doctor

2014/03/05

Dr Rola Hallam

“About a year ago in Syria I met an obstetrician who was delivering women on her kitchen floor.” Rola isRead more →

2014/03/05

Dr Zipporah Gathuya

“The surgeons were screaming they needed to get the baby out.” Zipporah is a Consultant Anaesthetist working in Kenya. Her areaRead more →

2014/03/05

Dr Sherry Wren

“They think of surgery as transplants and plastics and don’t realize that there’s a huge population that has no accessRead more →

2014/03/05

Dr Jane Fitch

“The comparison between resources can make anaesthesia a very different experience. It makes you realize how wasteful we are, howRead more →

2014/03/05

Dr Isabeau Walker

“Safe surgery should be a basic right that is available to all women who require it during childbirth.” Isabeau isRead more →

2014/03/05

Dr Eva Hanciles

“Often the first time a pregnant women come to hospital is when she’s been trying to deliver at home withoutRead more →

2014/03/05

Dr Angela Enright

“Women are the glue that hold the family together. If the mother dies in childbirth, it is a catastrophe forRead more →

2014/03/05

Dr Ronke Desalu

“Safe surgery is tied up with the socio-economic status, political participation and education of women.” Ronke is an Associate ProfessorRead more →

2014/03/05

Dr Queeneth Kalu

“They say ‘Abasi Akan uman ikwa,’ meaning ‘God forbid delivery by knife!’” Queeneth is a Senior Lecturer and Chairman,Medical AdvisoryRead more →

2014/03/05

Dr Nneka Anaegbu

“In the coming decade we’ll be on the frontier and at the helm.” Nneka is a Consultant Anaesthetist at LagosRead more →

2014/03/05

Dr Kelly McQueen

“Women with cancer in the early stages with the hope of treatment and cure often have no access to anRead more →

2014/03/05

Dr Michelle White

“It’s powerful to see how generous they are in their love and affection for each other.” Michelle is Head ofRead more →

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Dr Rola Hallam

Dr Rola Hallam

“About a year ago in Syria I met an obstetrician who was delivering women on her kitchen floor.”

Rola is a British-Syrian doctor in anaesthesia and intensive care. Since the beginning of the Syrian crisis, Rola has been working on health advocacy and the delivery of humanitarian and medical aid.

Is access to surgery really such an issue worldwide?

It’s a huge, huge problem. But we don’t talk about it very much. I think people underestimate how many incidences in our life we do need surgery, partly because it’s something we take for granted in this country. But for millions and millions of people around the world that’s simply not the case. They don’t have it at all, or it’s unsafe. Which means people are dying unnecessarily.

Is this the case for people in Syria right now?

Very few conflicts resemble each other, especially from a health perspective. Some don’t affect the system that much – and some unfortunately, as in the case of Syria, involve systematic targeting of healthcare and health professionals.

Just two weeks ago a hospital in Aleppo was destroyed with what’s called ‘intelligent’ missiles – a three-bedded intensive care unit, three ORs, 20 beds, newly-furbished by an NGO. It killed five patients, relatives, and injured 14 people.

70% of the hospitals and clinics have been destroyed or are non-functional; it’s near total destruction of the system.

What does this mean for the healthcare workers?

Healthcare providers are either killed, imprisoned or have left the country.

And so Aleppo – the largest populated city in Syria, which had just over 5000 doctors before the conflict – now has about 30.

You’re talking about a staggering reduction and therefore a massive burden of care on the remaining doctors.

A recent assessment of need in Syria found that the health sector is the biggest emergency and biggest priority in Syria, just ahead of food security. It shows just what a massive problem this is.

What does this mean for women?

We have a very high proportion of children and women in Syria – approximately 70% of the population, and we used to have relatively good antenatal and maternal care. Now public health becomes a massive issue, primary health becomes a massive issue – and of course, maternal health is significantly compromised.

And we haven’t even talked about the violence itself. If you were a civilian under constant bombardment you’d think twice before traveling to see a doctor – especially when you can’t afford to pay for medication because there’s huge unemployment.

You can’t collect data easily under the conflict, but there’s a huge amount of anecdotal evidence of harm to women and children.

So where are women giving birth?

