Building the frontline surgical workforce needed to deliver global health progress, drive economic growth

Photo courtesy of ReSurge International.

Photo courtesy of ReSurge International.

In May 2017, two important anniversaries will be noted: the earthquakes in Nepal and the passage of World Health Assembly (WHA) Resolution 68.15, acknowledging the critical role of strengthening emergency and essential surgical care and anesthesia as part of universal health coverage (UHC). While these events may seem unrelated, one illustrates the importance of the other.

The photo above was taken soon after the Nepal earthquakes. It is of the ReSurge Nepal surgical team, the largest reconstructive plastic surgical team in Nepal, with nine of the country’s 16 reconstructive plastic surgeons. With our local partner NGO, they treated more than 800 earthquake victims in the recovery.

ReSurge Nepal was able to immediately care for the injured after the earthquakes because of the investments we made in surgical capacity and health workforce. ReSurge’s investment in training began in the early 1990s, with Dr. Shankar Man Rai, who was a young resident then. With our training and support and Dr. Rai’s leadership, ReSurge Nepal now restores the lives of thousands by providing the reconstructive surgical care needed year-round.

Yet, further investments and health workforce training must be made to counter the extreme shortfall of surgical access in low-income countries, including Nepal. Although thousands are now receiving care in the country, millions are still without access.

“Contrary to a half-century of consensus among economists, investing in health—and specifically health employment—is good, not only for health but also for the economy…. Investing in the health workforce is not a ‘cost disease’ at all. On the contrary, investing in health workers improves the growth rate of economies.”
— Dr. Richard Horton, editor of the Lancet

According to the Lancet Commission for Global Surgery, as many as 5 billion people do not have access to safe, affordable surgical and anesthesia care, with only 6% of all surgical procedures benefiting the world’s poorest third. Surgical conditions – from trauma, obstetric conditions, and infectious and non-communicable diseases – represent approximately 30% of the global burden of disease.

Contrary to popular belief, surgical care is as cost effective as many other public health initiatives — $82 per disability-adjusted life years (DALY) for general surgery vs. $52 per DALY for BCG vaccine for tuberculosis prevention and $454 per DALY for antiretroviral drugs to treat HIV/AIDS. The World Bank’s Disease Control Priorities (DCP3) states that “essential surgical procedures rank among the most cost-effective of all health interventions.” For every $1 spent on strengthening local surgical capacity, $10 is generated through enhanced health and increased productivity, according to a United Nations’ report.

Access to surgical care is also a critical component of health systems strengthening, UHC and fulfilling the Sustainable Development Goals. Inherent in the framework of a sustainable health system is access to safe surgical care. Non-communicable diseases kill 38 million people around the world every year, and surgical conditions make up a significant proportion of this burden. For example, 60% of all cancers require a surgical intervention.

Moreover, there is a shortage of 1 million surgical, anesthesia and obstetrical specialists in low- and middle- income countries. By 2030, the Lancet Commission estimates that this workforce must double to sustain the maintain status-quo, let alone account for increases needed to address the unmet burden of surgical disease.

This critical shortage of surgical health workforce, coupled with the unmet need of 5 billion people, motivated the world’s health ministers in May 2015 to recognize that strengthening surgical and anesthesia care is essential to universal health coverage; their resolution was unanimously adopted, with strong support of the United States. And just as the WHA recognized that surgical care is essential to a complete health system, the WHA also recognized that such a robust health system depends on a comprehensive global health workforce on the frontlines of care, from community health workers to nurses to surgeons. The UN Secretary General’s High-Level Commission on Health Employment and Economic Growth recently called for investment in a “fit-for-purpose health workforce” to stimulate economic growth, promote gender equality and the strong global workforce necessary to achieve the SDGs.

A relatively small investment in building surgical capacity in Nepal has already made a significant impact. The impact of surgical training is long-term and exponential..

Imagine if the US and countries around the world also invested in a robust global health workforce, as recommended. Could there be a better investment? As Dr. Richard Horton, editor of the Lancet, explained,

“Contrary to a half-century of consensus among economists, investing in health—and specifically health employment—is good, not only for health but also for the economy…. Investing in the health workforce is not a ‘cost disease’ at all. On the contrary, investing in health workers improves the growth rate of economies.”

