{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T17:21:41Z","timestamp":1770744101166,"version":"3.49.0"},"reference-count":59,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,11,11]],"date-time":"2020-11-11T00:00:00Z","timestamp":1605052800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Burnout and related concepts such as resilience, wellness, and taking care of healthcare professionals have become increasingly prevalent in the medical literature. Most of the work in this area comes from high\u2010income countries, with the remainder from upper\u2010middle\u2010income countries, and very little from lower\u2010middle\u2010income or low\u2010income countries. Sub\u2010Saharan Africa is particularly poorly represented in this body of literature. Anglo\u2010American concepts are often applied to different jurisdictions without consideration of cultural and societal differences. However, anesthesia providers in this region have unique challenges, with both the highest burden of \u201csurgical\u201d disease in the world and the least resources, both in terms of human resources for health and in terms of essential drugs and equipment. The effect of burnout on healthcare systems is also likely to be very different with the current human resources for the health crisis in East and Central Africa. According to the Joint Learning Initiative Managing for Performance framework, the three essential factors for building a workforce to effectively support a healthcare system are coverage, competence, and motivation. Current efforts to build capacity in anesthesia in East and Southern Africa focus largely on coverage and competence, but neglect motivation at the risk of failing to support a sustainable workforce. In this paper, we include a review of the relevant literature, as well as draw from personal experience living and working in East and Southern Africa, to describe the unique issues surrounding burnout, resilience, and wellness in this region.<\/jats:p>","DOI":"10.1111\/pan.14054","type":"journal-article","created":{"date-parts":[[2020,10,30]],"date-time":"2020-10-30T02:17:25Z","timestamp":1604024245000},"page":"39-46","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Not a \u201cfirst world problem\u201d\u2014Care of the anesthetist in East and Southern Africa"],"prefix":"10.1111","volume":"31","author":[{"given":"Rediet Shimeles","family":"Workneh","sequence":"first","affiliation":[{"name":"Department of Anesthesia Yekatit 12 Teaching Hospital Addis Ababa Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eugene","family":"Tuyishime","sequence":"additional","affiliation":[{"name":"Ohio and University of Rwanda Ohio Health Columbus OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mbangu","family":"Mumbwe","sequence":"additional","affiliation":[{"name":"Department of Anesthesia Ndola Central Hospital Ndola Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth Namugaya","family":"Igaga","sequence":"additional","affiliation":[{"name":"Department of Anesthesia Uganda Heart Institute Kampala Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1675-466X","authenticated-orcid":false,"given":"M. Dylan","family":"Bould","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Pain Medicine The Children\u2019s Hospital of Eastern Ontario University of Ottawa Ottawa ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,11,11]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000004866"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.12777"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-015141"},{"key":"e_1_2_6_5_1","unstructured":"World Federation of Societies of Anesthesiologists.https:\/\/www.wfsahq.org\/workforce\u2010map accessed May 27 2020."},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000002258"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000004302"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-012-1482-7"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-012-1729-3"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-011-1125-4"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000004363"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000001690"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30001-1"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60990-8"},{"key":"e_1_2_6_15_1","unstructured":"https:\/\/data.worldbank.org\/WorldBank accessed May 27 2020."},{"key":"e_1_2_6_16_1","unstructured":"https:\/\/www.transparency.org\/en\/TransparencyInternational accessed May 27 2020."},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.13202"},{"key":"e_1_2_6_18_1","doi-asserted-by":"crossref","first-page":"97","DOI":"10.2478\/gp-2020-0005","article-title":"Strategies for mitigating burnout among early career doctors in Nigeria: lessons learnt from the qualitative CHARTING study","volume":"3","author":"Adebayo O","year":"2020","journal-title":"Global Psychiatry"},{"key":"e_1_2_6_19_1","first-page":"309","article-title":"Teacher burnout in Hong Kong and Germany: a cross cultural validation of the Maslach Burnout Inventory","volume":"12","author":"Scharzer R","year":"2000","journal-title":"Anxiety Stress Coping"},{"key":"e_1_2_6_20_1","volume-title":"Maslach Burnout Inventory Research Edition","author":"Maslach C","year":"1981"},{"key":"e_1_2_6_21_1","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1186\/s12882-020-01732-w","article-title":"Challenges in the provision of kidney care at the largest public nephrology center in Guatemala: a qualitative study with health professionals","volume":"21","author":"Flood D","year":"2020","journal-title":"BMC Nephrol"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2018-007905"},{"key":"e_1_2_6_23_1","volume-title":"Nursing Practice: The Ethical Issues","author":"Jameton A","year":"1984"},{"key":"e_1_2_6_24_1","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.amjmed.2019.08.002","article-title":"A Possible and simple response to physician burnout","volume":"133","author":"Alpert JS","year":"2020","journal-title":"Am J Med"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.19.00703"},{"key":"e_1_2_6_26_1","unstructured":"Human Resources for Health Overcoming the crisis Joint Learning Initiative 2004 Harvard.https:\/\/www.who.int\/hrh\/documents\/JLi_hrh_report.pdf?ua=1 accessed July 28 2020."