About a year ago in Syria I met an obstetrician who was delivering women on her kitchen floor. There was no health service nearby but people knew she lived there. They’d literally go knock on her door and she had no choice – she closed the kitchen and turned it into a little birthing centre.

We’ve been hearing about women who set off over long distances in the last month of their pregnancy, under the shelling, to get to areas of slightly better healthcare.

It’s devastating. In any nice world you’d be sitting down and getting excited about your new arrival. Instead you’re crossing really scary military barricades, questioned for hours perhaps – and then you’re essentially homeless. You have to find somewhere to live, guns and bombs going off around you.

Are their babies surviving?

We’re seeing a huge rise in premature birth, which may well be due to poor nutrition and health of mothers. Some are in the siege area, where food and medicine aren’t allowed in. There’s a lack of clean water.

Some people think it might also be to do with their mental state. If you’re heavily pregnant and suddenly bombs are falling around you, and your neighbours are being killed and your house destroyed – a lot of them are delivering early from the stress.

And because the healthcare system is so inadequate, a lot of babies are dying. If not from lack of facilities, from the lack of baby milk. We’re finding – again, anecdotally – that women under these stressful and malnourished circumstances don’t have adequate breast milk.

I must have heard tens of these cases – it only leads me to believe there must be hundreds, if not thousands.

What can people be doing?

Under humanitarian law it’s absolutely illegal to be targeting and destroying healthcare structures. We’ve heard it condemned but there hasn’t really been anything concrete on that, so we need serious pressure on a policy level.

Everyone needs to do their bit. Governments, NGOs, individuals – whether you adopt a health center to rebuild it, provide security and salary support for doctors so they stay, antibiotics for arriving patients.

You have to be specific about what you need. Hand in Hand for Syria went back to the obstetrician’s kitchen and we built a small children’s and women’s facility in the excavated basement, generously funded by the public. It’s amazing what can happen with willpower and staff and incredibly dedicated colleagues on the ground. It can be done, it is being done, and people can engage with that. I hope so, anyway.

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Dr Zipporah Gathuya

Dr Zipporah Gathuya

“The surgeons were screaming they needed to get the baby out.”

Zipporah is a Consultant Anaesthetist working in Kenya. Her area of interest is Paediatric Anaesthesia and anaesthesia education.

Why is access to safe obstetric surgery essential for women?

Women are the carers for the family, especially in low-income countries. There are always other people who they are taking care of, despite having just had a baby. And there is certainly not much income to spare for complications.

Most women go for delivery being healthy. For them to continue in that health is paramount.

And if they don’t get it? What is the impact on the baby?

When the mother has a difficult labour the child risks hypoxia [oxygen starvation] or another complication like cerebral palsy, which has such a high infant mortality rate. These children can become a big burden on the whole family, and usually have miserable lives.

I have also seen many children whose mothers died at delivery and whose relatives never came to pick them from the hospital. It is very sad for that child, who will never quite appreciate maternal love.

Is there a particular case that sticks in your mind?

When I was training a mother was brought to the labour ward with severe pre-eclampsia [a life-threatening complication of pregnancy]. She was 33 years old, on her third pregnancy but had no living baby.

Just as she was wheeled into the operating room for an emergency C-section she had a seizure and began vomiting. The surgeons were screaming they needed to get the baby out.

We delivered a live male infant, but the mother went into renal shutdown. It took her three weeks to recover, and she went home with her son after a month.

Access to safe anaesthesia was essential to her survival. Though it has been more than 10 years, the scenario is still very vivid in my mind.

What is the role of education here?

The impact and importance of education to the mothers on access to antenatal care cannot be overemphasized. Caesarean sections are now more acceptable, whereas initially women would have the notion that a Caesarean section was a sign of weakness.

Education and skill advancement of both the anaesthesia and surgery providers will go along way towards minimizing the risk of many mothers dying or suffering complications.

Let’s talk again about the positive aspects of safe obstetric care. What is the long-term legacy?

If the mothers are sure that they will have safe pregnancy, delivery and child survival; even the issue of family planning will be more widely acceptable.

A healthy mother is a healthy community.

