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Operation HealthSusan Hale Thomas

Operation Health

Surgery is public health? Researchers argue that the quintessential clinical intervention deserves an essential place on the global health agenda.

The 2-year-old girl arrived at Phebe Hospital in rural Liberia barely alive.

Her abdomen had been ripped open, and her intestines spilled out of the gaping wound. She had been attacked while playing with her village’s pet monkey.

“Something happened to upset the monkey, and it literally tore the child’s abdomen open,” says Johns Hopkins surgeon Fizan Abdullah, MD, PhD. The girl likely had an umbilical hernia that the monkey grabbed, allowing the animal to easily tear open the abdomen, he says.

  “The mother thought that the baby was dead and immediately abandoned the child,” Abdullah explains. Then a neighbor—who had seen a visitor in a pickup truck earlier that day—picked up the baby and ran a mile-and-a-half to find the truck’s owner. They drove the child over 30 miles of bad roads to reach the hospital.

“We helped the local surgeons put IV fluids in, put her intestines back in and close up the abdominal cavity,” says Abdullah, who was in Liberia leading a medical education program to train surgeons in a cost-effective and efficient hernia repair technique.

The toddler survived. She was lucky. Many in the developing world—especially its rural areas—are not. Women who need Cesarean sections die in childbirth. Surgically repairable conditions like clubfoot, hernias, cataracts and abdominal complications become disabling and even fatal. Injury victims needing emergency or orthopedic surgeries often don’t survive the trip to a distant hospital or receive subpar surgical care.

“You’re talking about a major burden of disease that is not being addressed by global health through funding or policies or development of new training procedures or supportive, innovative programs where effectiveness can be documented,” says Henry B. Perry, MD, PhD, MPH ’71, a senior associate in International Health.

For decades, the former surgeon and primary health care expert has maintained that closing the global surgical gap is a public health issue.

“If a kid in Sierra Leone, Liberia or Sudan falls out of a tree and breaks his arm, he’s potentially disabled for life,” adds surgeon Adam L. Kushner, MD, MPH ’99, an associate in International Health.

Worldwide, the surgical imbalance is staggering.

Of the 234 million major surgeries performed in 2008, only 3.5 percent took place in the poorest countries, whose people account for 35 percent of the world’s population. The World Bank estimates that 11 percent of the global disease burden is treatable by surgery. Two billion people have no access to surgical care.

The issue will only become more acute because of the growing number of injuries related to increased vehicle traffic in developing countries and unsafe roads.

“Obviously it’s not feasible to think about heart transplants or complicated cancer surgeries,” says Perry, “but where the global health agenda has missed the boat is in looking at low-cost ways to provide access to hospital care for lifesaving or life-changing surgical services… It’s bringing a public health vision to surgery.”

"You’re talking about a major burden of disease that is not being addressed by global health."
                           —Henry Perry on the unmet surgical need in developing countries


  • Keith Apelgren, MD

    United States 05/21/2013 09:42:53 AM

    Surgical and anesthesia care are as important as vaccination programs or prenatal care.

  • Bruce Steffes, MD

    Kenya 06/04/2013 12:00:29 AM

    The Pan-African Academy of Christian Surgeons is training over 40 national physicians in a COSECSA approved five-year general surgery program. Thus far, we have had 100% retention in Africa and almost all in rural areas. Our website is

  • James Militzer

    Michigan 06/05/2013 11:08:21 AM

    Great post, and a topic that deserves more attention. One complication to making surgery accessible in low-income countries is the lack of infrastructure - especially reliable electricity. We recently covered this issue on NextBillion Health Care, with an overview of an innovative anesthesia machine that can work even when the power goes off: I hope to see more innovations like this, and more attention in general to this issue.

  • Amanda Slagle

    HeartGIft, Austin TX 07/12/2013 01:48:11 PM

    Increasing the number of trained surgeons throughout the world is by far the best way to create a sustainable workforce. However, specialty surgeries, like pediatric cardiac, cannot always be completed in the developing world. HeartGift provides lifesaving heart surgery to disadvantaged children living in developing countries where specialized medical treatment is scarce or nonexistent. Please refer to our website for more information,, and contact us if you feel you know of a child who is in need of lifesaving heart surgery!

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