},{"key":"e_1_2_6_27_1","first-page":"135","article-title":"Motivation of health care workers\u2010review of theories and empirical evidence","volume":"45","author":"Dolea C","year":"2005","journal-title":"Cah Sociol Demogr Med"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.320.7237.768"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000004794"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000004464"},{"key":"e_1_2_6_31_1","doi-asserted-by":"crossref","first-page":"E174","DOI":"10.1503\/cmaj.109-5556","article-title":"Addressing physician burnout at the systems level","volume":"190","author":"Collier R","year":"2018","journal-title":"CMAJ"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2007.05309.x"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.7326\/M18-1422"},{"key":"e_1_2_6_34_1","doi-asserted-by":"crossref","first-page":"600","DOI":"10.7326\/L19-0522","article-title":"Estimating the attributable cost of physician burnout in the United States","volume":"171","author":"Dyrbye LN","year":"2019","journal-title":"Ann Intern Med"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-019-7566-7"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1080\/22201181.2015.1102798"},{"key":"e_1_2_6_37_1","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1093\/occmed\/kqy155","article-title":"Family cohesion and family size moderating burnout and recovery connection","volume":"69","author":"Ugwu FO","year":"2019","journal-title":"Occup Med"},{"key":"e_1_2_6_38_1","first-page":"589","article-title":"Physicians' burnout and factors in southern Ethiopia affecting It","volume":"28","author":"Lrago T","year":"2018","journal-title":"Ethiop J Health Sci"},{"key":"e_1_2_6_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajp.2014.02.010"},{"key":"e_1_2_6_40_1","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1002\/smi.982","article-title":"Short communication: Occupational stress and burnout among South African medical practitioners","volume":"19","author":"Pelter K","year":"2003","journal-title":"Stress Health"},{"key":"e_1_2_6_41_1","doi-asserted-by":"publisher","DOI":"10.1093\/inthealth\/iht038"},{"key":"e_1_2_6_42_1","doi-asserted-by":"publisher","DOI":"10.1111\/jonm.12397"},{"key":"e_1_2_6_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2702.2011.03995.x"},{"key":"e_1_2_6_44_1","doi-asserted-by":"publisher","DOI":"10.4102\/curationis.v40i1.1695"},{"key":"e_1_2_6_45_1","doi-asserted-by":"publisher","DOI":"10.5402\/2012\/402157"},{"key":"e_1_2_6_46_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph120100652"},{"key":"e_1_2_6_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2702.2012.04171.x"},{"key":"e_1_2_6_48_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1813-6982.2008.00164.x"},{"key":"e_1_2_6_49_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13104-018-4004-3"},{"key":"e_1_2_6_50_1","doi-asserted-by":"publisher","DOI":"10.4314\/ahs.v14i1.37"},{"key":"e_1_2_6_51_1","doi-asserted-by":"publisher","DOI":"10.1093\/milmed\/162.10.707"},{"key":"e_1_2_6_52_1","doi-asserted-by":"publisher","DOI":"10.1080\/13548506.2018.1502457"},{"key":"e_1_2_6_53_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2834.2012.01467.x"},{"key":"e_1_2_6_54_1","doi-asserted-by":"crossref","first-page":"359","DOI":"10.2190\/DNBR-8E28-JXTM-MEAW","article-title":"The influence of marital status on self\u2010report of symptoms of psychological burnout among nurses","volume":"52","author":"Ifeagwazi CM","year":"2005","journal-title":"Omega J Death Dying"},{"key":"e_1_2_6_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2012.11.002"},{"key":"e_1_2_6_56_1","doi-asserted-by":"crossref","first-page":"101","DOI":"10.4314\/ejhs.v26i2.3","article-title":"Burnout status at work among healthcare professionals in a tertiary hospital","volume":"26","author":"Biksegn A","year":"2016","journal-title":"Ethiop J Health Sci"},{"key":"e_1_2_6_57_1","doi-asserted-by":"crossref","first-page":"145","DOI":"10.4103\/jehp.jehp_196_18","article-title":"Prevalence of burnout syndrome among health\u2010care professionals working at Gondar University Hospital, Ethiopia","volume":"7","author":"Bhagavathula AS","year":"2018","journal-title":"J Educ Health Promot"},{"key":"e_1_2_6_58_1","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2147\/PPA.S90323","article-title":"Motivation of health workers and associated factors in public hospitals of West Amhara, Northwest Ethiopia","volume":"10","author":"Weldegebriel Z","year":"2016","journal-title":"Patient Prefer Adherence"},{"key":"e_1_2_6_59_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4172\/1994-8220.1000142","article-title":"Burnout syndrome among medical workers at Kenyatta National Hospital (KNH), Nairobi, Kenya","volume":"17","author":"Kokonya DA","year":"2014","journal-title":"Afr J Psychiatry"},{"key":"e_1_2_6_60_1","doi-asserted-by":"publisher","DOI":"10.1186\/1478-4491-7-13"}],"container-title":["Pediatric Anesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pan.14054","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pan.14054","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pan.14054","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,16]],"date-time":"2024-08-16T17:21:57Z","timestamp":1723828917000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pan.14054"}},"subtitle":[],"editor":[{"given":"Francis","family":"Veyckemans","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2020,11,11]]},"references-count":59,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,1]]}},"alternative-id":["10.1111\/pan.14054"],"URL":"https:\/\/doi.org\/10.1111\/pan.14054","archive":["Portico"],"relation":{},"ISSN":["1155-5645","1460-9592"],"issn-type":[{"value":"1155-5645","type":"print"},{"value":"1460-9592","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,11]]},"assertion":[{"value":"2020-07-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-10-26","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-11-11","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}