By Dr. Dominique Vervoort
Five billion people continue to lack access to safe, timely, and affordable surgical healthcare when needed. As a result, more than 17 million people die from surgically treatable conditions every year, more than five times as many deaths as due to HIV/AIDS, tuberculosis, and malaria combined. Contrary to historical misperceptions, surgical healthcare is favorably cost-effective, including when compared to many common global health interventions. Moreover, without investing in surgical healthcare, low- and middle-income countries are projected to face a potential loss of socioeconomic growth of up to $12.3 trillion by 2030. Surgical healthcare was once coined the “neglected stepchild of global health” by Dr. Paul Farmer and Dr. Jim Kim. Progress in recent years, with the growth of academic global surgery and national and international policy commitments, suggests that surgery may no longer be a neglected stepchild; however, it is clear that there is much work left to do.
Trainees around the world have taken a central role in the growing field of global surgery through advocacy, peer education, research, and policy. For example, the International Student Surgical Network (InciSioN) is the world’s largest global surgery trainee organization with over 8,000 members in over 100 countries. InciSioN provides a platform for students, residents, fellows, and young doctors to get involved with global surgery and foster a social network of future global surgeons, obstetricians, anesthesiologists, and global surgery researchers. In addition, it leverages its network to sustain a grassroots movement for global surgical advocacy. For example, National Surgical, Obstetric, and Anesthesia Plans (NSOAPs) driven by countries’ Ministries of Health have seen the involvement of trainees at stakeholder meetings (e.g., InciSioN Colombia) and in data collection (e.g., InciSioN Nigeria). Beyond InciSioN, trainees are increasingly involved through subspecialty-specific organizations, academic global surgery centers, societal initiatives, bilateral partnerships, and individual advocacy through social media.
As a result of the growth of the field of academic global surgery and the emergence of national and international trainee organizations in global surgery, the future of global surgery is bright. However, this surge in interest has also highlighted under-discussed areas that must be addressed, including the ethics of trainees’ clinical involvement in global surgery as well as prevailing neo-colonialism in many global surgical and global health activities. The involvement of visiting trainees in global surgical activities should adhere to strict ethical and mutually agreed upon requirements to not negatively affect local teams (e.g., displacement of local trainees). Similarly, at an academic level, equity should be prioritized within research activities and collaborations; recent findings suggest that high-income country researchers continue to be predominant in first and last authorship positions in global surgery and global health.
Providing access to life-saving and life-changing surgical healthcare for the world’s population will require not only a recognition of the indispensable role of surgical healthcare in health systems; it will also require recognition of existing disparities, power imbalances, financial and programmatic inefficiencies, and the importance of locally-driven interventions. Only so can we truly ensure that surgical healthcare is no longer the neglected stepchild of global health.
Please join us on Monday, April 18, 2022, from 8-9 PM EST for an AWS TweetChat about Global Surgery! The chat will be moderated by Dr. Geoffrey Anderson (@GeoffAndersonMD), Dr. Rashi Jhunjhunwala (@rashijjw), Dr. Nancy Abu-Bonsrah (@BonsrahNancy), and Dr. Dominique Vervoort (@DVervoort94). The questions will be posted directly from the @WomenSurgeons Twitter account. You can also find them by following the hashtag #AWSchat. If you have not participated in a tweet chat with us before, check out this tutorial written by Dr. Heather Yeo (@heatheryeomd) to know more. We will be discussing the following questions during our tweet chat:
- What role(s) can trainees play in the field of (academic) global surgery?
- What are the benefits for trainees to get exposed to (academic) global surgery?
- What barriers have you observed and/or experienced when seeking to get involved in the field of global surgery?
- What are the ethical considerations of trainees’ involvement in the field of global surgery, whether academically or clinically?
- What actions must be taken to decolonize global surgery?
- Why is gender equity in global surgery critical to ensure access to safe, timely, and affordable surgical healthcare for the world’s population?
Dominique Vervoort, MD, MPH, MBA, is a PhD student in Health Services Research at the Institute of Health Policy, Management and Evaluation and Division of Cardiac Surgery at the University of Toronto. Dominique completed the Paul Farmer Global Surgery Fellowship at Harvard Medical School, is Advisor to the Global Surgery Foundation, Advisor to the Johns Hopkins Global Surgery Initiative, co-Founder and past co-Chair of InciSioN – International Student Surgical Network, and Founding President of the Global Cardiac Surgery Initiative. He can be found on Twitter @DVervoort94.
Our blog is a forum for our members to speak, and, as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.