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Dr Sherry Wren

Dr Sherry Wren

“They think of surgery as transplants and plastics and don’t realize that there’s a huge population that has no access to the most basic, lifesaving procedures.”

Sherry is an Associate Dean of Academic Affairs and Professor of Surgery at Stanford University School of Medicine. She runs clinical and research programs in global surgery, gastrointestinal oncology, and surgical robotics. She is the co-developer of the International Humanitarian Aid Surgery course which has now trained more than 200 surgeons to prepare for work in low resource settings.

Why is safe surgery essential for women’s health?

When you look at the number one killer of women across the world it really is childbirth. And there’s just no way you can impact maternal mortality without having access to safe surgery.

And that’s just from an obstetric standpoint – women also get injured in car accidents, women get appendicitis – all multiple other conditions that need surgical care.

11% of the global burden of disease can be classified as surgically-treatable. I can think of no more important issue, in many ways, than safe surgery.

What, you mean that ‘neglected stepchild’ of public health?

You know I’ve actually only ever read that once, in the Paul Farmer and Jim Kim Kim article - I think it just gets quoted by everyone who keeps waiting for the situation to change.

I’m amazed when I speak to people in the public health domain who talk about the MDGs for maternal mortality or the ‘Decade of Road Safety’ but have an absolute disconnect and don’t recognize that safe surgery must be part of these programs. There will be excess maternal mortality as long as there is no access to safe C-sections, and consider the best road safety programs in western nations where people still get in accidents and need surgeons to take care of them.

Do you have any theories on why that is?

A couple! Surgery in the western world has become so commonplace it’s seen as standard care, assumed safe. To the point that people say “I’m just getting a minor op,” and they forget that before the advent of laparoscopic surgery having your gallbladder out was a 5-7 day hospital stay.

They think of surgery as transplants and plastics and don’t realize that there’s a huge population that has no access to the most basic, lifesaving procedures. It’s a profound disconnect in reality.

I also think that surgeons need to learn how to speak public health language. We need better research data. We need to go to their meetings – but it can be tough to break into a club, and it’s not like there’s a huge amount of funding for these topics.

Do I think the ‘neglected stepchild’ will be part of the family in my lifetime? I hope so. But I’m not going to hold my breath.

You run a training course for high-income setting surgeons going to work in a low-resource setting. What’s the most important thing for them to realize?

The most common area of concern is obstetric emergencies. Surgery in low-resource settings is split roughly in thirds – obstetric, orthopaedics, and everything else, so you have to be prepared – but in the U.S. you can’t just say “I’m going to learn to do some ortho today.” To participate, or even scrub in on a case you have to have malpractice insurance that would cover that kind of surgery. Anyone who’s not an obstetrician is terrified to take care of a pregnant woman because of the litigation risk.

It’s also about preparation. Some surgeons go overseas as as part of a comprehensive group bringing everything – physicians, machines, resources – you’re bringing a piece of your own world with you and parking it somewhere. It’s very different if you actually go work in the context the way it is with the resources on hand.

Does surgery around the world keep pace with advances in education and technology?

If your hospital doesn’t have power, running water 100% of the time it’s very difficult to keep up with where technology has moved.

Technology is a double-edged sword. I look at global surgery and I think the goal is someplace in the middle – a happy medium between over-care and over-testing (as I think we do in the U.S.) and availability of resources populations fundamentally need.

Interestingly educational knowledge is easier to disseminate. I participate in a collaborative programme in Zimbabwe on medical education where trainees have not had the opportunity to use advanced technology but they are knowledgeable about the recent advances and often will say “if we had the ability to perform x, this is what I think it would show.”

Is surgery a growing field for women around the world?

In the U.S., absolutely. About 40% of new surgical trainees are women, 50% of medical school graduates. There are still some barriers, areas that are still more commonly within the male domain but it’s rapidly going away – as opposed to when I started training and it was me and 17 guys!

In some places I would say that the issue of women in the profession is still many years behind. I believe there are cultural and biases, both conscious and unconscious– on rounds when I’m working in Africa I’ll ask a doctor if he’s going to encourage a bright young female student on a surgical track and he’ll say “oh no, you know women don’t want to be surgeons.”

