Surgery and Global Health: A View from Beyond the OR

Excerpt

In Africa, surgery may be thought of as the neglected stepchild of global public health. There are fewer physicians per population on this continent than on any other; surgeons are rarer still, and almost all of them work in the urban enclaves of what remains a rural region. The story is the same in the poorer parts of Asia and Latin America (with a few exceptions, such as Cuba). 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 [1]. Equally unattended, among the very poor, are motor-vehicle and farm accidents, peritonitis, long-bone fractures, and even blindness [2-4]. Cardiac disease, congenital or the sequela of infection, is a death sentence for most people—many of them children—so afflicted in the poorest parts of the world [5, 6]. In some settings, surveys reveal that surgical disease is among the top 15 causes of disability [7], and surgical conditions account for up to 15% of total disability adjusted life years (DALYs) lost worldwide [8]. …