For a very long time, surgery was not included in the discussion of how healthcare could be improved worldwide, especially in the most remote corners of the earth. Only recently has surgery been brought to the table, being called the “forgotten step-child” of global health by Paul Farmer and others. At the core, global surgery is “a field that aims to improve health and health equity for all who are affected by surgical conditions or have a need for surgical care, with a particular focus on underserved populations in countries of all income levels, as well as populations in crisis, such as those experiencing conflict, displacement, and disaster.” Important to this effort is all aspects of surgery, including anesthesia, OB/Gyn, and nursing.
Currently, 5 billion people around the world do not have adequate access to basic surgical care. Worse yet, the disparity in surgical care is stark, with the poorest 30% of the world receives only 3-6% of operations, whereas the richest 30% receives almost 75%. 17 million people die and 77 million DALYS are lost each year because of this, greater than HIV/AIDS, malaria, and TB combined. Our global economy could lose 21 trillion dollars between 2015 and 2030, with 12.3 trillion lost by low- and middle-income countries, so the lack of surgical care worldwide is also a significant detriment to the progress of humanity. 2.2 million more surgeons, anesthetists, and OB/Gyns (SAOs) and an investment of $350 billion dollars is needed to prevent this from happening, with a goal to raise the operative volume of countries to 5,000 per 100,000 population, meaning an increase of 143 million more surgical procedures per year. It can be easy to get lost in the numbers, but ultimately, health is a human right, and no one should have to live with a condition that would have been treated had they been born somewhere else.
So the bigger question becomes how we address this need for surgical care. In the past, this has almost exclusively involved efforts such as week-long surgical missions and the provision of money/resources in order to acutely work on the problem. However, the field has evolved with the creation of the Lancet Commission on Global Surgery, which called for a more in-depth analysis. Their major report from spring 2015 outlined an approach through investigation, innovation, and implementation, pointing out that research, technology, and capacity-building efforts were necessary to advance the field. In addition, they did a thorough economic analysis which showed that upscaling the number of surgeons and operations alone will not work – an economic approach that helps decrease catastrophic health expenditure for patients and their families is necessary. As the Lancet Commission encompasses almost 110 different countries, efforts have now been set on working at the highest level – with governments, health ministers, and financial officers – to enact changes in policy and infrastructure for whole countries to improve people’s access to surgical care.
Ultimately, whether you are interested in surgery/anesthesia/OBGyn, global/public health, economics/finance, policy, technology/engineering, education/empowerment, statistics/research, or any combination of these, you have a very significant contribution to make to this growing field. And no matter how young or old you are, no matter how little or how much you can contribute, your involvement in global surgery is incredibly necessary and valuable.
*Reference: Meara, J, Leather A, Hagander L, et al. Global surgery 2030: Evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386:569-624.
