Global perspective Human stories

Many deaths, disabilities in poor nations avoidable under UN basic surgery plan

Many deaths, disabilities in poor nations avoidable under UN basic surgery plan

With hundreds of thousands of deaths or permanent disabilities from traffic accidents, violence, war and other causes easily preventable through simple surgery, the United Nations health agency has expanded its programme to train health care staff in low- and middle-income countries in essential basic surgical and anaesthesia skills.

“The initiative signifies a shift in the way we think about surgery,” UN World Health Organization (WHO) clinical procedures official Luc Noel said. “Until recently, surgery was a neglected health issue in developing countries because it was assumed to be too expensive and sophisticated.”

The programme, which already exists in 22 countries, will boost the capacity of first-level health facilities – rural or district hospitals and health centres – to deal with simple but essential surgery in a growing number of developing regions.

In many cases, death and disability can be avoided through simple surgical interventions after road accidents, interpersonal violence or war, abdominal emergencies, pregnancy complications, congenital abnormalities, fractures, burns, or the consequences of acute infections, which together cause the loss of approximately 11 per cent of total lost years of healthy life.

Injuries alone kill more than 5 million people every year, accounting for nearly one in every 10 deaths worldwide. The WHO Emergency and Essential Surgical Care Project trains health staff in simple surgery, anaesthesia and emergency care. After training and with the help of basic equipment, health care staff are able to perform surgical procedures that save lives and prevent disability.

“Why should a child die from appendicitis, or a mother and child succumb to obstructed labour, when simple surgical procedures can save their lives?” WHO surgery programme chief Meena Cherian said.

The quality of emergency and essential surgical care is often constrained by inadequate basic equipment for interventions that are simple but vital, such as resuscitation, giving oxygen, assessing anaemia and inserting a chest drain. Other barriers to the timely and appropriate delivery of basic surgical services include poor infrastructure and insufficient numbers and training of health-care professionals.

In most developing countries, adequate surgical services are found only in urban areas. Furthermore, the migration of health professionals leaves a shortage at primary-health facilities, where services are provided by non-specialist or even non-medical personnel, many of whom are inadequately trained.

A number of isolated local initiatives have shown that even with only basic training and technologies, many lives can be saved or improved. For instance, clubfoot, a congenital deformity of the foot marked by a twisted position of the ankle, heel and toes which affects well over 100,000 newborns each year, can greatly impede mobility in children and if untreated can lead to severe disability and loss of productive life.

Yet, if diagnosed at birth or soon after, it can often be treated using minimally invasive techniques, the so-called Ponseti method, involving multiple manipulations and plaster castings early in a child’s life. The techniques, which have been quite effective in the industrialized world, require minimal resources and can be implemented by health personnel in primary health-care facilities. In Uganda, over 100 professionals have been trained, resulting in effective treatment of 95 per cent of new cases of clubfoot.

Surgical intervention has also become a common component in HIV/AIDS care. Some complications associated with HIV infection, such as abscesses, anorectal disorders, lymphadenopathies, lipoatrophy or mild forms of Kaposi sarcoma, are also diagnosed and treated with simple surgical interventions.