Global Disparities In Surgery

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Studies show that though most of the global burden of surgical disease falls among the world’s poorest, only a small percentage of surgical interventions occur in lower income countries.

Gap Medics students with their mentor at Nakornping Hospital, Chiang Mai. Global disparities in surgery are truly staggering, with only 26% of operations performed in poor countries that have a correspondingly low expenditure on healthcare. Besides lower income, another of the main reasons that poorer countries have lower rates of surgery is because they do not have enough trained local surgeons to meet their surgical needs. Where high income countries have at least 5 orthopedic surgeons per 100,000 people, there is less than 1 surgeon per million in poorer sub-Saharan countries. Such statistics point to the glaring inequality that exists. On a positive note, they also point to the potential improvements that could be realised if such disparity was addressed.

For people in low income countries, the biggest drawback to the lack access to basic surgical care is that minor surgical pathologies can over a period of time develop into potentially lethal conditions. Often as cancer patients wait for proper surgical treatment, cancers will become inoperable and incurable. An injury that could have been corrected in a few hours becomes a permanent, untreatable disability or a woman’s uterus might rupture because of obstructed labor. 

Fistula is another condition which if not operated upon immediately could become increasingly disabling and difficult to treat or cure. There are more than two million women in Africa who live with untreated obstetric fistula.  Because of the lack of access to basic emergency surgery, their conditions will in all likelihood get worse, causing them to become even more disabled. Moreover, when and if they are able to receive care, they will most likely end up requiring more resource-intensive surgery to treat the disease in its advanced stage.

Though recent reports show that a significant part of the global burden of disease can be treated with surgery, the majority of health facilities in low-income countries do not have the capacity to deliver even the most basic surgical services. It is especially important that surgical services be more easily accessible to low-income countries because they tend to negatively affect the young working population and impoverished patients, through lost days of work and out-of-pocket health expenses.

For hospitals anywhere to be able to provide safe, effective surgery, they first must have an operating room with the proper infrastructure- electricity, running water and oxygen. In addition, all hospitals with surgical programs must necessarily have the proper facilities related to postoperative care and blood-banking. No matter how small a hospital, it must compulsory have at least two operating theaters (one for emergencies and another for elective cases), anesthesia machines, an on-site blood bank, a laboratory, an uninterrupted electricity source and experienced staff who know how to use the various equipment. In resource-poor settings, equipment for carrying out anesthesia and surgery is often deficient, and facilities for sophisticated postoperative care are frequently minimal and dependent on the individual initiative of the surgeons concerned.

Education and funding are the only solution to eliminating such glaring inequalities in the global surgery scene.  

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