“The ability to provide quality surgical care is a proxy for a well functioning medical system.  And that’s part of the reason why it should be important to the entire global health community.”

Kathleen is a general surgeon who created the Operation Giving Back program for the American College of Surgeons and served as its director for 10 years.  She co-developed the International Humanitarian Aid Surgery course that has trained over 200 surgeons to prepare for work in low resource settings.  She serves as an officer in the Alliance for Surgery and Anesthesia Presence (ASAP).

Tell us why surgery is an important part of a country’s healthcare system.

In our advocacy efforts, we speak of the need for “access to surgery and anesthesia when needed”.  That currently doesn’t exist for more than 2 billion on this planet.

But having surgical capabilities and infrastructure in place doesn’t only serve surgical patients – those facilities that can deliver quality surgical care are more likely to have lab and radiology capacity, skilled staff, and more of the medical infrastructure that is essential to all medical care.

The ability to provide quality surgical care is a proxy for a well functioning medical system.  And that’s part of the reason why it should be important to the entire global health community. 

Why is it essential for women?

With regard to women, the most distinctly female condition is, of course, pregnancy, which is a life threatening condition in much of our world.  Whether for a difficult delivery that requires Cesarean section, or the complications of delivery that require control of hemorrhage or repair of a fistula, access to safe and timely surgical care is critical for women.

Is surgery for women just about reproductive health?

Women’s surgical needs extend beyond those related to childbirth.  Where access to quality healthcare is lacking, patients with breast or cervical cancer often present with such advanced disease that unfortunately the only appropriate treatment is palliative.

Burns – either from cooking fires or chemical burns as a form of violence against women – are another common condition that needs early treatment to avoid debilitating contractures and disfigurement.

And women are susceptible to most of the same surgical problems as men – trauma, appendicitis, cleft lip, etc.   Appropriate access to surgical care would allow these women to be diagnosed and treated at an early enough stage to potentially save their lives and allow additional medical care as indicated.

The term ‘neglected stepchild’ is heard so frequently in conversations about global surgery.  How do you see it becoming fully part of the global health family?

Neglected stepchild” comes from an opinion piece written by Drs. Jim Kim and Paul Farmer several years back. It was significant to have such prominent figures in global health outside the surgical community make a public statement in support of surgery in global health.

In the years since, I dare say that surgery is not so off the radar anymore.  We’ve made tremendous inroads in terms of collecting and publishing data and participating in multidisciplinary conferences in order to better tell the story of why surgery is a critical part of an effective global health strategy.  But despite the progress, we have quite a way still to go to see that happen.

How are we going to do this?

One important current effort is advocating for a formal resolution on surgery and safe anesthesia at the World Health Organization.  We need all the members of the global health community to lend their voices in support of this resolution because of the synergies that it will bring about in improving health care across the board.

If a medical facility has the ability to safely perform an emergency C-section or effectively treat road traffic injuries, it has the skill sets, equipment, and infrastructure to perform emergency abdominal surgery and handle important more routine cases like hernias too.

Have you noticed any trends in attitudes to global surgery or approaches to addressing the issue in the last 10 years?

Well, I like to think there’s been an increased appreciation for the importance of surgical care in low and middle-income countries and as a part of the global health strategy as a whole.  Trending in the right direction at least, but still not there yet!

One important trend has been recognizing the importance of community building – both within the global surgical community as well as for surgery within the greater global health community.  With greater awareness of what others are doing and how it is all interconnected, we’re able to better collaborate and learn from each other to improve access, quality, outcomes, education, communication and collaboration across countries as well as across disciplines.

This Lifebox initiative in honor of International Women’s Day is a great example of multidisciplinary collaboration – many voices with a common commitment to saving lives, improving patient care, building community and raising awareness of the importance of surgical care for women around the world.  Thanks for doing this!