What is ‘global surgery’? Defining the multidisciplinary interface between surgery, anaesthesia and public health

Abstract

‘Global surgery’ is the term adopted to describe a rapidly developing multidisciplinary field aiming to provide improved and equitable surgical care across international health systems. Sitting at the interface between numerous clinical and non-clinical specialisms, it encompasses multiple aspects that surround the treatment of surgical disease and its equitable provision across health systems globally. From defining the role of, and need for, optimal surgical care through to identifying barriers and implementing improvement, global surgery has an expansive remit. Advocacy, education, research and clinical components can all involve surgeons, anaesthetists, nurses and allied healthcare professionals working together with non-clinicians, including policy makers, epidemiologists and economists. Long neglected as a topic within the global and public health arenas, an increasing awareness of the extreme disparities internationally has driven greater engagement. Not necessarily restricted to specific diseases, populations or geographical regions, these disparities have led to a particular focus on surgical care in low-income and middle-income countries with the greatest burden and needs. This review considers the major factors defining the interface between surgery, anaesthesia and public health in these settings.

Significant improvement in quality of life following surgery for hydrocoele caused by lymphatic filariasis in Malawi: A prospective cohort study

“…The men presenting for surgery were predominately poor farmers, who had suffered from their condition for around a decade and had their work capacity restricted. Not surprisingly, the main barrier to surgery was the cost, which has been shown to be a problem elsewhere [12,15,26], and for other conditions requiring surgery [20], and emphasises the need for national and international stakeholders to prioritise financial support and access to free surgical services [36], especially for those living far from facilities [28]. Currently, UK Aid provides the largest financial support for hydrocoele surgeries across 25 endemic countries, but more resources are urgently needed to address the immense global burden with quality surgical procedure and potentially improve millions of men's lives [20,37].…”

“…Not surprisingly, the main barrier to surgery was the cost, which has been shown to be a problem elsewhere [12,15,26], and for other conditions requiring surgery [20], and emphasises the need for national and international stakeholders to prioritise financial support and access to free surgical services [36], especially for those living far from facilities [28]. Currently, UK Aid provides the largest financial support for hydrocoele surgeries across 25 endemic countries, but more resources are urgently needed to address the immense global burden with quality surgical procedure and potentially improve millions of men's lives [20,37]. In Malawi, the average cost of the surgery during the hydrocoele camp was US$68 (including surgical supplies, support to surgical and hospital teams, patient transport, food and accommodation), and recent economic analysis of this hydrocoele camp data found a very high benefit-cost ratio of 24.5 [38], with surgery enabling men to lead more economically productive lives.…”

“…For men to access and fully benefit from surgery, they need to be better informed of the causes as there were many misconceptions, which is a common problem across endemic countries [10,39]. National LF elimination programmes need to advocate for resources to support social mobilisation to increase community awareness, help to reduce stigma, and increase the uptake and demand for quality surgical services [20]. Building on the existing health system network and optimising health worker programmes will be essential [40], as we found men were more likely to correctly identify the cause of their hydrocoele if the information came from community health workers.…”

“…Hydrocoelectomy is one of 28 essential surgical procedures that should be available worldwide [8] and the rapidly developing field of 'global surgery' aims to provide improved and equitable care to the world's population [20]. The World Health Organization (WHO) has recently released a new report on the surgical approaches to the urogenital manifestations of LF [6].…”

Ethical considerations in global surgery: a scoping review

“…Global surgery, the 'enterprise of providing improved and equitable surgical care to the world's population', has garnered increasing attention over the last two decades. 1 A number of academic and policy developments, most significantly the Lancet Commission on Global Surgery, have drawn attention to the staggering burden of surgical disease harboured by low-income and middle-income countries (LMICs). An estimated of 5 billion people worldwide lack timely access to safe and affordable surgical care, and 143 million surgical procedures worldwide are required to make up this shortfall.…”