Surgery, the "Neglected Stepchild" of Global Health

Iraqi surgeons during an operation.

In preparing for my 2nd internship with PLC this summer I came across an article written by two well-known global health advocates and physicians (a prof at Harvard and the current president of Dartmouth, if you're into credentials) on the topic of surgery in the global health movement. [Paul E. Farmer and Jim Y. Kim. 2008. "Surgery and Global Health: a View from Beyond the OR." World Journal of Surgery 32:533-536].

 After discussing this article with one of the directors and thinking about our current model for surgical aid in Iraq, a few points stood out: The authors' first argument is that surgery is the "neglected stepchild of global healthcare."

The fact is, although surgical diseases (CHD being one of the most prevalent) are a major cause of death and disability in much of the world, the vast majority of healthcare programs don't address surgical needs.


Because surgical interventions are usually complicated and require a larger investment than other kinds of health interventions, and treating surgical diseases requires a more advanced infrastructure and the involvement of more professionals than treating, for instance, malnutrition or malaria. There is also the fact that surgical diseases have lacked the same kind of advocacy and exposure that have led to funding and programs for "high-profile" diseases like tuberculosis or AIDS. The other major issue addressed by Farmer and Kim is that countries that actually have the surgical services often only have them in just a few locales, and the treatment is usually too expensive to be accessible by most of the population.

The question then arises: how do we make this treatment available in settings where infrastructure is poor, trained professionals are scarce, equipment is needed, and "the only thing not needed is disease, which exists abundantly." Remedy Missions are our answer to that question.

As you know, we recently moved from sending children abroad for surgery to a model that provides more surgeries at less cost while simultaneously training local professionals.

These Remedy Missions specifically address the impediments to surgery in global health described by Farmer and Kim. They provide treatment of CHD for families that would never be able to afford traveling abroad for surgery. Our work also means we're freeing surgeons up to focus on surgery, because, as Farmer and Kim write, "clearly we don't want surgeons to be dragged out of the operating room to manage logistics, supply chains...and financing."

An international nurse explains dosages to an Iraqi nurse.

Remedy Missions provide crucial training for all the different health professionals that are required for a surgery to be successful (surgeons, cardiologists, nurses, etc.). This process of providing surgery and training is also an exercise in infrastructure building as we work toward the development of heart centers in northern and southern Iraq.

The fact that we can count both regional and national governments as partners addresses the need for surgical care in the public sector in Iraq, and it bodes especially well for poor families who will need to receive treatment in the future.

Lastly, the partnership and advocacy of our supporters (that's YOU) is helping to raise awareness of the burden of CHD and other surgical diseases in places like Iraq. With well-planned, structured interventions that take into account the needs and problems associated with surgical disease globally, and the support and advocacy of a Coalition of concerned individuals and communities (that'd be you again), problems like CHD can cease to be a "neglected stepchild" of global health and instead serve as a model for building health systems and effecting powerful change in global contexts.

Iraqi doctors look on as Dr. Novick operates.


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Surgery, the "Neglected Stepchild" of Global Health
Surgery, the "Neglected Stepchild" of Global Health
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