Note: The G4 Alliance’s Mira Mehes and Lauren Baumann, as well as the research of the Lancet Commission on Global Surgery, contributed to this article.

Between Life and Death: Making Surgery Work at a New Hospital

This is a guest blog post by G4 Member Jhpiego - an affiliate of Johns Hopkins University.  

Jhpiego is a partner in the Safe Surgery 2020 initiative, which brings together the G4 Alliance,  Assist International, the Harvard Program in Global Surgery and Social Change (PGSSC) and Dalberg, with leadership and funding from the GE Foundation in an effort to accelerate access to safe surgery and anesthesia for those in need.


“I was between life and death,” the young mother recalled.
“I didn’t think I would survive, but thanks to the emergency surgical officer and his team, I and my child managed to survive.”

Dangila, Ethiopia – Fernos Fente was in labor and in need of simultaneous surgeries—a highlyunusual and highly risky scenario—when she was referred to Dangila Primary Hospital in northwest Ethiopia. She needed both a cesarean section and removal of a portion of the intestine due to a gangrenous blockage.

Emergency surgical officer Tiruneh conducts an ultrasound on a pregnant woman. Photo provided by Jhpiego. 

Emergency surgical officer Tiruneh conducts an ultrasound on a pregnant woman. Photo provided by Jhpiego. 

Not that long ago, Fente and her baby likely would have died.

When the health center was upgraded to a primary hospital in 2015, its staff lacked the skills to confidently diagnose and treat cases like Fente’s, and the facility lacked necessary equipment such as X-ray and ultrasound machines. The Safe Surgery 2020 (SS2020) Initiative leadership program, implemented in June 2016, made all the difference to Fente and her baby. 

“We used to have difficulty in confirming [pregnancy-related] conditions that required immediate interventions.”
— Medhanit Mulugeta, Midwife

She and 67 other staff at the hospital—including Amsalu Tiruneh, Fente’s emergency surgical officer—routinely fielded negative feedback from patients who weren’t satisfied with accessibility, affordability and quality of care.

The government’s hope was for Dangila to serve rural Ethiopia, where more than a million people couldn’t easily reach any hospital that offered surgery. But the staff quickly realized that easy access to the hospital wasn’t enough to persuade nearby residents to come to the hospital for services. Serious challenges to offering high-quality health services needed to be overcome, and improving surgical care was the top priority, hospital leaders decided.

Through the SS2020 Initiative, a multi-stakeholder partnership funded by GE Foundation with Jhpiego heading up the leadership program - a core group of hospital staff, including Tiruneh, began learning how  to improve surgical services at Dangila. In Partnership with the Government of Ethiopia, the SS2020 leadership program seeks to motivate and guide hospital staff in how to identify problems, innovate solutions and lead the efforts that will result in improvements. This system-wide approach focuses on the process of delivering high-quality surgical care across a broad range of procedures, regardless of a facility’s size, location or age.

Emergency clinical officer Amsalu Tiruneh (left) and Dr. Zebenay Bitew are part of a team-approach to improving surgical services.

Emergency clinical officer Amsalu Tiruneh (left) and Dr. Zebenay Bitew are part of a team-approach to improving surgical services.

The training supports Ethiopia’s national Saving Lives through Safe Surgery (SaLTS) program. As the first national surgical plan to be implemented globally, SaLTS aims to make surgical care available and accessible through holistic quality improvements at the facility level. Jhpiego’s focus is the key pillar of leadership development, where staff at a local hospital develop the skills to identify goals, establish strategies and implement lasting change for improved patient outcomes.

Through SS2020, the Dangila team participated in leadership training that emphasized problem-solving and management skills. Supported by the Amhara Regional Health Bureau and the Surgical Society of Ethiopia, the training recasts challenges as opportunities for improvement. It also empowers staff to be entrepreneurs and innovators who drive change to strengthen skills and improve health services.

