My parents, whose uncanny ability to predict my career path to this point is either prophetic or extremely manipulative, are probably the earliest influencers of my interest in Global Surgery. They’ve provided constant reminders of my obligation to serve the less fortunate here and abroad, specifically in Nigeria, our place of origin. Their promptings must have stuck because I find myself several years later pouring over twitter feeds from the G4 Alliance and leaders in global surgery, trying to keep up with the latest developments in the field. I now get more global surgery updates across my social media platforms than I do videos of cats doing cute things (#catsoftwitter). So instead of living vicariously through others, I’ve decided to give it some real thought and do a little research on what’s going on and what needs to be done. This blog post is not meant to be a comprehensive review of the field by an expert. On the contrary it is the musing of a novice, a resident who is pursuing a career in pediatric surgery, but trying to decide whether his career can have a global and lasting impact. It is a plea for more information, personal accounts, testimonies from the global warriors, the veterans, the pros. Hopefully by sharing my thoughts over this blog, and by hearing stories from those more experienced, it may encourage other students, residents, and faculty to ask a few questions of their own, or at least to do a Google search and explore all the exciting things going on related to global surgery.
So what is the need? Things can’t be that bad across the world, right? I give out CT scans and ultrasounds like dinner mints (joking!). Certainly others have the same capability? The reality is that there is a huge disparity in care available to people that persists across this country, let alone the world. While surgery has historically been left off the agenda when discussing global health (you may have heard it referred to as global health’s neglected stepchild1), in recent years more effort has been spent on evaluating the health and economic burden that neglecting surgical diseases has placed on countries. An estimated 2 billion people lack access to basic surgical care2, and 1.5 million deaths per year in low-income and middle-income countries can be averted by universal coverage of a set of basic “essential” surgical procedures3. Many of these procedures can be performed cost-effectively and would theoretically eliminate the economic deficit gained by not having the patient as a contributing member of society. Across 23 low- and middle- income countries, the ratio of general surgeons per population range from 0.13 to 1.57 per 100,000, compared to nine per 100,000 in the US3. But those are numbers. What does it look like on a more personal level?
I’ve had the opportunity to travel abroad and have been alarmed by the healthcare infrastructure, or lack thereof. In some areas are large university hospitals rivaling US facilities, but in many areas the basic resources needed for healthcare professionals to properly deliver care to the people they serve are lacking, as well as the roads and emergency vehicles needed to transport patients. I’m most compelled by stories of people who have traveled abroad. Atul Gawande recently interviewed an anesthesiologist in India who recounts his experience of taking care of a trauma patient4. #Spoileralert the physician has to transport the patient miles to the next facility because they didn’t have a chest tube or surgeon to care for a child with a hemothorax. I know, some of you are saying, “no chest tubes, that sounds like my local VA”, but can you imagine going somewhere and not even having a pulse ox to measure oxygen saturations on a trauma that just rolled through your door? The problem is more than just a personnel shortage; it is one of inadequate health system capacity, economic development and affordability of care.
Now I won’t say too much about the solution to the problems because honestly, I’m not qualified. I can comment, though, on the amazing movement that is going on right now. Global Surgery is in the spotlight like never before, so much so that I wouldn’t be surprised to see a new episode on Grey’s Anatomy about global surgery! (#youhearditherefirst!) While efforts to provide safe surgical care to people around the world has been going on for some time, the movement recently gained steam with the formation of the Lancet Commission on Global surgery. Addressing the commission was Dr. Jim Kim, president of the World Bank, who stated target goals for universal health coverage by 2030 and the importance of essential surgical care as part of this. Then, a whole volume of the Disease Control Priorities, 3rd edition (DCP3) was dedicated to global surgery3. The DCP, published by the University of Washington Department of Global Health, provides the most up to date evidence on intervention efficacy and program effectiveness for the leading causes of global disease burden. Never before has surgery been allotted an entire volume in this publication, and the significance of this move is a realization that any discussions about health system building and global health in general need to include conversation about surgical care.
Since then, the World Health Assembly passed a resolution in which several countries pledged to prioritize the strengthening of emergency and essential surgical care and anesthesia as a component of universal health coverage. As a response to the resolution, the G4 Alliance helps member organizations “build political priority for surgical care as part of the global development agenda”5. The G4 Alliance is formally known as the Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, and their emphasis on collaboration is a great asset to the global surgery movement. It will be exciting to see what happens in the upcoming years as a result of this resolution and the increased advocacy surrounding these developments.
OK so global surgery is #thenewsexy. That’s awesome, but what does it mean for me? For sometime I’ve had a nagging interest in global surgery which I haven’t been able to shake. I call it a nagging interest because the field is extremely exciting to me, but forces me to ask several hard questions of myself. Questions like, am I satisfied with short-term missions or would I give up a potentially lucrative career in the States to work full-time abroad? Where will my children go to school? What safety concerns should I have as I think about dragging my family with me to who knows where? As a Christian, will I have the same religious freedoms abroad as I am privileged to have here in the US? And are these questions all secondary to the fact that there is a great need? Despite these tough questions, I’ve finally had the courage to start doing a little research on the field. What I have found has been really encouraging and exciting. While questions still need to be answered, I am even more convinced in my need to be involved in some shape or form. I really feel like there is so much room to make a difference.
So this is where I make my plea to the community. I learn a lot from other’s narratives and would love to hear your experiences with global surgery.
We want to hear from you – whether you’ve done shorter or longer missions; whether you’re a student, a resident or a veteran.
Have you thought of some of the same, or different questions that I have?
What are the things that drove your decision to be, or not to be, involved (#Shakespeare??).
We need success stories and epic failures. Anything you’ve got, we would all love to hear!
- Farmer PE, Kim JY. Surgery and global health: A view from beyond the OR. World J Surg. 2008;32(4):533-536. doi:10.1007/s00268-008-9525-9.
- Funk LM, Weiser TG, Berry WR, et al. Global operating theatre distribution and pulse oximetry supply: An estimation from reported data. Lancet. 2010;376(9746):1055-1061. doi:10.1016/S0140-6736(10)60392-3.
- Mock CN, Donkor P, Gawande A, et al. Essential surgery: key messages from Disease Control Priorities, 3rd edition. Lancet. 2015;1(15):1-11. doi:10.1016/S0140-6736(15)60091-5.