The unmet surgical need in low-income countries is an issue generally neglected within the global public health arena. This however is slowly changing. Over the past several years, a group of individuals interested in surgical care in the developing world has been informally comparing ideas and experiences. Buoyed by the work of economist Dean Jamison and the chapter on Surgery in the Disease Control Priorities in Developing Countries, 2^nd edition by Drs. Haile Debas, Richard Gosselin, Colin McCord, and Amardeep Thind on the cost effectiveness of surgical care in the developing world, the “Global Burden of Surgical Disease Working Group” held it’s 1^st Annual Meeting on April 16-17, 2008 in Seattle.

The meeting started with a dinner reception and keynote address by Dr. Haile Debas. He stressed the importance of advocating for improvement of surgical service delivery in the developing world. He also stressed the importance of developing partnerships for training of not only surgeons, but also training of non-surgeon providers (both general practitioner physicians and mid-level providers).

Two days of talks and break-out sessions followed. There were about 50 participants representing multiple surgical fields (general, plastics, urology, pediatrics, orthopedics, ENT, trauma & burn), anesthesiologists, emergency physicians, and experts in health metrics and health economists. We came from academic centers, from private practice settings, from the American College of Surgeons, from the WHO, and from various NGOs and Private Voluntary Organizations (PVO).

The overwhelming concept to come from the meeting is that there is a critical lack of data concerning the true amount of global ill health which could be alleviated by surgical expertise. Trying to get better data is critical to garnering more support and funding for these services. The number often quoted, that of 11% of global burden of disease being related to surgical conditions is based on very limited data. Truly, it is based on best guesses from 14 surgeons around the world. Yet, at the moment, it appears there is no better source of data. Most participants agreed that there are large numbers of people in need of surgical intervention who never show up to health facilities because they know there is no one available to provide the services. So there is a large undercount of the potential impact of surgical services.

Participants left the meeting with various tasks all relating to ways of enhancing surgical delivery in the developing world. Some tasks relate to how to best set up partnerships between academia/NGOs/PVOs to try to tap into the broad interest in global health among trainee’s in the developed world. Other tasks relate to trying to determine new ways to look at the data, or to collect new data to try to get a more realistic picture of the true global burden of disease amenable to surgical expertise. The WHO Global Initiative for Essential and Emergency Surgery (GIEESC) was presented and discussed, as were lessons learned from the Safe Motherhood Initiative and the Violence and Injury Prevention program. Also presented was the newer WHO Safe Surgery Initiative. Of particular interest was the use of the GIEESC Situational Analysis instrument for evaluating a facility’s surgical services as a tool for estimating local burden of surgical disease. Academic twinning projects in the delivery of surgical services based at UCSF, University of Washington, and Harvard were presented for collaboration of ideas. A web-based Global Surgical Research Network was also show-cased, which we hope will be an important tool in linking global surgery researchers. Importantly, a time constraint is in place for these tasks to be accomplished, as the next meeting of a more broad coalition of the working group will be held in mid September 2008 in Seattle. All left the meeting with work to be done.

To read more about the Global Burden of Surgical Disease Working Group, articles and additional resources on surgical disease and care, check out the group’s literature section. Many thanks to Robert Riviello who contributed to this post.

In case you haven’t seen it, check out Paul Farmer’s interview that aired on 60 Minutes yesterday. In addition to the video, you can also read the entire transcript on CBS news web site. In addition to being the co-Founder of Partners In Health, Paul Farmer is one of the leaders of the Global Health Delivery Project.

Jim Yong Kim, Director of the Francois Xavier Bagnoud Center for Health and Human Right at Harvard School of Public Health, Chief of the Division of Social Medicine and Health Inequalities at Brigham and Women’s Hospital, and Leader of the Global Health Delivery Project, welcomed Agnès Binagwaho, Executive Secretary, Rwanda’s National HIV/AIDS Control Commission and Co-Chair of The Joint Learning Initiative on Children and HIV/AIDS, and Paul Farmer, co-Founder of Partners In Health, for a public presentation focused on Rwanda titled: Public health and public good: Breaking the cycle of poverty and disease. They discussed progress made in Rwanda’s health care system and the long road ahead in new projects, and answered questions from the public (you can read more on the Q&A session on Christine Gorman’s blog post Agnes Binagwaho on Brain Drain).

Agnès Binagwaho - April 22, 2008 @ Harvard School of Public Health
View the entire video of the event here.

Agnès Binagwaho started her presentation “Breaking the Cycle of Disease and Poverty by building a Comprehensive Health System in Rwanda” with an excerpt of the World Health Organization’s mission statement that “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being.”

She then poignantly recalled her experience of coming back to Rwanda after the genocide, and seeing more deaths in a few weeks than in her whole career as a Pediatrician in France, and the unbearable feeling of being “incapacitated,” “unable to do anything” because HIV/AIDS drugs were way out of reach for most developing countries, but also because there were zero resources whatsoever.