The Dangila team returned from the Safe Surgery training in June invigorated and ready to make improvements. In just 5 months, the hospital’s surgical team improved their practice and operations, leading to lifesaving gains in surgical care.

“Surgery is not a luxury, it’s a basic human right. The Ministry of Health is working vigorously at improving safe surgery.”
— Dr. Daniel G. Michael, Director General of Medical Services, General Directorate, Federal Ministry of Health.

Snapshot of Success: Improvements at Dangila

OutcomeJuly–Dec. 2015July–Dec. 2016

Cesarean sections112219

Laparotomies434

Management of open fractures523

Minor surgery6284

Referrals6414

Time from emergency surgery “decision to incision”2.5 hours< 1 hour

 

Importantly, Dangila convened a SaLTS committee, charging members with coordinating and enacting an overall surgical improvement plan. In addition to allocating resources for purchasing or borrowing needed equipment, the committee mobilized the community to donate more than $13,000 toward an ultrasound machine, an essential piece of imaging equipment used to help assess and diagnose internal health problems. Impressed by those efforts and the team’s clear vision to continue to improve, the regional health bureau’s deputy head, Bizuayehu Gashaw, helped Dangila to properly install an X-ray machine.

With new resources and support, Dangila’s emergency surgical officers focused on gaining the skills to confidently diagnose and manage surgical cases—a vital step for a hospital staff lacking a senior general surgeon. The officers attended surgeries in pairs, alternating as surgeon and assistant to share ideas and experiences, ultimately gaining confidence while reducing duration of surgeries and referrals to other hospitals.

The surgical team held daily meetings to review every surgical case, identifying and solving challenges, and incorporating new practices into their routines to better manage the delivery of care – a key outcome of the training. They liaised as needed with the SaLTS committee or conferred by phone with senior surgeon mentors from larger referral hospitals.

Finally, with new equipment, skills and a focus on providing high-quality care to every patient, the Dangila team spread the word that they were competent to handle complicated referral cases. They posted announcements throughout the region communicating the types of procedures and services available at their hospital.

Emergency surgical officer Tiruneh conducts an ultrasound on a pregnant woman.

“What is more interesting than serving and satisfying the community?” Tiruneh asks rhetorically.

The SS2020 Initiative underway at Dangila also is being piloted at five other hospitals in the region, with each reporting important gains in surgical capabilities.

Plans to extend the leadership training to an even greater number of hospitals in Ethiopia and throughout eastern and southern African mean that more mothers, like Fente, will be thanking local emergency surgical officers and teams for saving their lives and those of their babies.

Watch a video to learn more here.

Propelling Safe Surgery with Sustainable Technology

This is a guest blog post written in collaboration with Arbutus Medical, a member of the G4 Alliance's member network. Arbutus works to develop innovative devices for use in developing countries, disaster relief, and other low-resource environments. 

Dr. Danwald Mwayafu knows what it’s like to start from scratch. As a recent graduate and the lone orthopaedic surgeon at Mbale Regional Referral Hospital in Eastern Uganda, Dr. Dan is building his practice from the ground up. Budgets are limited, and Dr. Dan doesn’t have access to all the tools he needs.

“I deal with broken equipment on a daily basis,” laments Dr. Dan. “It ranges from small equipment to major tools. I don't have access to the most basic tools for orthopaedic surgery - large fragment sets, Schanz pins and clamps for basic external fixation of open fractures, intramedullary nailing sets for closed femur fractures, small fragment sets, LCDCP, recon plates and buttress condylar and plateau plates."

“This [lack of equipment] affects my patients,” he continues. “Increased or prolonged hospital stay, malunions and nonunions of fractures.” There is a raw frustration in Dr. Dan’s words. His orthopaedic ward is overflowing with trauma patients requiring urgent surgery. If he doesn’t treat them, they will end up with lifelong disabilities.