But I’ve got a group of female students in Zimbabwe who are so excited to be surgeons. Why? Because they see that it’s possible.

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Dr Jane Fitch

Dr Jane Fitch

“The comparison between resources can make anaesthesia a very different experience. It makes you realize how wasteful we are, how disposable everything is for us.”

Jane is President of the American Society of Anesthesiologists.

People don’t always recognize the role of anaesthesia in safe surgery. What can you tell me about it?

There are very few medical specialties where you can literally take care of people from birth – and actually, pre-birth – all the way to end of life. Anaesthesia cares for everyone, and everything in between.

What about in lower-resource countries where you’ve worked?

The comparison between resources can make anaesthesia a very different experience. It makes you realize how wasteful we are, how disposable everything is for us.

In the U.S. we have all kinds of fancy warmers for giving blood products and fluid. In Egypt we draped it across some lights to get the ambient heat. Working in China in the late 1980s you’d see rooms chock full of inoperable equipment. Purchased or donated, it was broken and there was no one who could maintain it, no spare parts.

We know that 70,000 operating rooms around the world don’t even have a basic pulse oximeter [a monitoring device essential for safe anaesthesia]. Literally a couple of billion people don’t have access to safe anaesthetic and surgical care.

How important is access to safe surgery for women’s health?

It’s critically important. The medical care of women during their childbearing years – the majority of their lifetime – is primarily obstetric and gynecological. It’s critical that all around the world, women have access to these surgical procedures.

And when safe surgery isn’t available?

There are complications that have a huge personal and social impact on a woman and her family.

If she doesn’t have appropriate care during childbirth she risks damage to the birth canal and development of fistula that can lead to incontinence. A woman in low-resource settings without the ability to have this repaired can be ostracized from her family, her social network, her employment.

And the mom’s status clearly impacts and somewhat determines a lot of what the child’s life will be like.

What can we do to support safer anaesthesia around the world?

Nicholas Greene, one of the ‘founding fathers’ of modern anaesthesia, recognized early on the constraints that low-resource settings have in being able to provide safe surgical and anaesthetic care. His focus was on training and education, and our Global Humanitarian Outreach committee and Charitable Foundation have really taken off from there in the last decade.

What is your hope for the future of women in global anaesthesia?

It’s only in the last 40-odd years that we’ve moved away from a 25-30% female minority in the field of anaesthesia in America. I hope that women will realize the critical role that we do play in the U.S. and beyond – women all over the world are vital for providing the safest anaesthetic care possible.

We all need surgery and anaesthesia at some point – but in particular I’ll go back to the fact that we know that women really need obstetric care at certain times to prevent complications that will negatively impact themselves, their children and their families. It’s just critically important.

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Dr Isabeau Walker

Dr Isabeau Walker

“Safe surgery should be a basic right that is available to all women who require it during childbirth.”

Isabeau is a Consultant Paediatric Anaesthetist in London, Vice President of the Association of Anaesthetists of Great Britain and Ireland and a trustee of Lifebox Foundation.

Who needs a Caesarean section?

We are so used to people talking about caesarean section rates that are too high, and women who are ‘too posh to push’. But for a woman in obstructed labour or with a low-lying placenta, a caesarean section is a life saving procedure, for herself, the baby, or for both…

Safe surgery should be a basic right that is available to all women who require it during childbirth.

Is this not the case?

No, this is definitely not the case. Thousands of mother’s lives could be saved if surgery was prioritised within all health systems. Tens of thousands could be saved from debilitating injuries, and millions of stillbirths, neonatal deaths, or newborn birth injuries could be avoided.

The rates for caesarean section in poor communities in sub-Saharan Africa or southern Asia are consistently less than 2%. It isn’t clear what the ‘minimum’ rate for caesarean section should be, although some academics have suggested that at least 5% of all births should be by c-section; so it is likely that many women die in these communities because they don’t have access to safe surgery.

Thousands of mother’s lives could be saved if surgery was prioritised within all health systems, not just those in high-income countries. Many more women could be saved from debilitating injuries, and millions of stillbirths, neonatal deaths, or newborn birth injuries could be avoided.

What does this mean for a woman in labour in a low-resource country?

