Investing in Essential Surgery: An emergency(care) public health issue

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Uganda, like many other African countries, has been growing rapidly. With this growth has come an even greater increase in the number of motor vehicles. Every year thousands of Ugandan’s die as a result trauma, most commonly from motor vehicle crashes. Unfortunately for Ugandans, studies show that an individual is more than 4 times as likely to die from trauma on their streets, than that of the streets of the United States, putting an immense burden of injury on the people and accounting for a quarter of the deaths at the largest hospital in the city. Surgery is an important aspect of injury care, however as the burden of injuries grows Uganda is actually losing surgeons to countries abroad with better salaries and resources.

Surgery is Global Health

Surgery is Global Health

In many ways, trauma represents a very visible and acute example of how surgery can be used for public health, however other surgeries, such as hernia repair, birth defect repair, or obstetric surgeries are equally deserving of attention. The recent launch of the 3rd edition of the Disease Control Priorities (DCP-3) Volume 1 suggests that in today’s world access to surgical services save an estimated 1.5 million deaths per year (1 million of them due to trauma) and some of the interventions have been shown to be as cost-effective as vaccination.

Several years ago, surgery was famously described as the “neglected step-child” of global health by Dr. Paul Farmer of Mountains Beyond Mountains fame and Dr. Jim Kim, now director of the World Bank. Interest among trainees in the US and academic surgery has never been higher with special commissions in the Lancet and NGO organizations, such as Surgeons OverSeas (SOS) investing in data driven research and advocating the public health benefits. Advocacy has gone on through film, such as The Right to Heal (trailer below) or through lobbying members of United States Congress. It’s clear, global access to surgery is needed, however funding remains auspiciously absent as global funders such as The Bill and Melinda Gates Foundation or USAID largely avoid surgical programs.

A generation of global surgeon’s-in-training waits, ready and willing to invest their time and considerable abilities into partnership with colleagues in low and middle-income countries to discover novel and cost-effective ways to prevent deaths, but without the support of funders their passion cannot be harnessed. Thousands and thousands more healthy and productive members of society, like those in Kampala, will die unnecessarily or live with life altering disease and conditions which could be addressed had they been lucky enough to have been born in a developed country. Surgery is essential to primary public health in low and middle income countries, it’s time we invest in it.

Sign a petition to WHO and Global Health Leaders to include Essential Surgery

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2 Responses to “Investing in Essential Surgery: An emergency(care) public health issue”

  1. kelsdcannon Says:

    While I completely agree with your point that access to surgery in low and middle-income countries is a neglected public health issue, there are very real reasons funding remains conspicuously absent for training more surgeons.

    One reason I can think of off the top of my head is that there are no guarantees that when a future surgeon is trained in surgery (whether in their own country or in a more developed country) that surgeon will stay in their own home country to treat the local population. If they have the advanced surgical skills necessary to succeed in a place that offers them more opportunities for professional and financial growth – why would they stay in their home country which might not offer those opportunities? So when thinking of funding projects such as these, the unintended consequence for future “brain drains” is a very serious concern – and perhaps that’s why initiatives haven’t been funded. Perhaps if countries were able to strengthen their health systems (especially the area of human resources for health) and economies and demonstrate that they can in fact hang on to their professionally trained healthcare workers – initiatives and projects working on this issue would have a better chance at securing funding.

  2. jwacker2 Says:

    Hey Kelsey, thanks for your comments! I think you bring up a great point.

    I understand your concern and I should have been more clear. I’m not advocating that funding be specifically levied to increase the training of LMIC surgeons (which I DO believe actually). My argument is more that global surgery is a huge need, but as a whole the public health community (i.e. academic centers, donors, funders) rely on disproved reasons not to invest in it. We have 1,000,000 HIV NGO’s and grants and departments, but lack of surgical care will kill more people this year than HIV/AIDS will. I also don’t think that concern over physician emigration is the root of the problem, more likely its the belief that surgery in the LMIC is 1) too expensive 2) requires health system strengthening (too hard!) and 3) isn’t valued highly in academia in HIC (which is in part because no one is funding studies, which is how an academic gets a job).

    However, even if that was a reason for not investing, I don’t think waiting for a country to “prove” it can hold on to surgeons is a reason not to invest in a essential and demonstratively cost effective intervention. The surgeon shortage is a huge public health concern, and yes surgeons leave LMIC to get better jobs in other countries, but shouldn’t we invest money into studying why this occurs and how it can be attenuated and invest in those surgeons who choose to remain? The problem is also true for nurses, medics, and other types of doctors, for which large organizations still fund interventions. When researching about it there is an interesting case pending in Uganda where people are suing the government for facilitating movement of HCW to the Caribbean. Check it out if your interested!

    http://www.theguardian.com/global-development/2015/feb/10/uganda-crippled-medical-brain-drain-doctors

    Also, perhaps I should note that in my post when I refer to global surgeons, I’m actually referring to surgeons in HIC who partner, through school’s of medicine or public health for research and capacity building in LMIC.

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