 

At Mulago Hospital, the ‘Medical Device Graveyard’ is where old medical equipment goes to die. Many broken devices have been out of service for many years, but remain (sardonically) affixed with prominent notes that read ‘NEEDS FIXING’. Photo by Arbutus Medical

At Mulago Hospital, the ‘Medical Device Graveyard’ is where old medical equipment goes to die. Many broken devices have been out of service for many years, but remain (sardonically) affixed with prominent notes that read ‘NEEDS FIXING’.

Photo by Arbutus Medical

Dan’s situation is not unique. It has been estimated that 11% of the global burden of disease can be treated with surgery, yet surgeons of all specialties worldwide face barriers when it comes to safe and affordable equipment. Five billion people worldwide still do not have access to safe surgery.

General surgeons in low- and middle-income countries regularly face barriers such as a lack of personnel and equipment when trying to implement modern techniques. For example, laparoscopic surgery involves using tiny keyhole incisions and small instruments to perform many procedures such as gallbladder removal. It causes patients less pain after surgery, allows faster recovery, and is the standard of care in developed countries. Yet many surgeons don’t have access to even the simplest instruments required for basic procedures, let alone the equipment required for laparoscopic surgery.

Spine and neurosurgeons are often hindered by lack of adequate support services such as radiology. For example, MRI machines required to diagnose and plan surgeries are few and far between.

Other specialists often reuse devices that otherwise should be disposable, simply for lack of another option.

And at the most basic level, electricity and running water are not always readily available. One survey among surgeons in Uganda reported sudden losses of electricity during operations, which not only delayed surgery, but also prevented hospitals from appropriately sterilizing their surgical equipment.

Even when equipment is available to surgeons, a shortfall in user training, supporting infrastructure, and technology management programs mean that devices regularly end up in disrepair. Robert Malkin of Duke University explored this problem in one study where his group catalogued over 120,000 pieces of medical equipment in over 21 countries. What they found: 38% of the devices were out of service, sitting idle. In another study, his group found that over 70% of donated medical devices fail after just one year of use.

I’d like to see hospitals purchase more equipment like the DrillCover. Affordable and reliable equipment designed specifically for our environment. If I had all the equipment I need, I could deliver quality work, and improve the quality of life for the local people.”
— Dr. Danwald Mwayafu

There isn’t one silver bullet that will make surgical equipment available worldwide, but the first step is to acknowledge the immense scope of the problem and the variety of ways we can address it as the global surgery community. First, we can invest in programs to train more biomedical technicians so they can maintain and service equipment. Second, we can support hospitals who are developing technology management programs so they can better plan and manage their entire inventory of equipment. For humanitarian groups, initiatives can be as simple as providing device donations with instruction manuals in the correct language, ensuring electrical equipment is compatible with the country’s power supply, and informing the receiving technology management department of a new device at the time of donation so they are aware that the device is in use.

Another way to help is through design and development of technology specifically for users in low-resource settings. Innovations to basic technology such as a pulse oximeter, a simple device which when placed on the finger can measure the patient’s oxygen levels, have provided tremendous benefit. Groups like Lifebox, Gradian Health Systems, D-Rev, and our team at Arbutus Medical design equipment from scratch for users in low-resource settings. This leads to technology that is affordable, requires minimal ongoing maintenance, is easy to repair, easy to operate, functions well under a fluctuating power supply, and requires few consumables.

Equally important, we can help low- and middle-income countries develop their medical device supply chains to ensure that when replacement parts are needed, surgeons can get access to those components in a timely fashion.

______________________________________________________________________________________________________________________

Our team at Arbutus Medical first connected with Dan when he was training as a resident at Makerere University in Kampala, Uganda. When Dan was posted in Mbale Regional Referral Hospital, Dan let us know that he didn’t have a surgical power drill. For an orthopaedic surgeon, a drill is vital for almost every procedure requiring insertion of plates, screws and other hardware. Dan only had access to a manual hand-crank drill to make holes in bone. With the operating theatre over 30° many days, and only dull drill bits at his disposal, it’s easy to imagine the sweaty challenge Dan would face each day when trying to drill holes in bone by hand. Dan’s only other alternative was to improvise and use a nonsterile hardware drill, a major infection risk.

