August 2016
Global Surgery
Surgery, Anaesthesia and Obstetrics for All Dominique Vervoort & Zineb Bentounsi
BeMSA - Belgium & IFMSA - Morocco dominique.vervoort@student.kuleuven.be
An estimated 5 billion people in the world lack access to safe surgical care, making operable conditions with an estimated 28-32% a big part of the global burden of disease.1 Even though 234 million surgeries (less than 1 in 30 people) take place every year, only 2-3.5% of these surgeries are reserved for the poorest third in the world. Mere access to surgical care does not necessarily equal to safe and adequate care, as 7 million patients suffer from major peri- or post-operative complications annually. 1 million patients die from complications, at least half of which are preventable.2 Moreover, lack of safe anesthesia is responsible for fatal complications in up to 1 out of every 150 surgeries in Sub-Saharan Africa.3 Lastly, 530,000 women suffer from fatal complications during labor, which –together with the numerous cases of stillbirths– could have been prevented with adequate surgery and obstetrics.4 Poor countries not only lack surgical groundwork; they are also subjected to disparities in its distribution. Bigger cities monopolize healthcare and, often, only the richest can afford medical interventions. In the words of Dr. Paul Farmer, surgery has been the neglected stepchild of global health for too long, partially because of the prejudice of being too expensive. Despite this belief, safe surgical and anesthetic care are cost-effective, in many cases even more so than other interventions (e.g., HIV/AIDS campaigns). Besides the many lives (and healthy years) that could be saved, countries’ economic growth would also benefit from it in the long-term. Lack of funding is another major problem as surgery is a complex intervention, not only needing diverse staff, but anaesthetics, operating theatres, equipment, postoperative care and blood banks as well. Last but not least, a lack of surgeons due to lack of qualified training is another problem that low and middle www.ifmsa.org
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income countries (LMICs) are facing. For instance, there are only 565 neurosurgeons in the entire African continent compared to 4600 in the USA, whereas many countries don’t even have a neurosurgeon.5 By adopting the resolution ‘Strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage’ on May, 22nd 2015, the 68th World Health Assembly in Geneva acknowledged the need for putting Global Surgery on the agenda. The United Nations’ recent Post-2015 SDGs have also included this crucial part of global health, another important step in the right direction. Considering the crucial importance of access to safe surgical, anaesthetic and obstetric care for all, the need of pushing Global Surgery on the global agenda is ever so high. As future surgeons and doctors, we should all work together towards this goal, as that will prove to be crucial to make this happen. References 1. Mathers CD, Loncar D (2006) Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 3(11):2011–2030 2. Debas HT, Gosselin R, McCord C et al (2006) Surgery. In: Disease control priorities in developing countries, 2nd ed. Oxford University Press, New York, pp 1245–1260 3. Ouro-Bang’na Maman, AF, Tomta, K, Ahouangbevi, S, and Chobli, M. Deaths associated with anaesthesia in Togo, West Africa. Trop Doct. 2005; 35: 220–222 4. World Health Organization (2005) World health report 2005: making every mother and child count. 5. Fuller, A., Tran, T., Muhumuza, M., & Haglund, M. M. (2016). Building neurosurgical capacity in low and middle income countries. eNeurologicalSci, 3, 1-6.