On a blistery cold day in December, I sat in a corner office on one end of a beautiful, large oak desk fidgeting in my interview suit. The man stationed at the opposing end leaned back in his leather recliner and scoffed at my previous statement.
"You want to do surgery in developing countries? Surgery has no place in global health," he said. "Leave that to the medical doctors."
My heart sank. The sad truth is that he is not alone in his sentiment. Most people today think about global health in a restricted and one-dimensional perspective that focuses only on communicable diseases and basic health needs. It is true there are horrible diseases plaguing the world, both insect and water-borne. However, attention to these alone creates an inaccurate representation of the global health care landscape--a misperception that permeates not just in popular media but amongst health care professionals as well.
In the past few years, a growing body of evidence has emerged bringing to light a significant disparity that exists in the delivery of health care to foreign countries: There are 5 billion people worldwide who do not have access to much-needed safe and affordable surgical and anesthesia services. Further, 18.6 million people die every year due to lack of surgical care, a number that is over three times the combined number of deaths caused by HIV/AIDS, tuberculosis, and malaria. In 2015, the United States spent over 60% of its global health fund on these three diseases, despite the fact that their death and infection rates have plummeted globally.
In a recent article in BMJ Global Health, a team of medical providers and experts from leading institutions around the world summarized current data on global surgery and provided consensus recommendations for high-income countries. They report that there needs to be at least 1.27 million new surgeons, anesthesiologists, and obstetricians worldwide by 2030 to reach conservative health-needs benchmarks.
To achieve these goals, these experts encourage the development of complex and long-term relationships with academic training institutions and partner organizations abroad. To allow surgeons in high-income countries to participate in global surgery, there needs to be a foundation already in place for the flow of funding and volunteerism. Establishing such a structure would not only improve the standards for training but also the number of trainees, and it would promote the retention of local providers in lower-income nations as well--many of whom leave for wealthier countries once they have completed their training.
But the burden of responsibility does not just rest with physicians. Investors are tasked with recognizing the cost effectiveness of surgical-care funding and supporting focused and well-informed efforts. Biomedical engineers and those in the tech industry can help by designing and manufacturing equipment from local resources that is tailored to the specific needs of a targeted region so as to avoid "dumping used or outdated devices." Additionally, the media has a responsibility to cover more international health-care-related issues and journalists need to become advocates of much-needed change on the global scene.
More than one-third of the world's global burden of disease can be ameliorated with access to surgical care. While this statistic is overwhelming, it is possible to achieve with concerted planning and efforts. Thinking back on that moment in the corner office made me realize the first step to reach these important goals is for the public to recognize that this need exists. The paradigm of global health care must be radically dismantled in order for change to even begin.
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