With help from the University of British Columbia’s Uganda Sustainable Trauma Orthopaedic Program, we were able to set Dan up with a kit of DrillCovers - a set of safe, surgical-grade linen covers for a nonsterile power drill. With the DrillCover, Dan doesn’t have to compromise the sterility of the procedure and his surgeries are a little more efficient. “I’d like to see hospitals purchase more equipment like the DrillCover,” he says. “Affordable and reliable equipment designed specifically for our environment. If I had all the equipment I need, I could deliver quality work... and improve quality of life for the local people.”

As a community, we are slowly improving access to safe surgical equipment for surgeons like Dan across the world. Let’s keep at it so surgeons like Dan can provide safe surgery for all.

 

Surgical NGO Forum: Collaboration for Change

Hosted by COSECSA in collaboration with the G4 Alliance, ASAP and the Surgical Society of Kenya.                                     COSECSA sNGO Forum, Mombasa, Kenya, 2016; Photography by: KEN 

Hosted by COSECSA in collaboration with the G4 Alliance, ASAP and the Surgical Society of Kenya.                                     COSECSA sNGO Forum, Mombasa, Kenya, 2016; Photography by: KEN 

( From left to right) Dr. Khadija Shikely, Chief Officer of Health, Mombasa County; Hon. Dr. Abdi Ibrahim, Chief Executive Officer of Health, Mombassa County; Dr. Kristeen O. Awori, President, Surgical Society of Kenya; Dr. Abdullahi Kimogol, WAHA International; Mr. Denis Robson, COSECSA Council and Board of Directors, Fistula Foundation COSECSA sNGO Forum, Mombasa, Kenya, 2016; Photography by: KEN

( From left to right)
Dr. Khadija Shikely, Chief Officer of Health, Mombasa County; Hon. Dr. Abdi Ibrahim, Chief Executive Officer of Health, Mombassa County; Dr. Kristeen O. Awori, President, Surgical Society of Kenya; Dr. Abdullahi Kimogol, WAHA International; Mr. Denis Robson, COSECSA Council and Board of Directors, Fistula Foundation

COSECSA sNGO Forum, Mombasa, Kenya, 2016; Photography by: KEN

Retirement is exhausting but exhilarating! I was proud to have been associated with the first Surgical NGO Forum hosted at the College of Surgeons of East, Central and Southern Africa (COSECSA) at their annual conference in Mombasa, Kenya in collaboration with the G4 Alliance, ASAP and the Surgical Society of Kenya. Too much time reflecting on my twitter feeds make me think that COSECSA needed to make new friends and NGO’s delivering surgical care were a perfect fit.  Despite thinking that NGO’s were notoriously bad at collaborating I pressed on with my research and became more convinced it was the right thing to do.

A paper by Dr Josh Ng-Kamstra et al confirmed that it was necessary to take into account the considerable amount of surgery performed by the NGO sector in countries where there was a growing unmet need. His findings painted a landscape of surgical activity where more than 400 charitable organisations were delivering care in LMIC’s contributing largely to surgical volume and workforce development.  In Kenya, a country with significant surgical access issues, this represents an important contribution as 60 organisations were identified as NGO surgical providers.

                                                             - Dr. Emmanuel Makasa, Counsellor-Health, Permanent Mission of Zambia, Geneva

                                                             - Dr. Emmanuel Makasa, Counsellor-Health, Permanent Mission of Zambia, Geneva

Other important inputs into the decision making process was:

1.      The Lancet Commission Report on Global Surgery called upon policy makers, implementers, and funders to include surgical care as a part of the national health and development strategies. For change to be successful it must be driven by local leaders and supported by global partners in order to achieve health, welfare, and economic development for all.

2.     The adopted World Health Assembly resolution 68/15 introduced a potentially transformative opportunity to increase attention and resources towards surgical and anaesthetic care.

3.     SDG 17 stated that a successful sustainable development agenda requires partnerships between governments, the private sector, and civil society.

4. Increased recognition by the global surgery community - including the G4 Alliance - that cross-sector collaboration represents an essential strategy to breakout down silos and encourage collaboration of civil society, private sectors and government partners. 

