September 26, 2015

Expanding Access to Basic Surgical Care in the Developing World

Written by Sruti Ramadugu, MCSP Communications Specialist

Fifty years ago, physicians in Boston completed the first successful renal transplant in the United States. This week, in Ethiopia, the first such successful transplant occurred in Addis Ababa. Though this procedure was a victory for the terrific community of healthcare providers in Ethiopia, it highlights a stark reality: every year, millions of people die due to untreated conditions that require surgical care, and the poorest one third of the world receive less than one-tenth of all safe surgery procedures.

This inequity hurts the most vulnerable amongst us. But there is good news: nurses and other frontline health care providers offer the best hope for expanding essential surgical care and preventing the deaths of millions of people in the developing world.

With the proper education and training, nurses, midwives and clinical officers could fill the gap created by a lack of surgeons and anesthesia specialists in countries as diverse as Haiti and Uganda, said several experts who participated in the “Safe Surgery: Challenges to Overcome, Opportunities to Exploit and Approaches that Work” event held Saturday during the opening week of the United Nations General Assembly.

Jhpiego, an international health affiliate of Johns Hopkins University, GE Foundation and the Global Alliance for Surgical, Obstetric, Trauma, and Anesthesia Care (The G4 Alliance) sponsored the event to raise awareness about neglected surgical conditions including obstructed labor, trauma, cleft palate, hernia, cataracts and other conditions. Five billion people worldwide lack access to such care, leading to 16.9 million deaths a year, according to the Lancet Commission on Global Surgery.

Leslie Mancuso, President and CEO of Jhpiego, welcomed the more than 200 people who attended the event, saying the global health community was expertly poised at this time to take steps to resolve this surgical care disparity.

Dr. Richard Besser, Health and Medical Editor for ABC News and the panel moderator kicked off a lively discussion with this stunning fact: nine people die each minute because lack of access to safe surgery. The panelists then engaged in a rich conversation around leadership, increasing coverage, and the need to work at every level in the health system – from the community to the national level — given the severe shortage of qualified surgeons and surgical specialists in the developing world.

The panelists — Dr. Stephanie Ferguson, Director, ICN-Burdett Global Nursing Leadership Institute (GNLI) and International Council of Nurses’ (ICN) Leadership for Change Program; Dr. David Barash, Executive Director, Global Health Programs and Chief Medical Officer, GE Foundation; Dr. Tigistu Adamu Ashengo, Associate Medical Director ; Dr. Pankaj Jani, Secretary General, College of Surgeons of East & Central Africa (COSECSA); and Dr. Neil Parsan, Executive Secretary for Integral Development, Organization of American States — agreed that current surgical needs are unlikely to be met and the global health community must consider the viable alternative in training nurses and clinical health officers.

Nurses and clinical health officers with 2-3 years of on-the-job training could provide basic surgical care in primary care facilities that presently lack these essential services. For example, a decade ago Jhpiego helped develop and train nurses in surgical skills to perform a leading role in voluntary medical male circumcision in Tanzania and elsewhere. More recently, Jhpiego has worked with the government of Nepal to develop an obstetric fistula repair program for nurses and doctors who work as a surgical team to relieve women of this painful and debilitating condition often caused by obstructive labor.

GE, Jhpiego, and other partners recognize that access to safe surgery can save lives, and has the potential to strengthen health systems. This conversation was all the more relevant with the recent launch of the Sustainable Development Goals, and governments the world over agreeing that improving the health and well-being of people should be a global priority.

With a strong and growing evidence base in mind, the GE Foundation announced Friday a $25 million Safe Surgery 2020 Initiative, a three year commitment to expand access to basic surgical care in places that need it most by strengthening health systems, developing surgical care leaders in low-and-middle income countries and leveraging innovation to improve surgical care.

Dr. Harshad Sanghvi, Vice President at Jhpiego, summed up the need for safe surgery succinctly: “We need to have a ‘healthy disregard for the impossible.’ We would have not thought 15 years ago that you can bank on a mobile phone, or that three pills could save a mother from post-partum hemorrhage, but that is possible today. Safe surgery may be today’s impossible, but it could also be tomorrow’s possible to solve the human resource problem in global health.”