She also looked at the five major killers (namely Malaria, HIV, TB, Digestive and Pulmonary Infections, and Maternal and Child mortality) and the Rwandan journey to economic growth and increased life expectancy with the creation of new policies, institutions - where accountability is on top of the agenda at all levels - strategies and protocols. She also underlined that Rwanda is bracing itself for sustainability by strongly focusing on economic development at all levels while mapping the new health care system.

Paul Farmer’s presentation, titled “Reinvigorating the public sector: Political will in post-genocide Rwanda” brought a closer look at the Rwanda’s model of care and its principles and how PIH was uniquely involved in implementing the model based on its own principles of care.

A few chosen tidbits: Answering a question on how to marry the “ancient/traditional” ways of healing with modern medicine, Agnès Binagwaho replied “Don’t fight the spirit; Fight the disease.”

Discussion brain-drain and staff retention issues, she underlined the importance of working conditions in addition to salary: “You need the tools of the trade in order to make a difference; and you can only retain people if they have the tools they need to do their job.”

This public event was held at Harvard School of Public Health on April 22, 2008, and sponsored by The Francois Xavier Bagnoud Center for Health and Human Right.

The WHO Regional Office for Africa is organizing in collaboration with UNICEF, UNFPA, UNAIDS, World Bank, African Development Bank and other development partners, an International Conference of Primary Health Care (PHC) and Health Systems in Africa in Ouagadougou, Burkina Faso, from 28 to 30 April 2008.

This Conference, hosted by the government of Burkina Faso, will be the first of its kind to take place in Africa in 2008 which marks the 30th anniversary of the Alma Ata Declaration on PHC, and the 60th Anniversary of WHO.

For more information and conference program, please visit the event’s page on the WHO Africa Website.

Read article: Africa: Continent Hosts Historic Conference on Primary Health Care to Renew Commitment to Health for All

The International Council of Nurses will hold its 24th Quadrennial Congress, “Leading Change: Building Healthier Nations,” from June 19 to June 25, 2009 in Durban, South Africa. ICN Members and colleagues are invited to submit abstracts now. The deadline for abstracts submission is midnight GMT, September, 15, 2008. Call for Abstracts, General information, Speakers Corner and more information is available in English, Français, and Español, on the ICN Congress website.

Abstract sub-themes:

1. The nursing workforce and workplace
What retention strategies ensure an effective workforce?
What skill pool is required for quality care?
What is the impact of positive practice environments?
How does the global international labour market affect the health of nations?

2. Pandemics/disasters
What is the role of nurses in disaster preparedness and relief efforts?
What competencies are specifically needed in disaster nursing?
How do we screen and deploy disaster nurses effectively?
What protective measures are required by relief workers?

3. Ethics/human rights
Do human rights provide the framework for equitable care?
What ethical dilemmas exist in building healthier nations?

4. Clinical care and patient safety
What innovations in clinical practice support better patient outcomes?
What is the link between positive practice environments and patient safety?
Should our health goals reach beyond safety?

5. Nursing education and the learning environment
Where are the service/education gaps and how are they addressed?
Will healthier nations depend on innovative learning environments?
Will nursing education become articulated to meet the nursing continuum skill and knowledge needs?

6. Advocacy, lobbying and legislation
How do nurses lead change?
What is the role of legislation in building healthy nations?
How can the media be enlisted to promote healthier nations?
What alliances can be generated to promote health?

7. Care systems
How are care systems evolving to meet changing needs?
What happens at the interface between the health and social sectors?

8. Technology, innovations and informatics
How does technology serve building health nations?
What have innovations brought to health care?
How can computers and software serve nurses and nursing?

9. Leadership - management
What competencies are needed by our nurse managers?
Are they different from the abilities of true leaders?
Where and how does nursing leadership develop?

10. Regulation
What is the role of professional regulation in building healthier nations?
How can accreditation systems benefit the patient?
How is the focus on competencies changing the health sector?

Check out the Yale Daily News report on the fifth annual Unite for Sight Conference, Unite for Sight sets global goals, held last weekend, April 12-13, at Yale University.

Themed “Building Global Health For Today and Tomorrow,” the conference included talks and panel discussions on global-health issues and brought together a wide range of global health leaders and implementers including Jim Yong Kim, who presented “Bridging the Implementation Gap in Global Health.”

“Unite for Sight was founded in 2000 at Yale by then-sophomore Jennifer Staple to provide eye screening and education for the medically underserved population of New Haven, Connecticut. The organization has now grown to include a force of over 4,000 volunteers working through 90 chapters, based at universities, medical schools, corporations and high schools worldwide. In 2006 and 2007 Unite for Sight restored sight to 10,062 patients and provided eye care to over 300,000 individuals,” states the conference news release by the Office of Public Affairs at Yale University.

For more information on Unite for Sight, take a look at Founder Jennifer Staple video (March 28, 2008) and her CNN/World Be the change Blog.