Richard Henker, PhD, CRNA, FAAN, FAANA, a professor at the University of Pittsburgh School of Nursing in the Department of Nurse Anesthesia, has dedicated much of his career to improving anesthesia care in underserved regions around the world.
Henker’s path to global volunteer work began in an unexpected way. He said he always wanted to do global work, but after being diagnosed with stage 3 melanoma in his late thirties, he found renewed motivation in that mission. His colleagues encouraged him to travel to Cambodia, where he began his work with Health Volunteers Overseas (HVO). From there, he traveled to other countries like Belize, Bhutan, and Laos to coordinate nurse anesthesia programs.
“I’m still here after having been diagnosed with melanoma over 20 years ago, and I’m more involved than I ever expected to be in a wide variety of projects in global health and global anesthesia,” said Henker, who’s been a board member of HVO since 2014.
Currently, he spends half the year teaching online and virtual courses for the University of Pittsburgh from his apartment in Nagasaki, Japan, and the other half of the year devoted to global work with a few months back home in Pittsburgh. Most recently, he’s been working with the nurse anesthesia program at Lao Friends Hospital for Children (LFHC) in Luang Prabang, Laos, training nurse anesthetists.
In Laos, Henker’s work focuses on regional anesthesia techniques that not only improve patient outcomes but are also more cost-effective, environmentally sustainable, and culturally appropriate. Since 2022, he’s traveled to Laos with Registered Resident Nurse Anesthetists (RRNAs) from the University of Pittsburgh to conduct workshops for the anesthesia providers in Laos on ultrasound-guided regional anesthesia techniques. Anesthesia providers follow the workshop with a clinical rotation to maintain the learning that took place during the workshop.
“The nurse anesthetists at LFHC are such experts at regional anesthesia, others in the country are learning from them. That’s why we developed this program,” Henker said.
During the rotation at LFHC, the University of Pittsburgh RRNAs learn from the Laotian nurse anesthetists Henker has trained with many other HVO volunteers, and he supervises LFHC nurse anesthetists’ teaching of the University of Pittsburgh RRNAs. HVO created a YouTube video documenting one of these workshops.
Working in Laos presents unique challenges. For instance, when Henker first arrived at LFHC, the anesthesia equipment was basic, with a draw over vaporizer and no end tidal CO2 monitoring, and there was no ultrasound machine available. Nurse anesthetists relied on anatomic landmarks to place nerve blocks.
“We wanted to be safer and more effective with our blocks, so we made sure that we got an ultrasound machine,” he said. “It’s nice to be able to have ultrasound, so we can identify exactly where we are regarding the patient’s anatomy.”
“The teaching the LFHC nurse anesthetists and the University of Pittsburgh residents do is amazing,” Henker said.
The LFHC nurse anesthetists and RRNAs teach the Laotian anesthesia providers how to give a block using ultrasound during the workshops. They often use the Block Buddy app, which is part of the American Association of Nurse Anesthesiology’s Rm8 Innovation Lab.
“When they return to the U.S., the Pitt residents realize the care we do abroad is actually quite impressive. They see that when it comes to innovative care, blocks are a great way to go.”
For the RRNAs, the trips overseas are eye-opening. They learn the importance of cultural humility and innovation in low-resource settings, and their experience helps them reframe the way they look at the U.S. healthcare system, Henker said.
“Regional anesthesia is more effective in many respects. It’s cheaper, has better patient outcomes and affects the environment less. It’s better for the planet because not as much anesthetic gas is used, and anesthetic gas is a greenhouse gas.”
Fewer opioids are used in regional anesthesia, he added, which provides a superior experience for the patient. “We use less systemic opioids [with regional anesthesia]. We may give a little IV morphine or IV fentanyl at the beginning of the case, but we don’t have to use nearly as much. The block may last up to six or eight hours and provide better pain relief, and usually less nausea and vomiting after the procedure.”
Another advantage to providing regional anesthesia in Laos has to do with cultural beliefs around receiving general anesthesia.
“Many of the patients are Hmong, and the Hmong believe that when you give them general anesthesia, their spirit leaves the body,” Henker said. “At LFHC, we get the families back in the recovery room after the surgery, and they see their child relatively wide awake. They’re feeling much better about the fact that the child’s spirit is back in the body.”
He added, “Three of the four nurse anesthetists are Hmong. One of the things that makes a huge difference is they know the Hmong beliefs and they can talk to the family about what it’s going to be like for their child to receive anesthesia.”
While he enjoys hands-on care, Henker’s passion for global work also extends to advocacy. Henker is currently working with the World Health Organization and Global Alliance for Surgical, Obstetric, Trauma and Anesthesia Care (G4 Alliance) to create and implement an operative encounter registry (OER). The hope is that the data from the registry will be used locally by hospitals to incorporate perioperative quality improvement. The WHO and G4 Alliance will use data from the OER to develop data-based policy initiatives to improve access and quality of anesthesia and surgical care. Additionally, he’s helped develop a forthcoming update of the standards of care document for the International Federation of Nurse Anesthetists.
“The support from HVO and the many volunteers that have come to teach at LFHC has created nurse anesthetists that are experts in regional anesthesia. The LFHC nurse anesthetists have taken the next step and they are teaching others in Laos,” he explained. He hopes more CRNAs will follow in his footsteps to make a difference around the world, particularly with HVO. Volunteer opportunities with HVO can be found on their website.
“HVO has a wide variety of teaching opportunities,” he added. “You don’t have to be able to lecture. You can do bedside teaching, and coordinators for the programs will help provide teaching materials.”
For those who may not be able to travel, we are actively seeking virtual lecturers for our programs in Cambodia and Laos, allowing you to make a significant impact remotely.” Sarah Zangle, RN, coordinates this program through HVO. She is also the coordinator of the HVO anesthesia program for Angkor Hospital for Children (AHC).
Henker’s own teaching will continue this winter when he travels to Siem Reap, Cambodia with RRNAs from the University of Pittsburgh to provide a crisis team management simulation course at AHC. The students will not only assist with teaching the course, but they will be taught by the talented nurse anesthetists at AHC, who are experts at teaching regional anesthesia. Over 60 University of Pittsburgh students have been in rotations at AHC since 2007.
“Going on these trips is a life-changing experience. When residents go over to either Cambodia or Laos, it’s something that sticks with them for the rest of their life.”