Increasing Access to Surgical Services for the Poor in Rural Haiti: Surgery as a Public Good for Public Health

Abstract

Although surgical care has not been seen as a priority in the international public health community, surgical disease constitutes a significant portion of the global burden of disease and must urgently be addressed. The experience of the nongovernmental organizations Partners In Health (PIH) and Zanmi Lasante (ZL) in Haiti demonstrates the potential for success of a surgical program in a rural, resource-poor area when services are provided through the public sector, integrated with primary health care services, and provided free of charge to patients who cannot pay. Providing surgical care in resource-constrained settings is an issue of global health equity and must be featured in national and international discussions on the improvement of global health. There are numerous training, funding, and programmatic considerations, several of which are raised by considering the data from Haiti presented here.

Surgical Relief Work in Haiti: A Practical Resident Learning Experience

“…3 The life expectancy is also the worst in the Western hemisphere, which is 54.3 years for women and 51.6 for men. 3,4 Eighty percent of Haiti's population lives below the poverty line, according to the United Nations World Food Program data, and less than half of the population has access to clean drinking water. 5 Most Haiti's inhabitants are unemployed and the annual per capita income is estimated at $450.…”

Global Surgery Fellowship: A model for surgical care and education in resource-poor countries

“…The wrong-side opening incision was during a hernia repair and this lead to the implementation of a preprocedure checklist in the operating rooms at Cange. Minor complications included wound infection (4).…”

“…Surgical diseases have been shown to be important causes of morbidity and mortality at a level on par with infectious diseases in resource-poor countries [3]. While still controversial, there is growing evidence demonstrating that this surgical burden can be relieved through various strategies, in even the most resource-poor of settings [4,5]. Further, not only is surgical care cost-effective [6][7][8], it can also be an important vehicle to bring the attention of the international community to needy areas, and to help develop health care infrastructure in resource-poor countries.…”

Critically Assessing the Haiti Earthquake Response and the Barriers to Quality Orthopaedic Care

“…Before the earthquake, there was already a critical need for surgical and orthopaedic services in Haiti [20,30]. Owing to this preexisting need and the magnitude of the natural disaster, a coordinated and effective surgical response was essential for this resource-poor country in the aftermath of the earthquake [42].…”