How Surgery Can Fight Global Poverty
Earlier this year in Madagascar, a man in his 60s named Sambany made international news after volunteer surgeons from Mercy Ships removed a 16-pound tumor from his face. For decades, he had sought treatment at 10 hospitals, most of which lacked surgeons. He was ostracized, then physically unable to work. His family had to sell a rice field just to pay for the cost of getting to the hospital (the surgery itself was provided free).
Earlier this week, the United Nations adopted 17 proposed sustainable development goals, which reflect the resolve of world leaders to “end poverty and hunger everywhere; to combat inequalities within and among countries; to build peaceful, just and inclusive societies.”
Although admirable, these goals cannot be achieved without explicitly addressing one of the most crucial needs facing the world: a lack of access to surgery. The aim of universal access to “health care and social protection, where physical, mental and social well-being are assured,” will come to nothing without it.
Most of the world lacks access to safe, affordable and timely surgical care.
Every year over 80 million people worldwide face financial catastrophe if they get surgery. And while the individual cost of getting surgery is great, the societal cost of inaction is staggering. If nothing is done to increase surgical access, developing nations are projected to lose $12.3 trillion from their gross domestic products between now and 2030.
Currently, infectious disease interventions are the main focus of global health policies, because many countries lack the personnel and infrastructure to carry out surgical interventions successfully.
Despite the fact that nearly one-third of human disease is amenable to surgery, it remains overlooked in much of the world.
This is shortsighted. After all, the treatment of solid tumors in the United States began with surgeons: William Stewart Halsted described the surgical removal of breast cancer in 1894, well ahead of chemotherapy. Surgery and early detection alone drove substantial drops in breast cancer mortality. Today over 60 percent of cancer diagnoses benefit from surgical intervention.
Surgery is more than just facial tumors, breast cancer and trauma; it is a crosscutting intervention, involved in every disease category from infections to blindness, from congenital abnormalities to maternal conditions, from the neurological to the cardiac to the neoplastic. To put this in perspective, H.I.V., tuberculosis and malaria — which have captured the global conversation — currently make up less than one-tenth of the global disease burden, combined.
Why, then, has surgery been ignored? In part, because expanding surgery seems daunting and expensive. Why not just focus global energy on vaccines, for example, which can be mass-produced and delivered to the population, rather than scaling up an entire health infrastructure? After all, providing surgery requires reliable electricity, water, suction, sterilization, oxygen — as well as surgeons, anesthesiologists, nurses and biomedical technicians.
But this is exactly what makes improving surgery ideal. Improve a surgical system, and you improve the very things that are necessary for the delivery of health care in general. Doing so is less costly than it might initially seem. The cost of scaling up a surgical system in resource-poor countries — about $300 billion over 18 years — represents only about 5 percent of the total combined expenses that governments in low- and lower-middle-income countries spend on health annually, and pales in comparison with the $12.3 trillion cost of inaction. And spending that money now will not only lower the current surgical disease burden and allow patients to return to economic productivity, but it will also make the health system itself more resilient when shocks like Ebola hit.
Moreover, reliable surgical infrastructure strengthens entire health systems. It is not enough to prevent maternal deaths during childbirth if a health care system cannot care for the children after birth. It is not enough to treat tuberculosis successfully if the patient then dies from a perforated appendix. Surgical scale-up is not and has never been envisioned to exclude other global health priorities — surgery is necessary to meet all global health priorities.
It is this inherent synergy that makes surgical delivery a cost-effective intervention. Researchers from Harvard and Stanford Universities, including one of us, recently compared the cost-effectiveness of surgical care with that of multiple accepted global health interventions.
They found that general surgeries, ophthalmic surgeries and cleft palate repairs, among others, had a similar cost effectiveness to some vaccinations, and that cesarean sections and orthopedic surgeries were potentially more cost effective than medical treatments for heart disease and H.I.V.
For Sambany, surgery was a personal issue. For developing nations, it is an economic issue. For the world, it is a moral issue, a question of equity. Surgery has been called the “neglected stepchild of global public health.” To achieve the recently approved global development goals, world leaders must explicitly develop systems to bring access to safe, affordable and timely surgery to those who need it.
As we approach the close of this year, let us take a moment to reflect on the challenges and trials faced by so many, especially those who have experienced profound loss. This season, while we gather with loved ones to celebrate, let’s also remember those who are still suffering, those who have lost their way, and those who have lost their faith in a better tomorrow.
During this holiday season, we invite you to join us in this mission of compassion, faith, and renewal.
Your generosity can make a real and lasting impact.
This Christmas season, let’s come together as a community of faith and support to bring restoration to people who have lost so much. Mercy Ships Canada is on a mission to heal and transform the lives of Children and adults in need. Your gift, rooted in faith, can make a significant difference in the lives of countless people. Your support will bring back smiles, health, and faith to children and adults who have suffered for far too long. Donate today and make this Christmas truly meaningful.
At Mercy Ships Canada, we serve those who have lost hope, bringing healing and transformation. Our volunteers, inspired by their faith, work selflessly to perform surgeries that renew not only bodies but also faith and hope. This Christmas, be a part of the miracle by making a donation to Mercy Ships Canada. Your contribution will help renew faith and offer a second chance at life. Together, we can make a significant impact on those who have suffered for too long.
As we approach the holiday season, we are reminded of the immense power of faith and the importance of giving back to those in need. This Christmas, you have the opportunity to be a beacon of hope, healing and transformation for those who need it most.
Your support this Christmas will not only change lives but also reaffirm the spirit of giving and faith. Join us in spreading love, hope, and healing.
Make a donation today, and together, we can transform the lives of people who have lost so much.
Our journey continues, and we’re excited to have you by our side as we embark on new adventures of compassion and change.
The last time Catherine Conteh saw the deeply familiar smile in front of her in Freetown, it was under dramatically different circumstances. Learn more about Aly’s act of kindness!