Decolonizing the decolonization movement in global health: A perspective from global surgery

Abstract

There has been a recent increase in dialogs around decolonization in global health. We present a perspective from global surgery emphasizing personal experiences around equity in barriers to education and surgical missions, citing specific personal challenges and local perceptions that we have experienced as well as potential solutions. We also cite fundamental challenges to the movement to decolonize global surgery, including donor-directed priorities and the creation of partnerships based in genuine bilateral exchange. We cite several models of current programs aiming to address some of these challenges.

Colonisation and its aftermath: reimagining global surgery

“…We traced this back to the historical evolution of obstetrics and gynaecology, which has always been relegated to a lower status than other surgical specialties, as a specialty focusing on the treatment of women 59 60. Third, care remains hospital-centric 16. Clinicians, particularly those from the Global North, lack experience interfacing with primary health and community care 54…”

“…This legitimises an ongoing unidirectional flow of personnel from the Global North to the Global South 30 37. We noted that the literature widely frames global surgery as being delivered by the Global North in the Global South 7 16 65. Global North researchers are recognised as ‘global’ experts, and Global South researchers are only recognised ‘local’ experts 66.…”

“…This opportunism reveals the benefits at stake. The benefits of surgical missions to Global North practitioners are not readily acknowledged but include clinical and surgical skill accumulation, exposure to new cultures, attraction of students, funding and promotion 16 19…”

“…Recent literature has highlighted persistent inequities in global surgery. These include skewed distribution of benefits, such as authorship,11–13 limited participation,14 15 unidirectional flow16 17 and Western dominance over knowledge production and funding 18 19…”

“…The concept of Global North and Global South was developed during the Cold War era. The terms are not geographically defined but rather follow an imaginary Brandt Line 16. This identifies the Global North as industrialised countries predominantly occupied by Western European people, with the exception of Japan, Korea and Israel.…”