Surgery Can't Be Sidelined
NEW YORK—In the quest to end preventable maternal mortality, safe surgery deserves greater attention as a key strategy, said advocates gathered at a UN General Assembly side event yesterday at the Roosevelt Hotel.
The scope of the problem is clear: More than 300,000 women will die from preventable conditions during pregnancy, such as a ruptured uterus or obstructed labor. Believing that safe surgery could make a major dent in the problem, Jhpiego, the GE Foundation, the G4 Alliance, and Safe Surgery 2020 assembled a panel to discuss practical needs and priorities needed, from practical training, to leadership, to getting countries on board with high-level commitments.
Some governments—including Ethiopia and Zambia—are answering the call and developing plans, but as moderator Wendy Taylor, former director of the Center for Accelerating Innovation and Impact at USAID, noted, implementation is the hard part. One obstacle, as Milliard Derbew, president of the College of Surgeons of East, Central and Southern Africa, explained is human resources: there is a big need to train and support more surgeons, anesthesiologists, gynecologists and obstetricians, especially in Africa, he said. But Derbew also called for greater regional collaboration to replace the independent, disorganized approach.
John G. Meara, professor of Global Surgery at Harvard Medical School, agreed that regional collaboration could be a pivotal game-changer. Meara, co-author of the landmark Lancet Commission on Global Surgery http://www.lancetglobalsurgery.org/, also challenged surgeons to recognize that surgery is a cross-cutting issue, not a vertical one, and to take on a greater leadership role. Thoughtful planning, backed by data, is needed. Many countries need help institutionalizing collection of critical data, such as Apgar scores, he said—a call he says the World Bank is stepping up to help answer.
Kris Torgenson, Global CEO of the Lifebox Foundation, emphasized the role of practical tools, such as the safe surgery checklist developed by Atul Guwande and others—which has proved helpful not only in improving outcomes, but also to highlight gaps and blind spots—such as the fact that huge disparities were found around conditions in obstetric theaters versus emergency operating rooms in Ethiopia surrounding the sterilization of equipment. Caesarean sections are still the highest level of surgical intervention taking place around the world, she said, and up to 15% of people who deliver via caesarean section develop infections that emerged after they went home.
The need for hospital leadership also bubbled up, and the panelists agreed that getting the funding to invest in leadership is hard. Industry can play an important role as well, they said, training facilities in managing logistics and other areas that are critical for surgery, Torgenson emphasized. Representing the private sector on the panel, Pierre Theodore, MD, vice president of Medical Devices for Johnson & Johnson, explained how industry can help expand access to surgery by supporting the development of logistics, supply chain delivery, and management and administration—a layer that is often missing.
Regarding the most pivotal immediate steps in need of financing, Meara offered up a request that he said might sound odd—to fund the WHO. The World Health Assembly passed a resolution recognizing the importance of surgery and named Walt Johnson coordinator of the WHO's Emergency and Essential Surgical Care Programme to lead the initiative last year, but he still has no funding or regional directors needed to scale up.
From the audience, Jim Campbell, director of WHO's Health Workforce Department, commented that access to surgery is a multi-faceted issue, involving workforce, leadership, data, financing, and governance—and the language should not be around single specializations, but rather the capacity and capability of health systems to try and drive forward toward a universal health coverage agenda … and to make that happen, we need to be reach out to a broad group of constituencies.
Closing with a rallying cry for safe surgery advocates, Leslie Mancuso, president and CEO of Jhpiego, emphasized that “No woman should die giving life.” Safe surgery should be a right not a luxury, she said, and the status quo is not acceptable … and with the SDGs, we have an opportunity to change the trajectory to drive progress faster so that we can improve maternal newborn survival” in order to prevent 800 women a day from dying due to pregnancy-related causes. To make that happen, she said, leadership and commitment of surgeons, obstetricians, anesthesiologists, non-medical specialists and yes nurses and midwives are needed and are essential to bend the curve.
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