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