Challenges To Providing Surgical Care In Developing Countries

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A worldwide survey carried out in 2008 revealed that of the 235 million surgeries performed in that year, less than 4% were performed in the poorest countries, simply because of lack of access to surgical care. If you consider the fact that the population in these countries accounts for about 35% of the world’s total population, the implications are staggering. It means that an estimated 2 billion people have no access to much needed surgical care.

Student helping examine a patient with doctors during ward rounds, Tanzania. A survey was done in Sierra Leone by well known physician and researcher Adam Kushner and his team. Their main aim was to determine the incidence of untreated surgical conditions in a country with only 10 trained surgeons in a population of 6 million. According to the research team’s findings, 25% of the population had some condition that required surgical intervention and 25% of deaths in the preceding year could have been prevented by timely surgical care. Most deaths were due to pregnancy related complications, abdominal conditions and treatable injuries. Based on the Sierra Leone results and findings from a similar study done in Rwanda, it is estimated that there are approximately 56 million people in sub-Saharan Africa who are currently in need of surgery.

There are multiple challenges that come in the way of providing surgical care in developing countries. One of the greatest challenges is the lack of qualified medical professionals who are trained to deliver this higher level care. Another challenge is the lack of infrastructure combined with the lack of resources needed to train future generations of specialty surgeons, who need several years of training beyond what primary care doctors require. Compounding the issue is the harsh reality that simply providing funds or equipment will not address these surgical disparities. The dearth of skilled physicians, nurses and other healthcare providers trained in emergency obstetric care lies at the core of the problem.

The scarcity of medical professionals throughout Africa and other developing countries has been well-documented. This shortage is largely due to the fact that trained surgeons prefer to work in urban hospitals in high-income countries to make up for the time and money spent in medical school.  

Global health organisations have been exploring numerous ways to resolve this situation and have finally arrived at the conclusion that the only solution lies in implementing short-term arrangements to attend to urgent cases while putting in place more viable, long-term arrangements. The short term solutions involve bringing in qualified surgeons and other medical professionals from other parts of the world while the long-term solution involves helping countries become self sufficient by training their own healthcare providers, including surgeons and specialty care physicians. That is an enormous task that is likely to take decades but there is comfort in knowing that there is some progress being made towards reducing this disparity in health care between the haves and the have-nots. For it to work though, what is needed is dedicated and committed skilled healthcare workers across all specialities, particularly skilled surgeons. 

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