Surgical conditions should be considered as “neglected diseases” disproportionately affecting the world’s poorest people. Patients with untreated surgical conditions,as well as the local clinicians struggling to care for them, must gain greater recognition by the global public health community. [1]
On May the 20th, a side event about global surgery and anesthesia took place at the WHA in Geneva, Switzerland. This day was a great one, it was a step forward toward advocacy for essentiel and safe surgical and anesthesia care. Health workforce, medical students are joining the debate to strengthen Members States’ capacity to integrate surgical care and anesthesia into primary health care in order to achieve progress toward Universal Health Coverage (UHC).
The lack of access to surgery for the world’s poor is one of the biggest global health problems that no one has ever heard of.
The WHO EB has included an agenda item on during 26-27 May 2014 in WHO EB room on: ‘Strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage’.
The WHA already approved in the past several resolutions including surgical care such as maternal and child health conditions, road traffic injuries, female genital mutilation, HIV, eye conditions, neglected tropical diseases (buruli, ulcer and filariasis), non-communicable diseases (cancer and diabetes), emergency response.
Two events were organized to support this agenda item for:
1) WHA side-event on 21 May 2014 at 12:15 at the Palais des Nations, on:
‘Improving Safe Emergency and Essential Surgical Care and Anaesthesia’
organized by the WHO Programme for Emergency and Essential Surgical Care (EESC) , the Department of Service Delivery and Safety (SDS) in collaboration with Member States (Zambia, Nigeria, USA, Rwanda, Kenya, Senegal and Australia) and NGOs in official relations with WHO (International College of Surgeons, International Federation of Surgical Colleges, International Society of Orthopaedic Surgery and Traumatology, and World Federation Societies of Anaesthesiologists);
2) Reception at the Intercontinental Hotel organized by International Collaboration for Essential Surgery, International College of Surgeons, International Federation of Surgical Colleges, International Society of Orthopaedic Surgery and Traumatology, World Federation Societies of Anaesthesiologists. International Federation of Medical Students Associations, Operation Smile, John Hopkins University, The Lancet Commission on Global Surgery. A movie directed and produced by Jaymie Ang Henry called The Right to Heal was presented in order to address this issue.
‘’We should have acted before’’, as Rwanda MoH pointed out, ‘’surgery and anesthesia did not received the deserved attention in the past and Africa should wake up more than others, in Africa there is 1% of surgeons compared to the US’’.
‘’Safe surgery is not a luxury but a basic right‘’ Australia MoH
The Australia MoH included the rights of the patients to receive primary health care service that is including surgical and anesthesia care, moreover as ‘’Mortality is an indicator of safety and quality of life, it is also an indicator of the right of the patient’’. Also Dr Kelly from the Department of Service Delivery and Safety called upon the importance of equity in healthcare.
‘’Education is the way out of poverty’’International Federation of Surgical Colleges
Both the International College of Surgeons and the International Federation of Surgical Colleges, supported by the IFMSA highlighted the importance of Education and the dissemination of best practices.
‘’The IFMSA is ready to support students with knowledge and trainings in order to be fully involved in research, to give inputs to health policies and to become good advocates for this global health issue.’’ Ivana Di Salvo – Liaison Officer to Research and Medical Associations
Everyone, from Angola, to Gambie, to Mongolia, agreed on the necessity of a campaign of advocacy that include civil society, patients, public health experts, healthcare professionals. Many members states were focusing on the high cost of technologic tools and equipments, and about the relevance of not guaranteeing only the 15 essential surgical interventions. They also addressed the significance of prevention of safe roads and prevention of violence, injury and trauma. Nevertheless in order to guarantee a gradual process to improve patients’ life, low-technology interventions would allow ‘’7 neglected surgical diseases (NSDs) to be managed by 15 essential surgical interventions in 15 countries so that:
· Every child born with a congenital problem such as cleft lip, clubfoot, cataracts, or hernia will receive life-changing surgery.
· Every woman needing an emergency C-section will have timely access to one.
· Every injured person worldwide will have timely emergency surgery.’’ ICES
‘’We are facing a task shifting, nothing real is happening, we need to guarantee every kind of surgery not only those 15 surgical interventions through a systematic approach’’ Waraguru Gangjau
Task shifting and sharing competences historically belonged to specific professional figures and it is a concrete step forward that has to be pursued. In the context where training facilities lack a systematic structure, alternative ways of training should be taken in consideration. [2-3]
‘’This cause is especially important among our members from low- and middle-income countries, many of whom see the problems of inequitable and scarce access to surgical care in their day-to-day lives as medical students, patients and friends or family of patients, and that sincerely wish to change status quo.
In conclusion, momentum for global surgery is growing fast. It is time to act, to change and to make sure that Access to Safe Surgery and Anaesthesia for All becomes a reality for all.‘’ [4]
Authors: Ivana Di Salvo, Marco Bonsano, Jouhayna Bentaleb, Waraguru Wanjau and Hampus Holmer
References
[1] Ozgediz D, Riviello R (2008) The “other” neglected diseases in global public health: Surgical conditions in
sub-Saharan Africa. PLoS Med 5: e121. doi:10.1371/journal.pmed.0050121.
[2] World Health Organization (2007) Emergency and essential surgery: Simple actions to make a
difference. Available: http://www.who.int/eht/sps/en/index.html. Accessed 23 July 2008.
[3] Brigham and Women’s Hospital (2008) Disparities in surgical care: Research to practice; 27–28 October
[4] The statement of the IFMSA
More information about WHO Global Initiative for Emergency and Essential Surgical Care (http://www.who.int/surgery/en/)
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