Paul Farmer and the new World Bank President Jim Kim called it the “neglected stepchild” of global health. Atul Gawande admitted his surprise, “I could not understand why the world was not seeing avoidable harm in surgery as a major danger to public health.” The global health agenda is moving forward at an astonishing pace, but surgery seems to only recently have begun substantially entering the picture. The typical medical access trends in the developing world- very few physicians, even fewer in rural areas, and even fewer than that when considering specialists- are all exacerbated when isolating the surgical subspecialties. Currently, estimates suggest that of the 234 million surgeries occurring annually, only 26% take place in the poorest countries accounting for 70% of the global population. Given the large number of nonsurgical interventions that are cheaper, quicker, and easier to administer, one must ask whether surgery is rightfully neglected in developing countries.
The numbers don’t seem to suggest so. In the paper referenced above, Farmer and Kim suggest that a lack of surgical interventions is responsible for up to 15% of global Disability Adjusted Life Years (DALY) and that surgical disease, in some settings, is in the top 15 causes of disability. Other estimates suggest that surgery is responsible for ~11% of the Global Burden of Disease. Moreover, obstructed labor, postpartum hemorrhage, and trauma from birth and road accidents are among the leading causes of death in low and middle income countries, all of which usually require surgical intervention. Continue reading