Collectively they were a call to action - game changers!

I highly appreciated attending the NGO forum and the ASAP track of the COSESCA / Surgical Society of Kenya(SSK). I gained and benefited a lot.”
— Charles Kabetu, Operation Smile and Kenya Society of Anaesthesia

My experience of NGO’s led me to believe these milestones presented an opportunity to create a trusted space for collaboration to maximize impact and coordination across the organizations delivering surgical care.

With limited resources at my disposal who would help co-create this Forum to enable collaboration to happen? COSECSA were members of the The G4 Alliance who represented a coalition of member organizations intent on developing strategic partnerships to improve access to surgery. They responded positively to the idea and were joined by ASAP. A dream team.

The event now termed the s-NGO Forum was organized at the COSECSA Mombasa conference and attended by 44 local, regional, and international representatives. Participating organizations included 10 local NGO’s, 9 professional societies and federations as well as mentors and observers from 16 international organizations. The programme included a series of introductory exercises, NGO presentations, interactive and co-creation sessions, expert speakers and group discussions.

Expert speakers presented on a range of topics relevant to the discussion groups:

Ms. Rosemary Mugwe - CEO, COSECSA COSECSA sNGO Forum, Mombasa, Kenya, 2016; Photography by: KEN   

Ms. Rosemary Mugwe - CEO, COSECSA

COSECSA sNGO Forum, Mombasa, Kenya, 2016; Photography by: KEN 

 

·      Promoting Excellence in Surgical Care –Rosemary Mugwe (CEO, COSECSA)

·      Strategic Leadership – Ian Walker (Corporate Citizenship Director, Johnson & Johnson)

·      The Power of Networks – Brendan Allen (Executive Director, G4 Alliance)

·      Monitoring and Evaluation – Ewen Harrison (University of Edinburgh)

·      Nairobi Surgical Skills Centre: Training Resource – Peter Gaturu (Philips)

·      SS2020 Initiative: Partnerships for Safe Surgery –  Abraham Mengistu (Jhpiego)

Co-creation breakout sessions represented an essential component of the s-NGO forum, providing an opportunity for partners to come together to discuss common challenges, identify opportunities for collaboration, and discuss innovative solutions to strengthen safe surgical care delivery.

 

Our collaboration blended with core values are critical in our journey towards addressing human health and surgical needs globally. Let us uphold and stay true to them.”
— Abdul Kimogol, Head of Mission, WAHA

The exercises and co-creation sessions were broken down into four components:

1.     Assessing Surgical NGO Needs, Challenges and Opportunities

2.     Alignment of Interests and Identifying Areas for Collaboration

3.     Defining Specific Objectives and Activities for Fundable Projects

4.     Proposal Creation

 

 

Key recommendations that emerged from the group discussions focused on four key themes:

1)    Leadership training with emphasis on advocacy training

2)    Establishing a Kenyan s-NGO network

3)    Information technology infrastructure and tools to support an s-NGO community/network

4)    Audits of facility for safe surgical anaesthesia care at level 4 facilities

In wrapping up the s-NGO forum, participants were keen to activate a network in Kenya and invite other organisations that were “missing”. Follow up webinars will be arranged and a face-to-face meeting in March of 2017.

The desire to create a forum with action-orientated outcomes was achieved and the momentum is building for a sustainable community of NGO surgical providers in Kenya.

I wanted to say thanks for instigating such a wonderful meeting. The Surgical NGO forum was superb…there was a real sense of enthusiasm in the room and a sense of wanting to make things happen. Clearly networking people together enhances this process exponentially.”
— Tim Beacon, Managing Director, Medical Aid International

Perspectives From the Field

HEAL Africa Hospital (HAH) is a 197-bed hospital in Goma on the eastern border of the Democratic Republic of Congo (DRC). It is regarded by the Congolese Government as one of only three tertiary referral hospitals in a country of 80 million people, where there is only 1 qualified surgeon per 1 million people. HEAL Africa Hospital is the preferred surgical provider for Medicin Sans Frontieres (MSF) in the North Kivu Province.

