Global Surgery 2030: a roadmap for high income country actors
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  • Published on:
    How much do LMICs need HICs?
    • Zineb Bentounsi, Student Faculté de médecine et de pharmacie de Casablanca
    • Other Contributors:
      • Isobel Marks, Student
      • Adrian Diaz, Student
      • Waruguru Wanjau, Doctor

    We congratulate Ng-Kamstra et al for their excellent work in bringing surgery to the attention of the global health community, and acknowledging the shift in discourse that the Sustainable Development Goals has brought. However, the emphasis of this paper on high-income country (HIC) actors only reinforces the global health paradigm which plagued the MDG era. It does not consider emerging economies who will play a bigger role in global health as we approach 2030. We obviously applaud all efforts made to combat colonialism. However, we believe that assuming low and middle-income countries (LMIC) to not be ‘major actors’ is antithetical to this pursuit. It is false to assume that majority of influence on and investment in health systems in LMICs will be from Western powers supported by HIC trainees and surgical colleges.
    There are several reasons we believe this to be misguided. Firstly, for many developing countries, aid from foreign nations is making up a decreasing part of their budget. The majority of spending in low- and middle-income countries (LMICs) is direct government expenditure supported by taxes. Donor money makes up just 14.8% of the health budget in Kenya, and much less so in countries like Morocco. Much of the prioritisation of surgical care must be led by the LMIC citizens, health workers, policy makers and business leaders, and any call to arms must be targeted as such!
    We are also concerned with the persistent use of ‘colonial...

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    Conflict of Interest:
    None declared.
  • Published on:
    We need training opportunities in global surgery for HIC professionals
    • Kathryn E Ford, Paediatric surgery registrar King's College Hospital; King's Centre for Global Health
    • Other Contributors:
      • Lilli R L Cooper, Plastic surgery registar

    As the authors of Global Surgery 2030: a roadmap for high country actors eloquently summarise, 2015 was a pivotal year for global surgery, with four important events being the landmarks of success and promise (1):
    (1) The Lancet Commission for Global Surgery (LCoGS) (2)
    (2) The Essential Surgery volume of the Third Edition of Disease Control Priorities (DCP-3) identifying 44 surgical procedures deemed essential for public health (3)
    (3) A World Health Organisation resolution on strengthening emergency and essential surgical care, approved by 194 member states during the 68th World Health Assembly (4)
    (4) The launch of the G4 Alliance (5).
    The sobering figure that an estimated 5 billion people have no access to safe surgery or anaesthetic care has galvanised the international community in response. Co-authors Ng-Kamstra and Greenberg, with their 39 other fellow authors, describe the discussions at the Boston launch of the LCoGS on 6th May 2015. They also provide a unified call for each cadre of high income country actors and include guidance for colleges and academic medical centres, trainees and training programmes, academia, funders, industry and finally the press and advocacy groups.
    The US launch was preceded by the UK launch of the LCoGS on 27th April 2016, where, there was palpable enthusiasm in the room, most noticeably from the trainee body. Similar to other anaesthetic, obstetric and surgical trainees in many other h...

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    Conflict of Interest:
    None declared.
  • Published on:
    Global Surgery and Global Surgeon are not synonymous
    • Adrian W Gelb, Anesthesiologist World Federation of Societies of Anaesthesiologists

    I read the article “Global Surgery 2030: a roadmap for high income country actors” with a mix of encouragement and disappointment. It is truly encouraging to see the publicity that this vitally important topic is garnering and that the message has been embraced by prominent journals. However, it was disappointing to see that the authors have not entirely embraced their own message.
    It should be appreciated that the term "surgery" refers to a multidisciplinary endeavor that includes surgeons, anaesthetists, nurses, and others. The current conceptualization is that perioperative patient care is a team effort by equals rather than a ship of lowly seamen lead by an intrepid captain. The authors allude quite often to the multidisciplinary aspect while at the same time stating "Academic global surgeons, therefore, have an opportunity to illustrate the evidence base for the expansion of surgical care and direct the global action plan to achieve it". Surely, the leadership and articulating the vision should be collaborative and should fall to whoever on the team is best able to deal with the specific issue. It was also further disconcerting to see that academic pursuit in LMICs is the exclusive domain of surgeons “Academia: support the conduct of research by surgeons in LMICs”. In order to succeed, the evaluation of care and the generation of new knowledge must be the role of all who provide perioperative care.
    The nuanced di...

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    Conflict of Interest:
    None declared.