The challenges of surgical intervention in low-income countries
A June 2015 study published in The Lancet reported that five billion people across the world do not have access to surgery. One would assume that being able to access surgical procedures in Africa, a continent where hundreds of thousands are denied this privilege, would help you live a longer, healthier life. But despite being younger and having fewer underlying health risks than patients in higher-income countries, African patients face almost twice the risk of dying.
A new study published in January 2018 followed 11,422 patients post operation in 25 African nations. The report found that 1 in 5 patients developed post-op complications and had a 5.6% chance of dying. Twice high as their counterparts in high-income countries. The lead researchers of the study pointed to the inadequate and understaffed post operative care offered in most hospitals as the cause of this phenomena.
Despite providing surgery, many hospitals do not have the infrastructure to ensure patients make a successful recovery. For example, hospitals often lack intensive care units, equipment and even sufficient nursing staff for follow-up care. Hospitals often do not have enough specialists (neurosurgeons, intensivists, pathologists etc. ) to attend to the fine details of patient’s recovery, or for consultations if something goes wrong. Many patients also live a significant distance from hospitals which means that they struggle to follow up on post-op visits, and cannot reach help in time if there are complications.
Given that 95% of deaths occur in the postoperative phase, tackling this issue begins with addressing these shortcomings. The most direct way to solve many of the problems faced by surgical staff would be by increasing funding to train and hire more nursing staff, surgeons and expand existing facilities. Although funding and resources are scarce in many developing regions, why do international donors or non-profit organizations tend to overlook surgery?
Surgery typically does not attract as much media attention as other global health issues, such as infectious diseases, and donors prefer programs with quantifiable results. For example, the number of children vaccinated under a new scheme. In surgery, it is not easy to state the number of individuals served as it is a more nuanced field. Perhaps the way forward would be to increase the role of innovation in the developing world’s surgical field. Devices to monitor patient’s vitals over long distances, the use of video call to consult with specialists nationally or internationally, engineering multi-purpose devices for use in an operating theatre – the possibilities are endless.