Congo had been in civil war for 40 years, particularly in the east of the country, but with peace initiatives over the past few years and the defeat of the M23 rebels in late 2014, patients have been enabled to safely travel further to seek medical help. This has exposed the poor state of surgical treatment that is occurring in DR Congo where 80% of the population live in rural areas.  This freedom to travel to seek assistance has also highlighted the enormous unmet surgical needs and workforce issues. 

Indicative of this is the increased number of patients referred to HAH with what the staff refers to as an 'Abdominal Catastrophe’. The following is a brief description of the treatment offered to just a few of the more than 40 cases like this that have been treated at HEAL Africa Hospital in the past 2 years. More often than not, these cases involve young women and children, underlining the fact that lack of surgical care isof maternal and child health concern as well as poor initial basic surgery. 

UNGA Advocacy Event Surgery's Essential Role for Achieving Health for All

The event featured an interactive discussion with special guest speakers as well as a lively audience Q&A session. Dr. David Barash, Chief Medical Officer and Executive Director of Global Health for the GE Foundation moderated the discussion and was joined by a robust panel including Dr. Leslie Mancuso (President and CEO of Jhpiego), Mr. Pape Gaye (CEO and President of IntraHealth International),   Dr. Alex Hannenberg (Founding Board Member of Lifebox USA), Prof. Diana Ayton-Shenker (Founder and CEO of Philanthropy & Social Impact Strategy).

The World Congress of Anesthesiologists to Launch the SAFE-T Campaign

The World Congress of Anesthesiologists to Launch the SAFE-T Campaign

The World Federation of Societies of Anaesthesiologists (WFSA) will be launching the Safe Anaesthesia For Everybody - Today (SAFE-T) Campaign at the World Congress of Anaesthesiologists (WCA).  This will be an exciting new way of engaging with stakeholders in various sectors with a mission to improve patient safety.

Safe Anaesthesia For Everybody - Today

Perspectives from a weary surgical oncologist in Sub-Saharan Africa by Peter Bird

Source: AIC Kijabe Hospital

Source: AIC Kijabe Hospital

“Is this my job as a surgeon sitting in a crowded rural Kenyan surgical clinic, to order tests and treatments based on a ‘guestimation’ of what my patients can afford?” This is the question Dr. Peter Bird finds himself wondering in his article “Perspectives from a weary surgical oncologist in Sub-Saharan Africa.” In it, he talks about the plight of a surgeon whose ability to save lives is hindered by financial and accessibility barriers, particularly in terms of delivering care to patients who cannot afford the out-of-pocket costs for care. In this specific case, Dr. Bird’s patient Muthoni and her family were unable to raise the necessary funds for her treatment, despite attempts to secure additional funding through a loan.  In low- and middle-income countries (LMICs) like Kenya, patients such as Muthoni and their families seeking essential surgical care may face the prospect of financial hardship or impoverishment due to burden of out-of-pocket costs.

Imagine being faced with the need to raise your annual gross income in cash to cover essential health care costs for yourself or a loved one.  And even then you may not be able to cover all the costs that arise.  Despite efforts of facilities such as AIC-Kijabe Hospital which seek to bridge the surgical gap, surgical care cannot be sustainably delivered for a population through donations and charitable organizations alone.  In his day-to-day work, Dr. Bird and many other surgical providers like him are faced with difficult choices.  As stated by Dr. Bird: “I don’t want to be the one destroying a family financially by suggesting relatively expensive therapies that might not work. But neither do I want to lessen their chance of cure.My advice can devastate a family for a generation.”  These are impossibly difficult choices and highlight the many obstacles faced by providers and patients in a system where access to essential and life-saving surgical care is not guaranteed.

The G4 Alliance and our member organizations remain committed to advocating for integration of emergency and essential surgical, obstetric, trauma, and anaesthesia care as part of universal health coverage and as part of the primary package of health care.  

The full editorial was published as a Viewpoint in the July 2016 edition of “The Breast”.  You can also access a pdf here.