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Study shows huge lag in surgery in poor nations

Doctors without Borders surgery picIn this country, if you suffer a broken leg, you can be reassured that there is a surgeon available to help fix it and there's a good chance you'll walk normally again and go back to your daily routine. But if you live in a poor country, that same reassurance isn't there, and you may find yourself disabled for life, unable to work and help support yourself and your family.

That disparity is reflected in a new analysis (.pdf) of surgical trends in 194 countries, which highlights the vast differences between care available in rich and poor countries. The study found that while the number of surgeries has been on the rise in developing countries, these countries still account for a small percent of the operations being done worldwide. Only 6.3 percent of surgeries in 2012 were performed in very poor countries, though these nations are home to nearly 37 percent of the world's population, the study finds.

"Surgery is being provided with increasing frequency in countries with very low expenditure on healthcare. Yet there is still a huge disparity between what is being offered in high health-expenditure countries versus the low-resourced countries," Stanford surgeon and lead author Thomas Weiser, MD, told me.

Among the operations that are being done in poor countries, the most common is caesarean section deliveries, as maternal health is considered a high priority for health systems in the developing world, Weiser said. But that means other urgent surgical needs, such as repair of traumatic injury or cancer treatment, are being largely neglected, he said: "In resource-poor settings, they don't have the capacity to provide the full repertoire of services. So they focus on the high-impact services - the ones that are given priority, like maternal health."

Weiser is also concerned about the quality and safety of surgical care in the developing world, where there is a lack of equipment and training, as well as sterile environments in which to safely perform procedures. A separate, recently published study in which he was involved showed high mortality rates and wide variability in patient outcomes in three common procedures - C-section, appendectomy and hernia repair - done in low-and middle-income countries.

"Surgery is a high-risk intervention. We are talking about millions of operations a year, so a lot of patients are at risk... So safety and quality of surgery is a concern," Weiser told me.

Weiser said the study points to the need for greater investment in surgical capacity in the developing world:

One is a skills issue. There aren't enough providers, and there's obviously a brain-drain issue... Surgery is a very unsupported discipline, in terms of infrastructure, and it's high-risk. It's very daunting, and it's a very hard environment to work in because of a lack of equipment and a sterile environment in which to operate. A lot of those fundamental issues need to be addressed.

The latest study appears in the monthly Bulletin of the World Health Organization.

Previously: Why millions lack access to surgery: A conversation with Stanford surgeon Thomas Weiser and Billions lack surgical care; report calls for change
Photo by Doctors Without Borders

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