Lamula’s story is a true account written by Juliet Tumwebaze, an anaesthetic officer working in Uganda.

Lamula was a mother from a rural village in obstructed labour, carried on the back of her husband’s bicycle ‘amidst her screaming’ for 4 hours to the local health centre. When she got there, they found that the hospital was not equipped to help her.

WHO has estimated that 800 women die every day due to complications of pregnancy or childbirth, and 7300 babies are stillborn, with almost half of stillbirths occurring when the mother is in labour. 99% of these deaths occur in low-resource countries and could be avoided.

Is global surgery keeping pace with technology?

As we develop ever more sophisticated equipment to improve patient safety in high-income countries, patients in low-income countries are denied even the most basic of surgical care. The gap between what we know and what we can deliver in poorer parts of the world seems to be widening.

Does that mean available surgery becomes unsafe?

Yes, definitely. A number of publications in the last few years have surveyed facilities in rural hospitals in sub-Saharan Africa, and found that they are not staffed or equipped to deliver even basic surgery. So there is poor access to surgery, and when surgery is provided, the essential equipment to provide safe surgery is often not there.

What are the repercussions?

When a young woman dies during childbirth, it is a tragedy for the whole family. The health, education and economic prospects for the entire family are affected, and the risk of the surviving children dying is increased. An effective way to make a difference is for patients to stand up and tell their stories, and to demand better services. Sadly, these women’s voices are rarely heard, so it is particularly important on International Woman’s Day that we tell their stories in solidarity.

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Dr Eva Hanciles

Dr Eva Hanciles

“Often the first time a pregnant women come to hospital is when she’s been trying to deliver at home without progress. She’s in urgent need of a Caesarean section.”

Eva is a Fellow of the Faculty of Anaesthetists of the Royal College of Surgeons in Ireland and of the West African College of Surgeons. She at present heads the Intensive Care Unit at the only Tertiary Hospital in Sierra Leone and lectures Nurse Anaesthetists in that country

Let’s talk about anaesthesia. Why is access to safe anaesthesia important for women?

Anaesthesia isn’t considered a lucrative and fashionable option for post-graduate doctors, but without safe anaesthesia – which also includes post-operative care – there’s increased morbidity and sometimes mortality.

It’s of vital importance to women, especially in low-resource countries. Often the first time a pregnant women come to hospital is when she’s been trying to deliver at home without progress. She’s in urgent need of a Caesearean section.

Can you talk us through how you handle a case like that?

I recall a patient who had been in prolonged labour at home and presented at hospital in a collapsed state. We couldn’t get her blood pressure and her pulse was weak and thready. We could only get a line in through the internal jugular vein.

It was obvious we were dealing with a ruptured uterus.

This is something you would never see in a country with wider access to surgical services and we had to do surgical intervention and resuscitation at the same time because her heart was so unstable.

Of course a dead foetus was delivered and the bleeding was stemmed only after a hysterectomy. But the mother’s life was saved.

What changes have you seen over your career that have made anaesthesia safer?

The greatest change to safe surgical care has been the widespread use of spinal anaesthesia. In settings where there is no oxygen supply, little or no monitoring, poor power general anaesthesia is out of the question – it’s very risky and can contribute to high maternal mortality rates.

Let’s talk about anaesthesia.  Why is access to safe anaesthesia important for women?

Anaesthesia isn’t considered a lucrative and fashionable option for post-graduate doctors, but without safe anaesthesia – which also includes post-operative care – there’s increased morbidity and sometimes mortality.

It’s of vital importance to women, especially in low-resource countries.  Often the first time a pregnant women come to hospital is when she’s been trying to deliver at home without progress.  She’s in urgent need of a Caesearean section.

What changes have you seen over your career that have made anaesthesia safer?

The greatest change to safe surgical care has been the widespread use of spinal anaesthesia.  In settings where there is no oxygen supply, little or no monitoring, poor power general anaesthesia is out of the question – it’s very risky and can contribute to high maternal mortality rates.

Who is it important to educate?

Everyone.

In rural Sierra Leone, anaesthesia services are provided by nurses, who must be constantly updated.  Failure to provide continuing education can make anaesthesia very unsafe.

