Is Surgery the Stepchild of Global Public Health?

By: Nina Rodriguez

Surgery is a medical service typically not on the agenda for global healthcare advocates.  However, inadequate surgical care and scarce access to anesthesia is a serious issue in low-income and middle-income countries, such as Uganda.  It is a matter that is severely overshadowed by other more discussed crises.  In fact, Paul E. Farmer and Jim U. Kim even went so far as to name surgery the neglected stepchild of global public health in their 2008 article “Surgery and Global Health: A View from beyond the OR.”

Globally, there are around 235 million operations that occur annually and only 4% of those are performed in lower income countries. GPAS, or Global Partners in Anesthesia and Surgery, suggest that this discrepancy is likely due to the “perception that all surgery is complex, expensive and resource-intense.” In fact, “surgery ranks comparably with more cost-effective health interventions, such as vaccines.” Yet instead, organizations allocate a lot of their resources into other concerns and health programs. Although most of these issues are significant, some countries would benefit more from improving surgical services rather than focusing on other programs.

In 2006, Uganda had fewer than 100 surgeons available for a population of 30 million and only 13 anesthesiologists. These shocking statistics reveal the inadequacies Ugandans face. Farmer and Kim also shed light on this issue by revealing that “although disease treatable by surgery remains a ranking killer of the world’s poor, major financers of public health have shown that they do not regard surgical disease as a priority even though, for example, more than 500,000 women die each year in childbirth; these deaths are largely attributable to an absence of surgical services and other means of stopping post-partum hemorrhage.”

In 2010, researchers studied Uganda to learn more about health policy development and address methods to improve surgical services. Among many goals, some of their objectives were to improve the conditions of the existing surgical workforce, address the shortage through task extension, and redesign the medical education in Uganda in order to require Ugandan doctors to have basic practical surgical skills.  They also sough to raise public awareness about the lack in surgical services and advocate for donor support. These goals would redefine the way Ugandans perceive injury and life-threatening diseases that require surgery.

In order to help these countries, we must redistribute some of the resources already generated to public health in order to support surgical services. We must no longer treat surgery as the stepchild of global public health.

 

Image reference

http://blogs.plos.org/speakingofmedicine/files/2013/09/Surgery.jpg

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