Presentation is loading. Please wait.

Presentation is loading. Please wait.

What effect can surgeons have on world health? Ross Elledge BChD(Hons) MFDS RCPS(Glasg) Final year medical student, University of Birmingham, UK.

Similar presentations


Presentation on theme: "What effect can surgeons have on world health? Ross Elledge BChD(Hons) MFDS RCPS(Glasg) Final year medical student, University of Birmingham, UK."— Presentation transcript:

1 What effect can surgeons have on world health? Ross Elledge BChD(Hons) MFDS RCPS(Glasg) Final year medical student, University of Birmingham, UK

2 Thinking globally 2 to 3 billion people have no access to surgical care Around 11% of disability adjusted life years (DALYs) are due to surgical diseases (similar to communicable diseases): Injuries 38% Malignancies 19% Congenital anomalies 9% Despite this, rates of surgery in LMIC lag behind those of richer countries – Africa has 25% of the disease, 3% of the health care workers

3 Who cares? Poorly researched problem Surgery is often “the neglected stepchild of global public health” regarded as not cost effective WHO Commission on Macroeconomics and Health (2001) “Minimum package” for healthcare US$34 per capita Failed to include any surgical services beyond emergency obstetrics

4 Is there a surgeon in the house? The scale of the problem – 5 million people worldwide die from traumatic injuries each year, equivalent to deaths from HIV/AIDS, malaria and tuberculosis combined – 90% of these occur in developing countries – For each person who dies 3 to 8 are permanently disabled

5 Still waiting...... Estimated 2.8million children/adults worldwide with untreated CLAP – Death from feeding difficulties, dehydration and malnutrition – Infanticide by an unenlightened community – A lifetime of social abandonment potentially extended to the entire family unit

6 Your flight is about to depart 27 million people In Uganda, there are 20 orthopaedic surgeons, 3 cardiothoracic surgeons, 3 paediatric surgeons, 3 plastic surgeons, 3 urologists and 27 million people in the waiting room

7 What are the answers? Surgery needs to be recognized as a concern Better reliability in data gathering to give a clearer picture of “gaps” in research so far Safety practices such as the WHO Guidelines for Safe Surgery following the second Global Patient Safety Challenge 2007-2008 – 5-10% mortality in major surgical procedures in the developing world the majority of which were preventable – safety of anaesthesia (1 in 150 mortality in Togo) – need for preventive strategies to reduce infection and other post-operative complications e.g. antibiotic prophylaxis

8 What are the answers? Improving access to healthcare – Increasing manpower – Correcting the rural/urban divide 70% of doctors in Ghana work in 2 major cities with only 30% in rural outreach areas Adequately funded and resourced hospitals – Early detection of surgical diseases e.g breast cancer through public awareness and screening infrastructure – Cost effective alternatives in standard surgical procedures e.g. sterilised polyester mosquito net for hernia repairs!

9 What are the answers? Education – building local surgical services – Interdepartmental partnerships such as UCSF and Makere University, Uganda in paediatric surgery Beneficial to visiting trainees as well resulting in research projects, masters degrees, scholars programs – University of Toronto and two centres Botswana “Teleconference teaching” – Texas Heart Institute and Tbilisi, Georgia Gradual reduction in the visiting team to allow independence

10 What are the answers? ATLS-style courses, WHO IMEESC toolkit – 81% of trauma patients die before reaching hospital in Ghana – Trinidad reduced its mortality from 67% to 34% The “Sandwich fellowship” model – Successful pilots in ophthalmology and orthopaedics by the University of Ottawa – May need retention clauses?

11 Money makes the world go round Surgery may reap $11-77/DALY averted compared with vaccination programmes at $5/DALY averted Surgery may reap $11-77/DALY averted compared with vaccination programmes at $5/DALY averted – Cleft palate repair added between $152,372 and $375,414 to lifetime earnings in a study by Corlew – For all patients operated on in a single calendar year by a single surgical outreach programme, this was a combined lifetime earning of $22,881,627 to $57,631,770

12 Is it worth it?

13 References Semer NB, Sullivan SR, Meara JG. Plastic surgery and global health: how plastic surgery impacts the global burden of surgical disease. J Plast Reconstr Aesthet Surg 2009 Jul 28 [Epub ahead of print] Corlew DS. Estimation of the impact of surgical disease through economic modelling of cleft lip and palate care. World J Surg 2009 Aug 22 [Epub ahead of print] Aziz SR, Rhee ST, Redai I. Cleft surgery in rural Bangladesh: Reflections and experiences. J Oral Maxillofac Surg 2009;67:1581-8 Ozgediz D, Jamison D, Cherian M, et al. The burden of surgical conditions and access to surgical care in low- and middle-income countries. Bull World Health Organ 2008;86(8):646-7 Ozgediz D, Kijjambu S, Galukande M, et al. Africa’s neglected surgical workforce crisis. Lancet 2008; 371(9613):627-8 Hodges S, Wilson J, Hodges A. Plastic and reconstructive surgery in Uganda – 10 years experience. Paediatr Anaesth 2009;19(1):12-8 Kingham TP, Kamara TB, Daoh KS, et al. Universal precautions and surgery in Sierra Leone: the unprotected workforce. World J Surg 2009;33(6):1194-6 Quansah R, Abatanga F, Donkor P. Trauma training for non-orthopaedic doctors in low- and middle-income countries. Clin Orthop Relat Res 2008;466(10):2403-12 Mock C, Cherian MN. The global burden of musculoskeletal injuries: challenges and solutions. Clin Orthop Relat Res 2008;466(10):2306-16

14 References Taira BR, Kelly McQueen KA, Burkle FM Jr. Burden of surgical disease: does the literature reflect the scope of the international crisis? World J Surg 2009;33(5):893-8 Mock C, Joshipura M, Goosen J, et al. Overview of the Essential Trauma Care Project. World J Surg 2006;30(6):919-29 McQueen KA, Hyder JA, Taira BR, et al. The provision of surgical care by international organizations in developing countries: a preliminary report. World J Surg 2009 Aug 15 [Epub ahead of print] Bickler SW, Rode H. Surgical services for children in developing countries. Bull World Health Organ. 2002;80(10):829-35 Azzie G, Bickler S, Farmer D, et al. Partnerships for developing paediatric surgical care in low-income countries. J Paed Surg 2008;43:2273-4 Velebit V, Montessuit M, Bednarkiewicz M, et al. The development of cardiac surgery in an emerging country: a completed project. Tex Heart Inst J 2008;35(3):301-6 Kassam F, Damji KF, Kiage D, et al. The Sandwich fellowship: a subspecialty training model for the developing world. Acad Med 2009;84(8):1152-60 Anderson BO, Braun S, Carlson RW, et al. Overview of breast health care guidelines for countries with limited resources. Breast J 2003;9(Suppl 2):S42-50 Clarke MG, Oppong C, Simmermarcher R, et al. The use of sterilised polyester mosquito net mesh for inguinal hernia repair in Ghana. Hernia 2009;13(2):155-9

15 Any questions?


Download ppt "What effect can surgeons have on world health? Ross Elledge BChD(Hons) MFDS RCPS(Glasg) Final year medical student, University of Birmingham, UK."

Similar presentations


Ads by Google