DUBLIN, Ireland, Dec 16 (IPS) – For decades, preventable death, lifelong disability, and disability have had devastating consequences for more than 90% of people in Africa, where surgical care remains inaccessible.
Simple, affordable procedures such as skin grafting, bone fracture repair, and hernia procedures are often not treated, causing unnecessary suffering and often leading families to extreme poverty due to loss of livelihood. Consider a young man in his 20s in rural Zambia, electrocuted by a low-hanging power line while riding in the back of a truck, his exposed skull and badly damaged scalp repaired in a 16-hour procedure, allowing him to remove everything. recovery; a 19-year-old woman with a deep tumor that caused her blindness and whose surgery was performed by a smart clinic using magnifying glasses without a microscope, completely removed the tumor and allowed her to come back. his opinion; a 32-year-old mother of two in rural Zambia, was run over by a truck and left with serious injuries who received eight months of intensive treatment and rehabilitation that put her on the road to recovery.
Situations like these are a daily reality for surgeons Dr. Peter Mushenya from Zambia and Dr. Nathalie Umugwaneza from Rwanda, both recently graduated from the College of Surgeons of East, Central, and Southern Africa (COSECSA), which is celebrating its 25th anniversary. December. Since its inception, COSECSA has grown from graduating six surgeons in 2010 to 152 in 2023. This growth reflects the organization’s commitment to equipping surgeons with the skills to meet the urgent needs of communities across the region. Over the course of their careers, COSECSA-trained surgeons are expected to operate on approximately 9.5 million people, a remarkable demonstration of the impact of successful training programs. Having graduated just a year ago, Dr Mushenya is a neurosurgeon working at Maxcare Hospital in Lusaka, where patients often travel 1000 kilometers to receive care from the only neurosurgery team in the country.
On average, he and his team perform 70 surgeries a month. He describes challenges such as shortages of surgical supplies, long waiting lists and unnecessary complications from untreated diseases that worsen due to delays in care. He explains, the most common is an untreated cough in children that progresses to meningitis and later abnormal swelling of the head due to excess fluid on the brain. “Many patients are two years down without a CT scan and they come to us in critical condition and need immediate attention. In many cases, we usually have to use our money to buy drills, sutures, shunts – not only expensive things like microscopes, but even small things are not available. Instead, we rely on well-wishers. “Many of the conditions we see are easy to treat, but we don’t get the support we need,” said Dr Mushenya. It is a very common occurrence in Rwanda, according to Dr. Umgwaneza, counting road accidents and falling into the midst of his most common surgery, “Patients often wait up to six months for surgery that is not considered serious, which leads to fractures that are not strengthened properly. which causes lifelong disability.” He emphasizes the need to strengthen the entire surgical system, from training surgeons to strengthening surgical teams across the chain of disciplines from nurses to anesthesiologists. The situation in Zambia and Rwanda is consistent with the wider challenges facing the region. In many countries in the Global South, the surgeon-to-patient ratio is alarmingly low, with one qualified surgeon per 2.5 million people. This neglect continues even though surgically treatable conditions cause more death and disability than AIDS, tuberculosis, and malaria combined.
Despite the World Health Assembly (WHA) resolution of 2015 promoting the inclusion of universal surgery within primary health care as an important part of Universal Health Coverage (UHC), surgical care remains surprisingly absent from the plans of policy makers.
This lack of resources has contributed to little progress in strengthening emergency and critical surgical and neurological services. As a result, 16 million people worldwide die each year from conditions that could be treated with surgery. Responding to the urgent need for surgical care, COSECSA, supported by the Royal College of Surgeons in Ireland has trained 910 surgeons through its rigorous five-year program, achieving this at a surprisingly low cost of just $600 per surgeon per year. Prof. Juan Carlos Puyana, Chair of Global Surgery at the RCSI University of Medicine and Health Sciences in Dublin, has seen first-hand the impact of this program and is a passionate advocate for more investment in global surgery.
An experienced surgeon, he worked for decades in low-resource settings, and emphasizes the robustness and cost-effectiveness of this program, stressing the importance of changing perceptions about surgical care: “There is a misconception that surgical care is very expensive, but it is a simple procedure. they do not require large investments in infrastructure and expensive equipment.
Our approach is based on evidence that safe surgery is not a cost but an important investment in health infrastructure and economic development.” Dr. Puyana’s views were echoed in the results of the 2015 Lancet Commission on Global Surgery, which emphasized that billions of people do not have access to safe surgery. The report found that investing in surgical services is not only affordable but essential to saving lives and securing safe health systems.
Bridging the gap to ensure that surgical services are easily accessible in low- and middle-income countries, will not only save lives but also restore patients’ ability to work and live productive lives, generating economic benefits far greater than their costs. This program stands as powerful evidence of how targeted, cost-effective interventions can make a lasting impact. In recent years, it has expanded its scope beyond surgical training. Recognizing that effective surgical care depends on many ethnic groups, we now support the development of colleges in anesthesiology, obstetrics and gynecology, and nursing throughout the region.
This expansion builds on a proven model for scaling up rapid training in the sub-Saharan context that involves a combination of virtual classrooms, training, and a support network for individual health workers. In other countries such as Zambia, Tanzania and Malawi, especially in rural hospitals, non-specialist and non-medical surgeons also play an important role in delivering important procedures. In addition, when qualified health workers from the Global South migrate to the Global North in search of better opportunities, this program has proved to be a game-changer in stemming the exodus of health workers from the region.
The 2024 study reveals a dramatic change, with an impressive 98.5% retention rate for specialist surgeons in Africa, addressing the chronic shortage of skilled healthcare professionals. This change represents not only a major success for the program, but also an important step towards the sustainability of local health care systems. Addressing the crisis in global surgery requires a fundamental change in global priorities: surgery is not a luxury intervention, but an essential part of any effective health system. This requires policymakers to prioritize investment in training, infrastructure, and system-wide support, ensuring that surgical care is accessible to millions who have yet to reach it.
As the network of skilled workers expands, communities themselves lay the foundation for strong health systems. By doing this, surgeons like Dr Mushenya and Dr Umugwaneza are protecting future generations from the preventable suffering that has long plagued the world’s poorest regions.
Eric O’Flynn is Program Director — Education, Training and Advocacy, Institute of Global Surgery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin.
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© Inter Press Service (2024) — All Rights ReservedOriginal source: Inter Press Service
