The Role and Duty of Global Surgery in Increasing Sustainability and Improving Patient Care in Low and Middle-Income Countries

Abstract

Global health is one of the most pressing issues facing the 21st century. Surgery is a resource and energyintensive healthcare activity which produces overwhelming quantities of waste. Using the 5Rs (Reduce, Reuse, Recycle, Rethink, and Research) provides the global surgical community with the pillars of sustainability to develop strategies that are scalable and transferable in both low and middle-income countries and their high-income counterparts.Reducing energy consumption is necessary to achieving net zero emissions in the provision of essential healthcare. Simple, easily transferrable, high-income country (HIC) technologies can greatly reduce energy demands in low-income countries. Reusing appropriately sterilized equipment and reprocessing surgical devices leads to a reduction of costs and a significant reduction of unnecessary potentially hazardous waste. Recycling through official government-facilitated means reduces 'informal recycling' schemes, and the spread of communicable diseases whilst expectantly reducing the release of carcinogens and atmospheric greenhouse gases. Rethinking local surgical innovation and providing an ecosystem that is both ethical and sustainable, is not only beneficial from a medical perspective but allows local financial investment and feeds back into local economies. Finally, research output from low-income countries is minimal compared to the global academic output. Research from low and middle-income countries must equal research from highincome countries, thereby producing fruitful partnerships. With adequate international collaboration and awareness of the lack of necessary surgical interventions in low and middle-income countries (LMICs), global surgery has the potential to reduce the impact of surgical practice on the environment, without compromising patient safety or quality of care.

An Analysis of Global Orthopedic Organizations Through the Lens of the Four Pillars of Global Surgery

“…A key component of equitable surgical care is the production of equally trained surgical residents in LMICs [16]. Advancing surgical training worldwide has the potential to improve the delivery of equitable and safe surgery with a cumulative effect that is far superior to any single medical mission [16].…”

“…A key component of equitable surgical care is the production of equally trained surgical residents in LMICs [16]. Advancing surgical training worldwide has the potential to improve the delivery of equitable and safe surgery with a cumulative effect that is far superior to any single medical mission [16]. However, prior studies have shown that postgraduate surgical training varies greatly in LMICs [17] and can lack appropriate specificity with regard to surgical specialties [18].…”

Eco-Friendly and COVID-19 Friendly? Decreasing the Carbon Footprint of the Operating Room in the COVID-19 Era

“…Although implementation needs to be country and region-specific, a number of overarching concerns over feasibility need to be taken into account. Surgical services have already been limited globally, notably in low to middle-income countries, and it has been challeng-ing to establish sustainable services in such regions [47]. This burden is not very much different for the high-income countries as well, as a considerable amount of resources is drained to maintain the quality of the surgical structure [48][49][50][51].…”

Surgical mentorship in low‐resource environments: Opportunities and challenges, a perspective

“… 22 Collaboration with external experts enriches the resource pool, leading to innovative solutions and the establishment of dedicated centers for surgical innovation. 23 …”