At the same time, further education of pregnant women to encourage them to visit ante-natal clinics would lead to further reductions in mortality.

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Dr Angela Enright

Dr Angela Enright

“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.

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Dr Ronke Desalu

Dr Ronke Desalu

“Safe surgery is tied up with the socio-economic status, political participation and education of women.”

Ronke is an Associate Professor and Consultant in Anaesthesia at the Lagos University Teaching Hospital. Her sub-specialty interests are paediatric anaesthesia and Training in CPR. She is happily married with 2 grown-up children.

Why is access to surgery essential for women’s health?

A third of the 4500 surgeries performed at my hospital in Lagos last year were related to women’s reproductive health. This is a substantial percentage for one ‘special group,’ and emphasizes the importance of ready access to safe surgery for women.

Yet not all women are lucky to get this professional treatment; the maternal mortality rate in Nigeria is approximately 585 per 100,000 live births.

Why did you become an anaesthetist?
I always wanted to be a doctor, even as a young girl growing up in Lagos in the 1960s. With two aunties showing that women were just as capable as men, and could be doctors, my mind was made up.

I’m passionate about helping the vulnerable and the sick, and it gives me great satisfaction to see the outcome and the value one person’s actions can have on another person.

Can you tell us about one of your most memorable cases?
I’m in a profession that has its fair share of risks, but I like to look on the positive side of my work, the good we do and the relief we bring.

Many years ago we treated a 5-year-old child with a large cystic hygroma [a growth that appears on a baby’s neck]. The surgery was difficult, and afterwards she was unable to breathe on her own. We admitted her to our intensive care unit, which didn’t have a functioning ventilator at the time.

The trainees and technicians took turns to manually ventilate her for 100 days.

The case emphasizes the importance of teamwork, perseverance – and above all, commitment to your patient.

What is the government doing to reduce maternal mortality?

In the last six years, the Lagos State Government opened six specialized maternal and child health hospitals, with full surgical facilities. This means more theatres, more surgeries, more training and better health service delivery.

What is the role of women in the surgical ecosystem?

Safe surgery is tied up with the socio-economic status, political participation and education of women. We need to support groups that advocate for women’s health issues – women shouldn’t have to travel such long distances for basic care.

I take as one of my critical roles in life, to uplift and raise the bar for young women. To show them that it is indeed possible to have both a happy home front and a sky that is the limit in their career.

 What is your goal for women in the medical profession?

I want them to realize that they’re part of a unique team. Many organisations assume that women can’t cope with the top positions and we need to change that mindset. We need to be amongst the counted when it comes to doing our job well.

Women need to be fully involved in the implementation and management of healthcare, as well as in the policy and mapping of future health plans for their community – and indeed the world.

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Dr Queeneth Kalu

Dr Queeneth Kalu

“They say ‘Abasi Akan uman ikwa,’ meaning ‘God forbid delivery by knife!’”

Queeneth is a Senior Lecturer and Chairman,Medical Advisory Committee at the University of Calabar Teaching Hospital in Cross River State, Nigeria.

Do women recognize that surgery can play a life-saving role in safe childbirth?

In my locality they say ‘Abasi Akan uman ikwa,’ meaning ‘God forbid delivery by knife!’ When it comes to childbirth, most Nigerian women prefer a vaginal delivery, meaning going to hospital is a last resort.

This translates to late presentation after laboring for hours in the traditional birth attendant’s home. They commonly arrive with obstructed labour, severe preeclampsia, foetal distress, haemorrhage – conditions requiring surgical intervention to save mother, baby or both.

The importance of safe anaesthesia in these emergency patients, arriving in suboptimal states into our very challenging health service system, cannot be over-emphasized.

What kind of challenges?

As a trainee anaesthetist I once had a patient who needed a Caesarean section at night. As soon as I gave her the spinal anaesthesia, there was a public power outage.

There was no back up power supply in the theatre. W e had no automated patient monitors at the time. We put on the small light of the laryngoscope, checked blood pressure every 5 minutes, palpated the pulse, kept communication with the patient and waited in the theatre till the anaesthesia receded.

