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Surgery can prevent up to 15 percent of deaths – Smith

- Kemantha Govender

Professor Martin Smith says that the role of surgery in achieving universal access can no longer be sidelined.

Surgery is raising its voice and 2015 has been a year when it has been most vocal.

Professor Martin Smith, Academic Head of Surgery at the School of Clinical Medicine at Wits University, said that the role of surgery in achieving universal access to health care has been highlighted through a number of key activities.

He was speaking at the recent two-day national forum on Global Surgery 2030, which took place on 7 and 8 December 2015 at Wits University.

Unmet needs

Smith said surgery has been considered to be an inefficient and expensive treatment modality with limited impact on communities for far too long.

“Even in middle income countries, there is a significant unmet need with regard to surgically treatable conditions. The consequences are an increased burden of disability and  poverty. It has been estimated that up to 15 percent of all deaths are due to surgically preventable conditions,” said Smith.

The Lancet Commission on Global Surgery (LCoGS) published in April this year, stated that five billion people do not have access to safe, affordable surgical and anaesthesia care when needed. Access is worse in low-income and lower-middle-income countries, where nine out of 10 people cannot access basic surgical care.

Making a case for surgery 

In May 2015, the World Health Assembly passed resolution on essential surgery.

The World Bank published the 3rd version of the Disease Control Priorities (DCP3) with a whole volume dedicated to surgery. In September 2015, the United Nations sustainable development goals replaced the millennium development goals with a new set of targets for achievement.

Professor Martin Veller, Dean of Faculty of Health Sciences said the forum is an important step in ensuring that surgical servicesbecome part an integrated health service in SA and universal primary healthcare.

“A substantial global gap exists between surgical needs and the equitable provision of state surgical care. Low income and middle income countries carry the greatest burden of untreated surgical diseases,” said Veller.

Focus on the poor 

Professor John Meara, Kletjian Chair in Global Surgery Professor of Surgery Director, who provided background to LCoGS, stated that 143 million more procedures are needed annually, and this remains a daunting challenge because there is a shortage in the surgical workforce globally.

Meara said the poorest – one third of the world’s population – receives only 6.3% of worldwide procedures.

Smith said that unlike treatment specific diseases, surgery is a treatment system that requires procurement and maintenance to ensure its efficiency.

Skills development 

“The development of the district hospital is crucial to increased delivery of surgical services.” Smith added that the challenge is to identify the basket of care package and key surgical competencies necessary as determined by the burden of disease.

“Without adequate skills development, having functional district hospitals will not meet the needs determined by the burden of disease,” Smith said.

 “In absence of surgical care, care-fatality rates are high for common, easily treatable conditions including appendicitis, hernia, fractures, obstructed labour, congenital anomalies, and breast and cervical cancer.”

Smith argued that surgical and anaesthesia care are essential for the treatment of many of these conditions and represent an integral component of a functional, responsive and resilient health system.

Meara suggested that investing in surgery is affordable, will save lives and promote economic growth.