This Conversation is the first of three in a series to underscore the importance of #safesurgery. More than 5 billion people worldwide lack access to basic surgical services. Advocates, project implementers and thought leaders from around the world are convening at the 70th World Health Assembly (May 22-31), bringing to the attention of key decision makers the needs and potential collaborative solutions for funding safe surgery initiatives around the world.

Photo: Lucy Perry/Hamlin Fistula Relief and Aid Fund Australia/CC BY 2.0

Dr. Abraham Mengistu, Project Director of the Safe Surgery 2020 initiative with Jhpiego in Ethiopia, discusses the challenges in achieving Safe Surgery from an implementers perspective:
 

Q: What are the greatest challenges or underlying causes of accessing safe surgery?

The first problem is that people delay their decision to seek care, perhaps because they live far from a health facility with the capacity to treat them, perhaps because there’s a cost associated with the care that they can’t pay. Then, once they arrive at the facility, their experience may be less than satisfying. The facility might be poorly equipped, without the proper machines or even the basic necessities like a reliable source of electricity. The staff might not have the skills and confidence they need to perform the surgeries they need to perform, or the leadership in the facility might be lacking, resulting in long delays and unnecessary referrals. And people suffering from health conditions that can be easily resolved with a basic surgical procedure – such as glaucoma, hernia or compound fracture – struggle on. In the worst case, a pregnant woman who needs a caesarean dies needlessly.

In essence, the entire system needs to be improved holistically. At Jhpiego, one of the key insights we’ve had in this process, through the Safe Surgery 2020 program, is that to really make change happen, everyone needs to be involved. In Ethiopia, we are building the capacity of everyone at the facility—whether it’s empowering the head surgeon or chief clinical officer to innovate and actively seek solutions to the problem his or her team is facing, or ensuring the nurse has the skills he or she needs to be an integral, leading member of the safe surgery team. Or outfitting the health facility with a working generator.

Everyone has a role to play, and a big component of the work that needs to be done—and the work that we’re doing—is empowering health providers and administrators with the skills, confidence and leadership ability they need to do their jobs well.

Q: Why is it important to be able to access a safe and sustainable surgical system?

It’s not an easy question, but a sustainable surgical system would be robust and resilient—one that would evolve and change based on the needs and resources of the local community. There’s not a one-size-fits-all approach, which is why developing the staff in the facility—ensuring that there are confident, skilled leaders and innovators—is so important. We’ll never be able to gauge the exact needs of every facility in every area of surgical need across the world—but we can prepare the staff in those facilities to identify their problems, devise their own solutions, and execute their own action plans to be successful.

In Ethiopia, we have partnered with the government of Ethiopia, the GE Foundation, Assist International, Dalberg, The G4 Alliance, and the Harvard Program for Global Surgery and Social Change to improve access to quality surgical care. In the hospitals that Jhpiego supports, a new surgical ecosystem is providing timely, surgical care on site and with great results. Patient referrals are fewer and, in one hospital for example, the surgical teams have performed more C-sections and laparotomies, and achieved better management of complex fractures than in the past. That’s a successful outcome and a strengthened health system that is saving lives.

Watch this surgery expert make the case for why #safesurgery is vital to saving millions of lives across the globe. https://t.co/VzpOYB9JOg

— Jhpiego (@Jhpiego) May 15, 2017

Read part two of the series >>
Read part three of the series >>