We’re familiar with occasional power outages during surgery and will usually carry on with torchlights until power from the generator or public supply is restored. In this case we felt it was too risky, so we returned the patient to the ward and surgery was done the following morning. These are not things we are proud of but the reality in Africa is: we work in a challenging environment.

Does experience of working in other countries change your perspective?

I witnessed a case of placenta acreta [a sever complication of pregnancy that often requires surgery] during my obstetric anaesthesia fellowship at Wolfson Medical Centre in Israel.

The early diagnosis and preparation of equipment, blood availability, personnel – obstetricians, anaesthesiologists, interventional radiologists, perfusionists, nurses…it was amazing. Such a sharp contrast to what’s available in our environment when we see the same condition.

I realised why our maternal mortality rates are so high and theirs so low. I realize that saving a woman’s life in an obstetric emergency situation, especially where there’s bleeding is more or less a warfare and must be treated as such. All hands must be on deck.

What are your goals for women in the healthcare profession?

My joy is that I have found my passion for public health being fulfilled along my career path, and I encourage women to rise to professional excellence.

They should strike a work life balance. Make the most of the opportunities that come their way, engage in community development projects. Share their knowledge through health education programs in churches, market places, media houses.

I pray that in the coming decades, women will not be looked upon in terms of gender but will be seen as too relevant to be ignored.

 

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Dr Nneka Anaegbu

Nneka Anaegbu

“In the coming decade we’ll be on the frontier and at the helm.”

Nneka is a Consultant Anaesthetist at Lagos State University Teaching Hospital, Nigeria.

Why is access to surgery essential for women’s health?
The woman’s role is vital in the maintenance of the family. Since the family is the smallest unit of the society, their function is essential for society at large.

Inability to get access to safe surgery can lead to unnecessary demise of a woman, a tragedy and a great disaster to her children and husband. Children who lose their mothers are negatively affected psychologically, which may affect their behavior in the society.

Does a woman’s role in society affect her ability to get surgical care?
There are various challenges that women face while trying to access health care. They include financial, educational, cultural, gender inequality, poor governance and religion.

In my culture the young girls are usually at a disadvantage due to gender inequality – their parents may not send them to school because they believe it is a waste of resources. Girls are soon married out to end up in a man’s kitchen, seen and not heard.

This leaves women financially dependent on their husbands for every need, including healthcare support. A woman whose husband does not provide money for her to access healthcare when needed is a woman at risk.

Is surgery seen as a safe option?

Education about safe surgery is vital, and sometimes lacking.

In our environment some women run away from Caesarean section for various reasons. Some believe they may die during the surgery, others feel that their family and friends will look down on them for not delivering naturally. Others feel that it means that they are not prayerful enough.

I remember a woman who was pregnant and attended antenatal care at the hospital. The doctors noticed that she had pre eclampsia, therefore she was told that she would require surgery to deliver her baby. Instead she went to a traditional birth attendant to deliver.

She eventually developed eclampsia, and by the time she came to the hospital the baby was dead. She still had to have a Caesarean delivery and died in intensive care after about 10 days.

What can women around the world do to support safer surgery?
Women should strive to educate their girls to enable them have a brighter future and be independent. Many of the young girls I know want to be professionals in various fields, and have a passion for healthcare. But there are many barriers –parents lack the financial capacity, while some girls get pregnant in secondary school and can’t further their education.

Women should be supported by other women to achieve their goals. My aim for women in the medical profession is that in the coming decade we’ll be on the frontier and at the helm of activities in the industry. Taking decisions that will favor women, in order to improve women health and prevent avoidable eventualities that may affect women.

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Dr Kelly McQueen

Dr Kelly McQueen

“Women with cancer in the early stages with the hope of treatment and cure often have no access to an exam or biopsy”

Kelly is Associate Professor, Department of Anesthesiology and Director of Vanderbilt Anesthesia Global Health & Development Affiliate Faculty at the Vanderbilt Institute for Global Health, and president of the Global Surgical Consortium.

How is surgical need related to gender?

The health of men and women over a lifetime is associated with risks specific to their gender and to their roles in society.  For women, there are several unique periods in her life when the availability of safe anaesthesia, and emergency surgery is vital – the most obvious time frame is during childbirth.

