Surgical Disease: The Reality Beyond the Big Screen

| November 25, 2012 | 0 Comments

Surgeons operating on a child in Moyobamba, Peru.

Here in the United States, in a culture where Grey’s Anatomy monopolizes the television screens of American households, it is difficult to envision a place without surgical infrastructure.  However, this is the reality of life, and death, in many parts of the world.  According to the World Health Organization (WHO), two billion people globally have no access to emergency or surgical care.1  However, unlike the success of surgical television shows in captivating public interest, the reality of surgical need on a global scale has yet to garner any significant attention.  Conditions amenable to surgical intervention such as trauma, cancer, infections, congenital anomalies and complications from childbirth ravage developing countries where there are often limited, if any, surgical options.  Injuries alone represent over 10 percent of the world’s fatalities.2  Surgical disease comprises a sizeable but neglected field in global health.  Addressing this unmet disease burden is a feasible undertaking that demands increased attention from the global community.

Despite the magnitude of surgical disease and the potential devastation lack of treatment can cause, global surgery receives little attention from the international community.  For example, the Bill & Melinda Gates Foundation does laudable work with underserved populations.  However, a recent search of its website for surgery resulted in a startlingly low number of results at 25, compared to 3,475 results obtained from a search for HIV.  However, the number of deaths worldwide from injuries alone is greater than the number of deaths from malaria, tuberculosis and HIV/AIDS combined.2

This attention deficit cannot be attributed solely to a lack of knowledge surrounding the problem.  Over 30 years ago, Dr. Halfdan Mahler, at that time director-general of the WHO, called absence of surgical resources the “most serious manifestation of social inequity in health care”.3  Nearly three decades later, Paul Farmer dubbed surgery the “neglected stepchild of global health”.4  However, global surgery has yet to gather the attention of many global health groups, ministries of health, or large-scale funders.

Some argue that surgery is too expensive to offer.  On the contrary, surgery has proven to be at least as cost effective as treatments commonly provided for other diseases.  For example, Gosselin et al found a cost per disability adjusted life year (DALY) averted for surgery of $32.78, which is comparable to oral rehydration solution at $35/DALY averted5 and cheaper than antiretroviral therapy at $350-500/DALY averted.6

Others argue that global surgery is too difficult to perform.  This is also a misconception.  Médecins Sans Frontières has been performing surgical operations for years in some of the most godforsaken regions of the world.Similarly, Zanmi Lasante, Partners in Health’s Haitian sister organization, provides surgical care at multiple sites throughout Haiti’s Central and Artibonite districts.

Despite the focus of a few groups, the global burden of surgical disease remains vast.  10 to 20 percent of deaths of young adults in developing countries are secondary to inadequate surgical knowledge.1  Maternal mortality is estimated at over 500,000 women per year, most frequently secondary to hemorrhage and other conditions amenable to surgical intervention.8 This blatant lack of care is not only unacceptable, but also unnecessary.  It is time for the international community to come together to give this neglected stepchild the kind of golden globe recognition it deserves.


  1. Essential surgical care makes a difference.  World Health Organization. September 2010. (Accessed October 21, 2012, at
  2. Injuries and Violence – the Facts.  The World Health Organization. 2010. (Accessed October 20, 2012, at
  3. Mahler, H.  Healthcare for all.  XXII Biennial World Congress of the International College of Surgeons. June 1980. Mexico City, Mexico. (Accessed October 20, 2012, at
  4. Farmer PE, Kim JY.  Surgery and global health:  a view from beyond the OR. World J Surg. 2008 Apr;32(4):533-6.
  5. Gosselin RA, Thind A, Bellardinelli A. Cost/DALY averted in a small hospital in Sierra Leone: what is the relative contribution of different services? World J Surg. 2006; 30: 505-11 doi: 10.1007/s00268-005-0609-5.
  6. Gosselin RA, Heitto M.  Cost-effectiveness of a district trauma hospital in Battambang, Cambodia. World J Surg. 2008 Nov;32(11):2450-3.
  7. Activity Report 2011. Medecins Sans Frontieres. 2011. (Accessed October 20, 2012, at
  8. World health report 2005: making every mother and child count. World Health Organization. (Accessed October 20, 2012, at

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Category: NCDs, Online

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