Changing that achieves an end well beyond the surgery
By Tigistu Ashengo, Assistant Medical Director, Jhpiego
Achieving safe surgery is a means to an end well beyond the surgery; it creates a health infrastructure that lifts us all and is critical to reducing some of the leading causes of morbidity and mortality around the world.
Right now a population of 5 billion1 doesn’t have access to basic surgery, mostly the world’s most vulnerable and poorest populations. That means it’s difficult, and sometimes impossible, to treat complications as commonplace as broken bones and as urgent as prolonged labor and pre-cancerous lesions, among other issues. Is it any wonder that a significant portion of health-related deaths in developing regions of the world come from conditions that are treatable with surgery?
Surgical teams in resource-constrained settings are often expected to transcend their assigned professional scope, develop a much broader skillset, and provide care for rural communities that might otherwise go without access at all. Such providers are often far from family and peers who could provide professional support.
Take Ethiopia, my home country and where I practiced as a surgical care provider for many years. The equivalent of level one hospitals cater to more than half a million people yet often don’t have surgical specialists and anesthesia care providers, resources that are relatively ubiquitous in the western world, and transferring to specialist care in higher level facilities often results in catastrophic expenses for these patients. These inequities in workforce then extend to the medical supply chain, maintenance of equipment and, extremely critical, safe anesthesia.
There are clear actions we can take now to impact change in the near future:
1) Focus on leadership – not just surgery – training: Expanding the number of specialists who have trained expertise in key surgical areas is a must, but the sum of the whole is greater than the parts. Through empowerment, coaching and recognition, they can see their connection with their local health system understand how they can support it and the other people and parts of it. The system in turn becomes stronger itself, further supporting these surgeons who are supporting it, and so on.
2) Foster openness to new partnerships: Much gain is to be had by smartly sharing tasks, ideas or resources across a variety of organizations in the healthcare community. The world has learned a lot from the strength of corporations’ supply chains. It is critical for health systems in resource-constrained areas, to be open to leveraging such knowledge, collaborating with the private sector to increase access to safe, appropriate anesthesia-related medicine, equipment, and supplies, as well as to standardize and increase the quality and quantity of the anesthesia workforce.
3) Invest in auxiliary medical staff: Nurses are commonplace and pivotal parts of medical teams in other parts of the world – not so in the areas without access to safe surgery. In our work in affected areas, my organization has seen that the ability of nurses with surgical skills to assist in voluntary medical male circumcision, for example, has shifted and effectively reprioritized the workload, in turn enabling countries to reach millions more men with this safe and cost effective HIV prevention intervention.
4) Understand the economic impact: We believe that the cost of inaction is much higher than the cost of these investments, particularly given the high rate of morbidity and mortality stemming from illness that could have been treated by surgery. While the wellbeing of clinicians and patients is ultimately the goal, being able to advocate for safe surgery in these terms is the only realistic approach in today’s society, in which governments are trying to find holistic solutions to the economic, political and social challenges in their countries.
We have already seen success with these approaches. The Safe Surgery 2020 initiative, for example, aims to make surgical teams the change agents for grassroots change in the surgical ecosystem. The GE Foundation, in collaboration with Jhpiego, the Federal Ministry of Health of Ethiopia, Johns Hopkins Medicine’s Armstrong Institute for Patient Safety and Quality, and the Surgical Society of Ethiopia trained surgical teams in leadership development in Tigray, Ethiopia, following this method.
This included conducting monthly mentorship visits with each surgical team to improve quality of care and patient safety in emergency and essential surgery. While the starting point is the surgical unit, the aim is to expand the work in the surgical ecosystem by creating a productive link between surgical teams and other services in a health facility and ultimately the larger community.
Much remains to be done. With partnerships – like that between Jhpiego and GE Foundation; proof – like the case study from Ethiopia; and passion – like that exhibited everywhere at the World Health Assembly this week, surgery can become safer and accessible for more people every day.
Dr. Tigistu Ashengo is the Associate Medical Director of Jhpiego, an international non-profit affiliate of Johns Hopkins, dedicated to improving the lives of women and children.
1 – Source: DCP3 (2015), “Essential Surgery;” Lancet (2015), “Global surgery 2030;” IHME.