TY - JOUR
AU - Gawande, A
AB - ‘Statistics are human beings with the tears wiped off’—Paul Brodeur1 In recent years, researchers have begun to put hard figures around a global health catastrophe that has been otherwise largely ignored by policymakers and public health agencies: the widespread absence of basic surgical care needed for survival. Public health efforts in impoverished settings have tended to focus on vertical programmes for specific populations and conditions—mothers in childbirth, people with human immunodeficiency virus (HIV), adults with avoidable blindness. Reasons of cost-effectiveness are cited. However, targeted approaches have proved limited and, in fact, inefficient. Saving mothers who die in childbirth requires access to emergency obstetric care, including caesarean section. Reducing HIV transmission requires adult circumcision capability. Averting blindness requires cataract procedures. Road traffic injuries require care for fractures, head injury and pneumothorax. Creating such capabilities separately is neither wise nor feasible. Instead, it is apparent that communities require health systems that can address the full range of life-limiting conditions they encounter, including surgical conditions. Our recent research has found, however, that more than two billion people live without minimal access to surgical care2. A strategy to increase access is essential in addressing core public health goals, such as reducing maternal deaths, HIV rates and road traffic deaths. The obvious strategy is to start by strengthening existing surgical facilities. This paper—the first comprehensive assessment of a nation's surgical systems anywhere—provides a major leap forward in information to guide such efforts3. It reveals that Rwanda, a nation of ten million, has just 124 operating rooms, 45 full-time surgeons and 12 anaesthetists. They labour under severe shortages of materials and skills. Yet, with general physicians and medical officers, they have produced a system that completes more than 50 000 major procedures annually (of which more than 75 per cent is for emergency obstetric care, cataract removal and orthopaedic trauma) and another 35 000 minor procedures—a stunning level of productivity. The data suggest that strengthening such surgical systems requires increasing skills training for doctors and other staff, closing gaps in availability of key safety equipment, and at least doubling the existing operating room capacity. Further research is needed to gather similar data from elsewhere and test sampling methods so that capacity can be monitored over time. These are feasible, highly cost-effective goals. The statistics show us that the problem is not nearly hopeless. The human beings behind them need not be ignored. Disclosure The author declares no conflict of interest. References 1 Brodeur P . Outrageous Misconduct . Pantheon Books : New York , 1985 . Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC 2 Funk LM , Weiser TG, Berry WR, Lipsitz SR, Merry AF, Enright AC et al. Global operating theatre distribution and pulse oximetry supply: an estimation from reported data . Lancet 2010 ; 376 : 1055 – 1061 . Google Scholar Crossref Search ADS PubMed WorldCat 3 Petroze RT , Nzayisenga A, Rusanganwa V, Ntakiyiruta G, Calland JF. Comprehensive national analysis of emergency and essential surgical capacity in Rwanda . Br J Surg 2012 ; 99 : 436 – 443 . Google Scholar Crossref Search ADS PubMed WorldCat Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
TI - Comprehensive national analysis of emergency and essential surgical capacity in Rwanda (Br J Surg 2012: 99: 436–443)
JO - British Journal of Surgery
DO - 10.1002/bjs.7815
DA - 2012-01-30
UR - https://www.deepdyve.com/lp/oxford-university-press/comprehensive-national-analysis-of-emergency-and-essential-surgical-YMecOX2qTw
SP - 444
EP - 444
VL - 99
IS - 3
DP - DeepDyve
ER -