Global surgery and global health: One size does not fit all

Abstract

Global surgery is interpreted differently and may lack an in-depth understanding which is complicated by socio-economy and culture. Global surgery and global health have become part of health care service following the report of the Lancet Commission. Sustainability, ethical principles, and decolonization are some important ongoing issues for recipient societies. Incorporating societal dimensions, socio-cultural values, patients’ needs, and affordability requires a tailored approach and not blindly pursuing the best technology. The recent COVID-19 has exposed the unethical and inequity in terms of equitable healthcare, vaccine rollout and its access, and unprecedented high mortality observed in some societies. Surgery has been a neglected stepchild of global health and in addition global surgery must not be a slave of technology for the promotion of the ‘gold standard’, especially corporate-led commercialized services because a sustainable and effective surgical service at a reduced cost is desirable for all, be resource-rich or poor. Global surgery and global health include health security and universal health coverage. Stakeholders of global surgery need to be aware that ‘one size does not fit all’ and are required to consider the diverse conditions.

Colonisation and its aftermath: reimagining global surgery

“…A review found that global surgery education and training programmes focus on specialists rather than the wider multidisciplinary team 55. Shah et al called for moving from ‘curing by cutting dictum’ and addressing the social determinants of health in global surgery 56. However, Jayaram et al found that only one out of 18 academic global surgery curricula included the social and environmental determinants of health 57.…”

“…Instead of relying on importing surgical equipment from the Global North, surgeons in the Global South have developed innovative surgical devices that are not only low-cost but also suitable and sustainable 83–85. Shah et al warned that ‘global surgery should not be a slave of technology for the promotion of ‘gold standard’ given by corporate-led commercialised services’ 56. We call for creative solutions to facilitate surgical device innovation and manufacture by the Global South, akin to the generic pharmaceutical industry in global health.…”

“… 55 Shah et al called for moving from ‘curing by cutting dictum’ and addressing the social determinants of health in global surgery. 56 However, Jayaram et al found that only one out of 18 academic global surgery curricula included the social and environmental determinants of health. 57 Most global surgery studies focus on healthcare delivery and management rather than social, environmental and economic determinants.…”

“…[83][84][85] Shah et al warned that 'global surgery should not be a slave of technology for the promotion of 'gold standard' given by corporate-led commercialised services'. 56 We call for creative solutions to facilitate surgical device innovation and manufacture by the Global South, akin to the generic pharmaceutical industry in global health.…”