Global need for surgery
Can you imagine having a child die from appendicitis because no surgeon could be found to treat her? What would it be like to fracture a limb and lead a life of disability because there was no one to fix it? How would it feel to watch a spouse die of cancer because there was no one there to treat it?
Few of us think about such things because we do not have to. Here in the Salt Lake Valley, while it may be costly, we have a choice of several places we could go and get excellent care. We even have an expectation that lives will be saved or that full, or nearly full, function will be restored for nearly all injuries.
For 2 billion of our fellow human beings, this is only a dream. They have no access to basic essential surgery and anesthesia. Each year more than 300,000 women die during childbirth, 5 million people die from injuries and 8 million die from cancer. There are hundreds of millions who suffer disabilities from acquired or congenital deformities. Many of these lives could be saved and/or impacted with access to surgery and anesthesia.
In recent years some quite amazing things have been achieved in the area of public health. Over the last 30 years, the number of preventable child deaths has been cut in half, from 40,000 to 20,000 each day. Public health experts are actually talking about, if we pay more attention to it, the end of preventable child death. This would mean that a child born anywhere would have the same chance of reaching his or her fifth birthday regardless of birthplace.
The Global Fund to Fight AIDS, Tuberculosis and Malaria has already saved more than 6 million lives since it was created in 2001. Great progress has been made in limiting the transmission of HIV from mother to child. Child deaths from malaria and measles have been reduced markedly.
Surgery, however, has been called "the neglected step-child" of global public health. In the past it has been widely thought that those without access to surgery and anesthesia will regrettably have to suffer because surgery and anesthesia are just too expensive. The burden of surgical diseases in low- and middle-income countries is huge. It is conservatively estimated that in sub-Saharan Africa alone, 56 million people need surgery.
There is a growing body of evidence that shows surgery at a district hospital level is not only affordable but compares favorably with many of the public health measures that we commonly accept. Operations such as emergency caesarean section, cataract surgery, hernia repair, male circumcision, cleft lip and palate repair appear to be as cost-effective as other interventions, such as anti-retroviral therapy for HIV, vitamin A supplementation, measles immunization and oral rehydration therapy.
Fixing this will not be easy or occur overnight. It will happen only when we give it the necessary attention. A logical next step is that the World Health Assembly, the governing body of the World Health Organization, should pass a resolution giving surgical care and anesthesia in low- and middle-income countries the priority they deserve.
Secretary of Health and Human Services Kathleen Sebelius, our representative to the WHA, should have the U.S. lead on such an important effort. I appreciate the actions of Utah Congressman Jim Matheson to push the country in such a direction. There is too much unnecessary suffering in this world. We should all do our part to end it as soon as possible.
Scott A. Leckman is a general surgeon in private practice in Salt Lake City. He is also an adjunct assistant professor of surgery at the Center for Global Surgery at the University of Utah.
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