Surgical Care in the developing world
Surgery is always accompanied by risks, regardless of the patient’s conditions, the doctor’s competency and the location of the hospital. However, these three factors compounded with the usual risks of the procedure often make surgery impossible for patients in developing nations. By not performing relatively simple procedures for treatable conditions, some afflictions can worsen and become major medical issues.

There are various methods to reduce the global disease burden, says the World Health Organization, “Surgery represents one of many possible interventions, such as vaccination, or antimalarial and antiretroviral chemotherapy.” Surgery specifically can be used to treat up to 11% of the GDB. The WHO outlines the top issues requiring surgery, including injuries, malignancies, congenital anomalies, complications of pregnancy, cataracts and perinatal conditions. These problems are especially common in Southeast Asia and Africa.

Various factors contribute to the delay or omission of surgical care in the developing world. The Disease Control Priorities Project states, “Access to surgical services is often hampered by poor communications, a lack of transportation, and the high cost that patients must bear for the services.” Additionally, a dearth of hospitals, doctors, and management of hospitals and other health care facilities inhibits patients from receiving care. Sanitary conditions in hospitals are also questionable. “Some lack such basic needs as water, electricity, and essential drugs and supplies,” says the DCPP. The main issue, however, is the “seriously underfunded health system,” which puts the cost of health care on patients.

Acta Biomedica suggests training local surgeons to deal with issues rather than relying on foreign doctors who are often only temporary fixtures. While “surgical activity in (developing) countries means working with local staff that is often poorly trained…local training programs are certainly the best option.” In the long term, maintaining doctors locally could reduce the disease burden by the delivery of consistent care.

Regardless of these issues, surgery will remain an essential component of healthcare around the world. The DCPP states, “No matter how successful prevention strategies are, surgical conditions will always account for a significant portion of a population’s disease burden.” Organizing health care into “community clinic, district, and tertiary hospitals” could maximize efficiency while providing essential care.

Clinics would be prepared to handle the least severe cases, providing “simple suturing, care of simple burns, and deliveries by a skilled birth attendant.” District hospitals would handle more serious issues, equipped to handle birth complications and general surgery for simple issues. Tertiary hospitals would tackle the most severe problems, “including a full intensive care unit, a major burns service, (and) orthopedics,” among other surgical specialties. The majority of surgical cases appear to fall within the domain of district hospitals.

In order to reduce the cost burden on patients, the DCPP recommends that funds be allocated to the facilities where surgical services are most often performed. According to 2006 research, district hospitals provide decent surgical care, but tend to be underfunded. Increasing the amount of funds for district hospitals rather than clinics, where serious surgery is rarely performed, would boost the quality and affordability of surgical services.

– Bridget Tobin

Sources: DCPP 1, WHO
Photo: Kiva