From Cataracts to Killer Monkeys: The growing need for surgery at the BoP (Bi-Weekly Checkup, 6/8/13)
I came across an unexpectedly gruesome story in the current Johns Hopkins School of Public Health magazine. If you’re squeamish, stop reading now.
A two year-old girl was playing with her village’s pet monkey in Liberia. The girl likely had an umbilical hernia, causing a bulging of her belly button.
Perhaps you can see where this is going…
Something upset the monkey and it attacked the girl, grabbing the hernia and tearing open her abdomen. Her intestines spilled out of the wound, and her mother left the child for dead. Fortunately, a neighbor picked up the toddler and managed to locate a truck that would carry them to the hospital 30 miles away.
“We helped the local surgeons put IV fluids in, put her intestines back in and close up the abdominal cavity,” says Johns Hopkins surgeon Fizan Abdullah, who was in Liberia leading a medical education program to train surgeons in hernia repair. Incredibly, the girl survived.
But as the article (and our recent coverage) describe, many in the developing world aren’t so lucky – if “lucky” is the right word for a little girl who suffered this kind of ordeal. More than 90 percent of the 5.8 million annual global deaths from physical injury occur in low-income countries, and many of these could be prevented with surgical treatment. There are already 32 percent more injury-related deaths in the world than malaria, tuberculosis and HIV/AIDS combined. And right now, more than 2 billion people lack access to adequate surgical services, with an estimated 56 million people across Africa in need of surgical treatment today.
What’s more, the problem could be poised to get substantially worse. With economic expansion comes more vehicle traffic, often on unsafe roads, leading to more road injuries. With increasing employment – often heavy physical labor in factories, farms and mines with lax safety regulations – more will fall prey to workplace injuries. And that doesn’t even take into account the continual need for surgeries to address congenital, child-birth or age-related conditions – like clubfoot, Cesarean sections, or cataracts – or for common maladies like appendicitis. Toss in the need for surgical interventions for diabetes and heart disease, both of which are skyrocketing around the world, and the BoP could see its already huge need for surgery grow past the breaking point in the coming years.
“You’re talking about a major burden of disease that is not being addressed by global health through funding or policies or development of new training procedures or supportive, innovative programs where effectiveness can be documented,” says Henry B. Perry, MD, a senior associate in International Health at Johns Hopkins in the article. “Obviously it’s not feasible to think about heart transplants or complicated cancer surgeries. But where the global health agenda has missed the boat is in looking at low-cost ways to provide access to hospital care for lifesaving or life-changing surgical services… It’s bringing a public health vision to surgery.”
After speaking with Dr. Devi Shetty of Narayan Hrudayalaya and learning about his low-cost approach to cardiac surgery, I’m not sure I agree with Dr. Perry about the feasibility of bringing complex surgeries to the developing world – though it may be wise to start with simpler operations that can impact public health in a more cost-effective way. But I definitely agree that expanding access to surgery should be a greater priority in global health.
Fortunately, there are some brilliant innovators that are tackling this issue in the developing world, making anesthesia safer and surgery more affordable. We covered two of them this week – if you know of any more, please email me. We’d love to highlight them in future posts on NextBillion Health Care, as we devote increasing coverage to this issue.
Here are some other posts from NB Health Care you may have missed in our past two weeks.
In Case You Missed It … Also This Week on NextBillion
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