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What should global surgery be and who should decide?

The Lancet Commission on Global Surgery tried to raise awareness about access to surgery and provision of surgery around the world. The Commission highlighted the previously underappreciated burden of surgical illness compared to the more charismatic tropical diseases of HIV, TB and malaria. So there is a call for global surgery to mean increasing access to surgery in the Global South and improve equity with surgical provision in the rest of the world.

Bruce Biccard and the ASOS collaborative study in Africa demonstrated that the secondary burden of global surgery is peri-operative mortality. This was despite a low-risk profile and relatively few postoperative complications. Initiatives to increase access to surgical treatments in Africa should therefore be coupled with improved surveillance and understanding about postoperative complications and their treatment.

Multi-centre trials like the group Safe Surgery Saves Lives Study Group demonstrated nearly a decade ago that simple process changes like the WHO checklist can make a significant difference. So global surgery should be all encompassing and improve multi specialty effort involving our anaesthetic and allied health professional colleagues across the health system.

Global Anaesthesia Workforce Density highlights inequality of healthcare resource distribution

Another Lancet commission on health systems strengthening emphasised that insufficient access had been overtaken by quality as a source of mortality. Global surgerydoesn’t exist in isolation and the whole health system needs to be sustainably strengthened and empowered to achieve longstanding levels of higher quality care that patients can trust and believe in.

This year, David Shay called on academic departments to embrace global surgery formally, and Tolu Oni and colleagues have reminded us that in a world of ever widening inequality there should be greater emphasis on intervening in the root causes of global ill health, namely social, economic, and commercial determinants of health. They advocate for interdisciplinary training across public, private and charity sectors and greater provision of public health and global health training in the Global South itself.

There is a need for global surgeons to consider their work and research in the context of changing global pathology and agendas, acknowledging the need for exchange and sharing of ideas and developments rather than the traditional “colonial” transfer of learning. As global surgeons we will need to evaluate the outcomes and impact of any changes and developments in partnership with local and global experts.

by Tom Hampton

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