“Women are the glue that hold the family together. If the mother dies in childbirth, it is a catastrophe for her and for the children.”

Angela is Head of Anesthesia for Vancouver Island. She’s a past president of the World Federation of Societies of Anaesthesiologists and the Canadian Anaesthesiologists’ Society, and a trustee of Lifebox Foundation.

Why is access to safe surgery and anaesthesia an important issue for women’s health?

In low-income environments, emergency obstetric surgery such as Cesarean Section and ruptured ectopic pregnancy constitute a large part of the surgical volume. Women also endure other surgical conditions such as trauma, cancers and bowel obstructions that require surgical intervention.

Often they present late to the hospital and are in a high-risk state. The rate of complications such as severe blood loss is high.

But if a woman in a low-resource setting needs a surgery?

The challenges are huge. Poor transportation, long distance from a surgical facility, lack of money to pay for surgical care, distrust of the care available and late presentation all affect the ability of the patient to access timely and appropriate surgical care.

In addition, women may have cultural issues which may prevent them going to a hospital for surgery – such as requiring a husband’s permission, which may not be freely given or delayed if he works away from home.

Has global surgery kept pace with developments in medical knowledge and technologies?

There are improvements in some areas – for instance education of women, which makes them more aware of what they need and how to access it. Provision of local health care workers, such as in Malawi, has improved care and resulted in earlier referral to a surgical or obstetrical centre. Cesarean section is now most frequently performed under spinal anesthesia. That provides a measure of safety over poorly managed general anesthesia.

But you need early access, resources and skilled providers to be able to treat these patients successfully. This is still a problem, as well as practical issues, like a functioning blood bank for life-saving transfusion during a crisis.

Does surgery in these conditions become unsafe?

Yes!

What are the repercussions?

Women are the glue that hold the family together. If the mother dies in childbirth, it is a catastrophe for her and for the children and also for the husband, who now has to figure out how to care for his family whilst trying to work to support them.

Many women have ‘cottage’ jobs – something they can do from home which brings in some money, like weaving baskets sold to tourists. This type of income often pays for the children’s education.

Late management of surgical problems such as breast cancer results in increased morbidity and early mortality for the woman. Often other problems such as an enlarged thyroid may be left until it presents a major airway problem. Bleeding from untreated uterine fibroids can result in severe anemia and a mother bereft of energy and the ability to care for the family.

Do women play a role in delivering care too?

I would say that women provide the backbone of care in anaesthesia and nursing. Most surgical care is still provided by men.

Does this crisis get much recognition?

There is a belief that surgery is expensive and unaffordable but that is not the case. Routine surgical conditions should be treated early to return people quickly to the workforce.

Major agencies such as WHO have invested much time and effort dealing with public health issues and communicable infectious diseases. Obviously these need attention but much has been done to improve their status and it is time to turn some attention to surgery.