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Operation HealthSusan Hale Thomas

Operation Health (continued)

Signs Of Change

Traditionally, public health and surgery have lived at opposite ends of the spectrum.

One deploys inexpensive, prevention programs for populations. The other is a one-to-one intensive clinical procedure. The separation becomes even more pronounced in the developing world. Surgeons are scarce, training is often limited, hospital capacity is insufficient and supplies and equipment are in short supply or unaffordable.

From a public health perspective, surgery has historically been viewed as expensive, time-consuming and generally not a good investment. It saves and changes individual lives, not populations. These assumptions, say global surgery advocates, are wrong and have contributed to surgery’s low ranking among public health priorities.

The past decade, however, has brought signs of change. “There’s an increasing recognition of the global burden of disease that can be addressed with surgery,” Perry says.

In 2006, Disease Control Priorities in Developing Countries, a World Bank publication, included for the first time a section on surgery in low-income countries. The chapter will be substantially expanded in the 2015 edition. In recent years, some U.S. medical schools and hospitals have established global health surgery programs, including the Johns Hopkins Global Surgical Initiative. And, the American College of Surgeons is offering more opportunities for international work.

 “There is no doubt that expanding access to even routine surgical procedures holds the potential to prevent disability and save lives,” says Bloomberg School Dean Michael J. Klag, MD, MPH ’87. “Procedures that we take for granted, such as incision and drainage of an abscess or repair of a laceration, can be lifesaving.”

As surgery gains more attention, interest in global health among younger surgeons and surgeons-in-training has clearly evolved. Julie Freischlag, MD, chair of the Department of Surgery and Surgeon-in-Chief at Johns Hopkins Hospital, remembers being surprised several years ago when a student told her that she wanted to work in global surgery. Things are different today. “In 10 years I think we’ll see more and more surgeons trained to perform more sophisticated interventions for both diagnosis of diseases and multimodality treatment of cancer in the global setting,” Freischlag says.


  • 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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