164 e-Letters

  • We need training opportunities in global surgery for HIC professionals

    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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  • Global Surgery and Global Surgeon are not synonymous

    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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  • Emergency obstetric care in India

    To the Editor
    The article by Iyer et al. depicted the huge gap between recommended and actual scenario in Indian maternity care.1 The authors correctly pointed out the concentration of case load in a few numbers of hospitals. The study also highlighted skewed allocation of health care resources and dominance of the private sector; two recognized obstacles for achieving universal health care in a developing country like India.
    However, had they adopted country-specific guidelines instead of UN criteria, they would have been able to reflect the scenario in synchronization with the national perspective. The guidelines, as envisaged under 12th Five Year Plan (FYP), recommend two comprehensive emergency obstetric care (CEmOC) centers and 18 basic emergency obstetric care (BEmOC) centers for a population of one million in our country, considering 70% deliveries in public sector.2 Although the required number of CEmOC centers matches the UN criteria, the national norm differs in term of number of BEmOC centers from the UN criteria.3
    The strategy under 12th FYP laid down uniform protocol for proportional distribution of delivery case load across the country. With this purpose, it designated all facilities conducting more than three deliveries per month as Delivery Point (DP) and identified few potential DP in each district. However, the presence of a Newborn Care Corner (NBCC) equipped with a radiant warmer and other basic amenities required for a newborn is a mu...

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  • Production of tobacco and prevention of tobacco use in India: two sides of the same coin?

    Mishra and colleagues1, discussed a fairly discouraging trend of smoking over decades in India. But in India, tobacco chewing is also associated with the risk of cancer among those who never smoked bidis or cigarettes.2 Smokeless tobacco products like Gutkha (crushed areca nut, tobacco) and pan masala (mixture of tobacco, essence and other ingredients) are available in attractive colorful small sachets for as low as half a rupee, and have become increasingly popular with aggressive marketing and advertisements.
    In addition, many Indians smoke the much cheaper, unfiltered crude tobacco product called Bidi, which is made of 0.15-0.25g of sun-dried flaked tobacco rolled in a dried rectangular piece of Tendu or Temburni leaf (Diospyrosmelanoxylon) and a thread securing the roll. Bidis have lower tobacco content than cigarettes, but more nicotine, tar and carbon monoxide. Stick for stick, they are deadlier. Unregulated, Bidi is a major form of tobacco use, with a predicted sale of 1031 billion bidis in 2007.3
    There are however two sides of the tobacco coin in India: One side allows for the production of tobacco in the country. In 2012, India was the 2nd largest producer of tobacco in the world.4 On the other side, there are increasing taxes on the sale of tobacco product, which is a way of generating revenue and restricting its use. Although it is thought that higher taxes would make cigarettes unaffordable to poor Indians, these taxes have had the effect of promoti...

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