• I did early research with wet wedge spirometer
• Developing a wider interest in history of anesthesia and medicine
• Building a day surgery centre which was used as a UK Department of Health blueprint
• Moving WFSA from being a ’club-style’ organisation to a proper internationally functioning non-profit association with renewed UN and WHO links

GG: And your biggest challenges?

DW: Finding the time to do what is needed…

GG: How can you describe your activity as a teacher and mentor?

DW: I always greatly enjoyed teaching. I have lectured all over the world about a myriad of topics.

GG: Indeed… I vividly remember your visit and lecture in my department, at Soroka Medical Center, Israel. Now, another series of questions about WFSA during your activity as an anaesthesiologist. What do you think about its main achievements?

DW: Turning it into a mainstream organisation with a CEO and a proper Secretariat.

GG: Do you think that WFSA activities are influenced by cultural and resource differences?

DW: The World Congresses and elected Committees and Council allow all cultures and resource differences to be noticed and recognised.

GG: Would you be so kind and try to think about the key moments of decisions in WFSA’s history?

DW: Yes, I think I have the answer:

• Creation in 1955
• Deciding to hold four-yearly World Congresses, the ‘Olympics’ of anaesthesia
• Creation of a proper organisation with a CEO and Secretariat

GG: In your opinion, what value does WFSA bring to its members?

DW: A global voice and ability to influence individual governments to work for change.

GG: Let’s speak now about your own activities at WFSA. By the way, did you start in your own National Society?

DW: Yes. I was elected to Council, then served as Assistant Secretary, Secretary, Treasurer and Vice-President.

GG: What led you towards the decision to seek a position at WFSA?

DW: I started by serving on the European branch of WFSA, in the European Regional section. I created CENSA (Confederation of European National Societies of Anaesthesiologists), so my move to WFSA was a natural progression.

GG: What position(s) did you hold at WFSA?

DW: Member of Constitution Committee, then its Chair, and then Assistant Secretary, Secretary, and finally President from 2012 to 2016.

GG: And what was the most important contribution or achievement at WFSA you are proud of?

DW: Appointing the first CEO and lecturing in less well-travelled countries.

GG: David, from your own perspective, speaking about WFSA in the future, who do you see our world federation in the next 25 years?

DW: It would be good to have a permanent home for the federation, and not a rented property. I would like to see it as an organisation which all governments turn for advice on anaesthesia, pain management, and intensive care medicine.

GG: What has to be kept?

DW: The basic philosophy of improving anaesthesia for all people throughout the world.

GG: And should be changed?

DW: Two points. First, finding a solution for countries failing to pay their dues. And then, trying to reduce the number of elected members who fail to attend Committee meetings. Actually, this is my basic message for the future of this organization.

GG: David, it was a pleasure to have this chat with you. Thanks a lot.

DW: Yes, I enjoyed it, too.

GG: Dr Wilson, it is a privilege to speak with you as part of this project dedicated to the 70th anniversary of WFSA. I have heard a lot about you and your work for WFSA and look forward to hearing more about this. But let’s begin with a question about your career. Where and when did you start?

IW: I qualified at Glasgow University in 1978 and started anaesthesia training in the Royal Air Force Medical Branch. Then I spent two years (1986-1988) at the University of Zambia, and then the remainder of my career as a Consultant in Exeter, UK.

GG: It would be interesting to know why you chose anaesthesiology as your future specialty?

IW: I was interested in the job and its challenges, also the team approach when working with people. It was good to be with patients when they’re facing a difficult time.

GG: Who are the mentors/seniors who inspired your career?

IW: John Zorab and Peter Baskett.

GG: I met John Zorab when he visited Israel and took part in congresses organised under the auspices of the Israeli Society of Anesthesiologists. And I vividly remember the lectures on trauma and massive casualties offered by Peter Baskett. I really envy you for having had such masters in anesthesia guide your professional way.

But now, let’s speak about your career as an anaesthesiologist. You have had many decades in the specialty, so tell us: How is today’s anesthesiology as a medical field in permanent development, compared to when you started to practice?

IW: In one word (speaking about the UK): Much more organised and more time-balanced.

GG: What are your own achievements as an anaesthesiologist?

IW: I enjoyed my career and met a lot of inspiring people from around the world.  I developed an interest in anaesthesia education after working in Zambia, which lead me to develop WFSA’s Update in Anaesthesia and later Anaesthesia Tutorial of the Week.  I edited various books and helped develop some courses – including some of the SAFE courses. I was also President of the Association of Anaesthetists (Great Britain & Ireland) from 2010 to 2012. I took part to the UK / Uganda partnership to support training, and was also a Founding Board member of Lifebox, which has made pulse oximetry and training much more widely available.

GG: Impressive! Now, can you tell us what have been the biggest challenges in your career?

IW: Throughout my career I tried to help anaesthetists in difficult environments.  I also represented anaesthesiologists as part of healthcare locally, nationally and globally.

GG: Speaking about WFSA’s activity during all these years, what do you think are its main achievements?

IW: The Education and Publications Committees and also the World Congresses.

GG: I am sure that during all these years of extensive involvement in WFSA you had the opportunity to observe how anaesthesia is performed in different parts of the world. How do you think WFSA activities are influenced by cultural and resource differences?

IW: It has improved from starting out as a loose group of professional friends / colleagues across the globe to a more functional organisation with a strategy.

GG: What are – in your opinion – the key moments in WFSA history?

IW: The appointment and work of Julian Gore-Booth, WFSA’s first CEO.

GG: Here is a very important question: What value does WFSA bring to its members?

IW: This is quite difficult to work out – the networking and potential for lobbying at WHO level is good, and the education and training is important.  Some initiatives, such as Lifebox and SAFE are clearly beneficial in the locations where they are set. But most politics involving anaesthesia are local or regional, and other than guidelines and discussion, impact is more difficult to measure.

GG: Dr Wilson, let’s look back for a moment, to your own activities at WFSA.

IW: Actually, I started at the national level, as a member of the International Relations Committee in my National Society. I was an ex-officio member of the Publications Committee to start with, becoming the Chair later on. This led me to seek a position at WFSA. Interestingly  enough, this is exactly what I did there: I was Chair of the Publications Committee and a member of the WFSA Council. This was my most important contribution at WFSA, and I am very proud of it.

GG: Now, at the end, I would like to ask you to try to imagine WFSA in the next 25 years. How do you see it?

IW: I think that in the future the most important task will be to keep on doing the basics and the politics well.

GG: What should be kept?

IW: The links between members and the importance of driving anaesthesia development. But if you ask me should be changed, I am not sure.

GG: And the last one: What should be the main WFSA focus in the next quarter of a century?

IW: Very simple: Safety and professional profile.

GG: Thanks a lot, Dr Wilson. I wish you all the best.