The Planning Phase
In many countries, anesthesiologists have limited experience with regional analgesia and anesthesia techniques for obstetrics. Turkey, for example, has a very high cesarean section rate in the Western regions, but limited use of regional anesthesia. Many Turkish women opt for cesarean section (with general anesthesia) because labor analgesia is not routinely provided for vaginal birth. Dr. Medge Owen (Wake Forest University, Winston-Salem, NC) and Prof. Dr. Sukran Sahin (Uludag University, Bursa, Turkey) have been collaborating for several years to improve childbirth conditions in Turkey.
 
While working abroad, Dr. Owen observed that regional anesthesia techniques could be quickly and effectively taught at bedside (versus in the lecture hall). She wanted to learn if her observations could be validated by other teachers. What began as an idea in 2003, came to fruition in September 2004 as a group of diverse obstetric anesthesiologists assembled to conduct a two week project with the following objectives: 1) To promote regional analgesia and anesthesia for childbirth in Turkey and 2) To help evaluate the effectiveness of a focused, short term teaching exchange for use in developing countries.
 

The Project Phase (September 19-October 4, 2004)
Eight obstetric anesthesiologists landed in Istanbul, Turkey to inaugurate the first international obstetric anesthesia teaching trip. The participants included:
Elizabeth Bell (University of North Carolina, Chapel Hill)
Terry Breen (Canadian, working at Duke University)
Brittany Clyne (Wake Forest University, Winston-Salem)
Jimmy Gardiner (Dublin, Ireland)
Medge Owen (Wake Forest University, Winston-Salem)
Marge Sedensky (University Hospitals of Cleveland)
Mark Scrutton (Bristol, UK)
Jessica Wolin (TUFTS Boston)

A 2-day group orientation was conducted in Istanbul after which the visiting doctors spread out for one week to work in 10 hospitals throughout Turkey to teach and supervise obstetric anesthesia. Travel varied by location (some flew, others took ground transport). The participants were given cellular telephones and the contact numbers of their hosts and the project coordinators to facilitate communication in case of travel delays or language issues. When the guests arrived at their city destinations, they were met by someone from their host hospital.
 
The participating hospitals included:
Kocatepe University, Afyon
Hacettepe University, Ankara
Akdeniz University, Antalya
Uludag University, Bursa
Maltepe University, Istanbul
Celal Bayer University, Manisa
9 Eylul University, Izmir
SSK Okmeydani Egitim, Istanbul
Capa University, Istanbul
Kocaeli University, Kocaeli

The outcome is summarized below. 

 
The Evaluation Phase
The program was a wonderful medical and cultural exchange deemed an overwhelming success by all participants and host hospitals. One of the visiting doctors is already invited to return to Turkey in January 2005 to speak at a meeting. All visiting doctors have remained in contact with their hosts and are helping with a variety of clinical research studies. The following comments were made by individuals from two of the participating hospitals:
 
Dr. Idil Tekin, Celal Bayar University, Department of Anesthesiology and Reanimation:

Before “KYBELE 2004 Obstetric Anesthesia” program, we have been very excited and believed in its potential success and benefits. After the program, we are grateful and thankful to you for allowing us to participate.
Through this program, we had the opportunity of meeting esteemed, distinguished scientists. Instead of going to conferences and being able to only discuss limited topics in limited times there, they came here and paid attention to only our problems for a whole week. These are not only my feelings but also those of all other participating doctors I knew in the region because we organized both the social and medical programs together with Dokuz Eylul University due to proximity of Manisa and Izmir. Besides, we attended to both of our two guests’ presentations together with fellow doctors from Celal Bayar University, Dokuz Eylul University, Izmir Ataturk Egitim and Research Hospital, and Private Cinarli Kadin Hastaliklari ve Dogum Hospital. Thus, we had the opportunity of knowing each other and comparing our studies and operations in obstetric anesthesia creating new ways to collaborate regionally. The discussion part of the meeting was very long and delightful. As Celal Bayar University, we are very proud of ourselves for creating such a scientific environment in our region.
The main topics discussed were: the principles of obstetric analgesia and C-section anesthesia, the techniques used for obstetric analgesia, the “walking epidural” technique,  the methods that can be used in risky situations, and applications of after-C-section post operational analgesia.
We are very touched and grateful because our guests were very attentive to our problems, open to all of our questions, and enthusiastic to help us in all ways. As one of the best part of this program, we’ll keep in touch and continue to communication in terms of problems, questions, and new projects.
Together with beautiful memories, pictures, friendships, and cultural awareness, this program also helped us realize what we’re doing, plan future projects, set new goals.

          
Dr. Bilge Karsli, Prof. Dr. Meliha Erman, Yrd. Doc. Dr. Nurten Kayacan, and Dr. Nihan Cete, Akdeniz University, Antalya:

We all congratulate you for your leadership in KYBELE project and thank you for letting us participate.
While Terry (Dr. Breen) was here, we executed a lot of spinal anesthesia in C-sections. Dr. Terry both gave us moral support in our operations and provided us a lot of useful information.
We organized a seminar together with obstetrics clinic. Terry talked about his studies that compare complications of C-section and normal vaginal delivery, and their advantages and disadvantages. The obstetricians were very impressed. Now, obstetric analgesia number is rapidly increasing in our hospital. Before this program, it was our job to convince the patients; now obstetricians guide patients and send us for obstetric analgesia.
He brought us an obstetric anesthesia textbook, and a lot of spinal-epidural combined sets. He also helped us revise some of our related papers and guided us on our new projects of obstetric analgesia.
We told him that some of our fellow doctors wanted to work with him as observers. As soon as he got back, he sent an invitation letter for one of our obstetricians. He/she will go to work with Terry for 6 months.
In conclusion, the program was very beneficial for us. Once again, we want to tell you that we really appreciate giving us this opportunity and support.

Media Coverage
The obstetric anesthesia training program (also known as the “Kybele Project”) sparked a barrage of media attention including a front-page article in a major national Turkish newspaper and 3 television programs on issues of cesarean section and regional anesthesia (with interviews from the visiting doctors). A final program aired on Tuesday, October 5 in which a patient underwent a cesarean section with regional anesthesia live on prime time Turkish national television from Maltepe University, one of the participating hospitals. Attempts were made to arrange the broadcast while the visiting doctors were present; however, it was difficult finding an appropriate patient in a condensed time period. Therefore, the program aired the following week and the regional anesthetic was successfully accomplished by the Turkish physicians alone without the “hands” of the foreign doctors. This was optimal because it clearly demonstrated that regional techniques can be performed successfully in Turkey. The program generated a lot of attention with substantial calls from viewers wanting more information. Obviously, the topics of cesarean section and regional analgesia/anesthesia are of interest to the Turkish public at large, not just isolated medical professionals!
 
Thank You
The program would not have been possible without the financial support of several organizations. More than $20,000 was raised to cover expenses. A big thank you to:
Kybele Inc.
B.Braun
Baxter International
Wake Forest University
Iontek Ltd.
The Turkish host hospitals
World Federation of Societies of Anaesthesiologists (WFSA)
Obstetric Anaesthetists’ Association (OAA)
Society for Obstetric Anesthesia and Perinatology (SOAP)


More information
Learn more about Kybele, Dr. Owen and about Kybele's work in Ghana and Croatia.