I. Context, Presidency, and Organization
The meeting began at 2 PM, moderated by Professor SAMA Hamza, and was chaired by Dr. Jacques ALAWOE, Training Expert from Montpellier and President of STAARMUC's Diaspora Committee, assisted by Dr. Xavier RAINGEVAL, Head of Mission, Training Expert, and STAARMUC Advisor. Eleven Anesthesiologist-Intensive Care Physicians (MARs), as well as three physicians undergoing the DES training program in Anesthesia-Intensive Care (serving as rapporteurs), were present.
In his introductory remarks, Professor SAMA recalled the context of the society’s creation: the indispensability of an association to ensure cohesion, organization, supervision, and the smooth running of activities within the profession.
The New Committee Structure
Professor SAMA presented the first draft of the committees driving STAARMUC, including the Resource Persons Committee (the seniors), the Diaspora Committee, the Young Professionals Committee, the Educational and Scientific Committee, the Pharmacovigilance Committee, and many others.
However, given the small number of members, it was decided to consolidate these structures into a maximum of five committees. Each committee was tasked with defining three clear objectives to achieve STAARMUC's missions.
II. Major Directions and Perspectives
Under the chairmanship of Dr. ALAWOE, discussions focused on three main agenda items.
A. Education and Continuing Training
Dr. ALAWOE emphasized an essential point: maintaining members' skills can only be achieved through continuing education. The main levers identified are the organization of practical workshops and the definition of a congress calendar.
- Proposal for Digital Workshops : Dr. Xavier RAINGEVAL suggested that training workshops could be held in a digital "Workshop" (Collective Workshop) format with his team. He proposed organizing a concrete practical LRA workshop for April 2026, subject to early notification for logistics.
- Promotion of Local Training : Dr. ALAWOE stressed the need to promote local training rather than favoring the FFI (Acting Intern) system, where positions are increasingly difficult to secure and where the learning efficiency is deemed poor.
B. Working Conditions and Partnership with the Diaspora
Dr. ALAWOE addressed working conditions, reiterating that good practice requires adequate equipment and a high-performing technical platform, which is not always the reality.
To remedy this, he proposed establishing strong partnerships with various entities: NGOs, associations, but especially the diaspora. He recalled the existence of goodwill within the diaspora, ready to contribute to improving the technical platform. This aid is conditional on the submission of a clear project with relevant objectives. Dr. ALAWOE committed to advocating for any properly formulated request for this funding among diaspora members.
C. Prehospital Medicine and Simulation
- The National SAMU Project : Professor SAMA mentioned the ongoing project to establish a National SAMU (Service d'Aide Médicale Urgente - Emergency Medical Services). The experts, delighted by this initiative, invited STAARMUC to draw on the experience of neighboring countries, notably Niger and Benin. They also expressed their availability to establish contacts with international medical transport organizations to optimize the SAMU's organization.
- The ESSAL Simulation Center : Professor SAMA announced the existence of a simulation center equipped with high-fidelity simulators at the Lomé Army Health Service School (ESSAL). This center, already used for the University Diploma in Disaster Medicine, is intended to be open to other trainees, whether civilian or military medical residents. The experts strongly encouraged STAARMUC to open this center to learners from other countries to eventually establish it as a sub-regional center.
III. The Crucial Debate on Delegating LRA Procedures
The second item on the agenda generated intense discussion: STAARMUC's draft text aimed at authorizing the delegation of certain loco-regional anesthesia (LRA) procedures to non-physician personnel. This project is motivated by the desire to reduce the risks associated with general anesthesia for surgeries that can be performed under LRA.
Arguments in Favor
The experts encouraged STAARMUC, providing solid arguments to raise with health authorities :
- The practice of spinal anesthesia by nurse anesthetists.
- The practice, although unauthorized, of loco-regional anesthesia under neurostimulation by nurse anesthetists.
- The precedent of performing certain surgical procedures within the framework of essential surgery in other countries, such as Burkina Faso.
Concerns Expressed
Some physicians expressed reservations based on legitimate concerns :
- The issue of legal liability in the event of morbidity/mortality linked to LRA performed by a non-physician.
- The lack of a control mechanism to prevent overreach and the unauthorized extension of non-delegated practices.
- The permanent availability of Intralipid (a crucial antidote) in centers.
Nevertheless, the everyday Togolese context (low number of MARs (Anesthesiologist-Intensive Care Physicians), lack of MAR training school in Togo, MAR presence only in Lomé and Kara) argues in favor of considering this delegation.
Decision and Outlook
The discussions concluded with a referral to a subsequent meeting to deliberate on the precise conditions and the type of procedures to be delegated. Dr. JOHNSON, STAARMUC's 2nd Vice-President, and his team were designated to work on a draft proposal on this matter.
In the meantime, three blocks were selected for the essential LRA program in Togo: the axillary block, the femoral and popliteal sciatic block, and the TAP block. A clear warning was issued: any paramedical anesthetist performing these blocks without medical coaching and outside the legal framework will be subject to disciplinary sanctions. MARs, for their part, retain the possibility of performing more complex blocks according to their level of technical mastery.