Advocacy for global surgery: a Pacific perspective

Abstract

Background The geographic region of the South Pacific covers a third of the globe, much of which is ocean, the world's largest geographic feature, spanning 155 km 2. The ocean expanse is scattered with numerous Pacific Island countries and territories (which fall into three main political groups, whose connections are historical, political and/or economic; Table 1). They represent nations generally with small populations but with the least access to safe, affordable and timely surgery in the world, partly as a result of their geography as well as their stage of economic development. This paper describes how the Royal Australasian College of Surgeons (RACS) and the Pacific region have been involved with global surgery and anaesthesia advocacy since 2012. This has included engagement with the World Health Organization (WHO) in Geneva, their Global Initiative for Emergency and Essential Surgery (GIEESC) and WHO's Western Pacific Region Organization (WPRO). The paper focuses on the Pacific Island countries with which RACS, and the Australian and New Zealand College of Anaesthetists (ANZCA), have established relationships and a history of engagement in supporting local agendas for capacity building. The Colleges engage not only in partnership with universities and health departments, but also collaborates with other Australian and New Zealand specialist medical colleges, and their Pacific or Papua New Guinea (PNG) surgical and anaesthesia counterpart associations (Table 2). Although Timor Leste falls outside of the WPRO, the clinical networks and partnerships established through RACS and the other colleges justify including their role in this account of regional advocacy.

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Thinking outside the box: not as easy as you might think

“…Others had noted this bacterium in the stomach, but any suggestion that it had a role to play in peptic ulcer disease was considered ludicrous. Botcher and Letulle (1875) 6 had postulated the association bacteria and gastric ulceration; Hoffman (1925) 7 had fulfilled Koch's postulate in an animal model with an inoculum from a gastric ulcer; and Dr Kohn Likoudis (1950s), 8 a Greek general practitioner, successfully empirically treated a large cohort of ulcer sufferers with a combination of antibiotics. He was initially fined and then deregistered by the Greek authority for his reckless behaviour.…”

Global Health in the ANZ Journal of Surgery

“…The history of our relationships in the region, and our contributions to health system strengthening are curated in Watters et al's perspective. 8 'What is not measured may not be planned for or managed'. 9 Responding to the Lancet Commission's recommendations on surgical metrics, the Pacific launched a collaborative effort to report these for our region, highlighting access to surgical care and limited workforce as critical issues.…”

“…Others had noted this bacterium in the stomach, but any suggestion that it had a role to play in peptic ulcer disease was considered ludicrous. Botcher and Letulle (1875) 6 had postulated the association bacteria and gastric ulceration; Hoffman (1925) 7 had fulfilled Koch's postulate in an animal model with an inoculum from a gastric ulcer; and Dr Kohn Likoudis (1950s), 8 a Greek general practitioner, successfully empirically treated a large cohort of ulcer sufferers with a combination of antibiotics. He was initially fined…”

“…The history of our relationships in the region, and our contributions to health system strengthening are curated in Watters et al . 's perspective 8 …”