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Stanford surgeon Sherry Wren and several officers of Women in Surgery Africa

Working to improve surgery in the developing world

Stanford surgeon Sherry Wren comments on the challenges of global surgery and gender differences in surgical care worldwide.

When Stanford surgeon Sherry Wren, MD, first volunteered in 2006 with Doctors Without Borders in sub-Saharan Africa, she realized that while she was a very skilled surgeon, her skills didn’t easily translate into humanitarian work in the developing world.

Through her work with the nonprofit, she also became acutely aware of a huge scarcity of surgical services in the developing world: As many as two billion people lack access to basic surgical procedures, like treatment of traumatic injuries, which are common in developing countries, she said. Though a third of global disease is treatable through surgery, only 6 percent of the world’s operations are performed in low- and middle-income countries, Wren told a Stanford audience earlier this month.

“Injury takes more lives than HIV, TB and malaria combined. Yet the amount of money that goes to injury treatment and prevention is microscopic compared to the other communicable diseases,” she told about 100 faculty and students at Stanford’s annual global health convening.

A professor of surgery, Wren was among the featured speakers at the day-long gathering, sponsored by the Stanford Center for Innovation in Global Health. The event, which focused this year on “Planetary Health in a Changing Climate,” included talks on a wide range of topics, including the impact of climate change on food availability, use of oral rehydration salts to treat diarrhea in Ugandan children and domestic violence among women in India.

Wren, who is also director of global surgery at Stanford, has been doing research on global disparities in surgery since 2011 and has found, among other things, that men in developing countries are more likely to undergo surgery than women. One reason is financial: Men are more likely to “crowd source” funding to pay for expensive procedures, but women don’t take advantage of this option. And many cultures tend to undervalue women, with the result that women don’t seek out surgical care.

“Women prioritize care of men over care of women,” said Wren. “So this is an important issue to think about.”

Amee Azad, a second-year medical student working with Wren, did a study of surgical trends in Malawi and found that women felt they were “too invaluable to the household to take time out for surgery,” she said during a poster presentation. Women also fear the stigma of surgery and are more likely to turn to traditional healers when they need care, Azad said.

Wren is working to counter these trends, helping to mentor and train women surgeons in developing countries, where there is a dearth of female practitioners.

“I was just in Vietnam, and they’d never seen a woman surgeon before,” she said. In sub-Saharan Africa, she has been collaborating with clinicians from the College of Surgeons in Eastern, Central and Southern Africa to train more women in the field. “There is a burgeoning movement of women in surgery there,” he said. “I’m seeing huge advances in that area.”

At Stanford, she also has led a series of continuing medical education courses for surgeons from around the country who want to hone their skills to do humanitarian work in the developing world. She has trained more than 400 clinicians through the program, some of whom are also applying what they learn in practices in rural America, she said.

“Our educational initiatives do help with capacity building,” she said.

Image, of Sherry Wren and several officers of Women in Surgery Africa, courtesy of Wren

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