The biggest risk to mothers worldwide is peripartum haemorrhage, often requiring surgery.  In low-income countries the risks are even greater because they relate to a lack of access to an emergency cesarean section for obstructed labor and for seizures related to high blood pressure.

Access to surgery and safe anaesthesia for these conditions – haemorrhage, obstructed labor and eclampsia – will save the lives of mothers and babies, and prevent related complications such a vaginal fistula and stroke.

Is it just about reproductive health?

Cancer affecting women specifically also illustrates the important relationship between certain surgeries and gender.  Cervical and breast cancer often require a biopsy for diagnosis, and frequently surgical intervention for treatment, palliaton and cure.

Cervical cancer when diagnosed early has a very good prognosis.  But when diagnosed late – often when the kidneys are blocked, or the tumour is so large that it protrudes from her body – there is little hope of treatment.

The later is a common outcome in the poorest countries, and the unnecessary death of a women often leaves children in need of care behind.

Why is this a global rather than local concern for women?

Disease for the most part knows no geographical boundaries.  But the prevalence of surgical disease does correlate with increased non-communicable disease such as heart disease, trauma and cancer that we’ve been seeing for many years in higher-resource countries.

Recently in low-income countries, non-communicable disease has been increasing and therefore the need for safe surgery and anaesthesia has as well.  The needs for these same services are commonly required by women all over the world, and so women from every country must engage to create awareness about the role of surgery and safe anaesthesia in our good health.    

What is the reality of the situation faced by a woman in need of surgery when she lives in a low-resource setting? 

In the lowest-income countries, need for surgery has never been greater.  Sadly it’s in these same countries that access to safe anaesthesia and surgery is most often unavailable.

Organizations such as the The Global Surgical Consortium are committed to revealing the unmet need, and advocating for availability: in many hospitals surveyed we note a lack physicians and other providers, the absence of essential medicines including oxygen, and the absence of safety equipment and basic surgical supplies

This means that many women who need an emergency Caesarean section never receive one or are delayed until after the baby has died and the mother has birth trauma – which will affect her the rest of her life.  Women with cancer in the early stages with the hope of treatment and cure often have no access to an exam or biopsy, and therefore are diagnosed very late in the disease when it is too late to provide definitive care.

What role do women play in delivering healthcare worldwide?

Of course women in every society are often engaged in care-giving.  In lower-resource countries this is especially true within the home, and also in the nursing profession.  They’re also physicians, but many fewer of them have the opportunity for the extended education that is required and available to their higher-resource counterparts.

More women should be given the professional opportunity to work in health care for one very important reason we’ve seen. Women are much less likely to leave their families to seek higher pay or new opportunities outside their community – the retention of women in professional roles in the low-income countries is higher than for men.   

For someone who has never worked in a low-resource setting hospital, or thinks safe surgery is a luxury –

Just a few hours in a hospital of a low-income country bears witness to the vital role of safe anaesthesia and surgery in the lives of women.

Women die in childbirth everyday because of a lack and unsafe practice of anaesthesia, and limited or no access to a life-saving surgical intervention when they need it.  Their babies die too because of the mothers excessively high blood pressure or being stuck in the birth canal with no availability of a cesarean section.

Walking in the halls you see women with large tumors protruding from their breasts, or large thyroid goiters taking over their neck.  Visiting the Emergency Department you see women – mothers, sisters, aunts – morning the loss of a husband or son, because there is no access to emergency anesthesia and surgery for trauma.

Safe anaesthesia and basic surgery can be provided in a cost-effective and appropriate manner. There is no doubt that the lives of women around the world are impacted daily by lack of access to it.

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Dr Michelle White

Dr Michelle White

“It’s powerful to see how generous they are in their love and affection for each other.”

Michelle is Head of Anaesthesia on the MV Africa Mercy, the largest floating hospital NGO in the world. She is currently docked in Congo.

Are women at a disadvantage when it comes to access to surgery in low-resource countries?

Any money usually goes to the men, to the children; women are the neglected person in the family unit, often the poorest of the poor.

But with a lot of women’s health issues – uterine prolapse, obstetric fistula – there really is no other alternative to surgery. So it’s important that they get access to surgical care, that it’s safe – and that it’s effective. Obstetric fistula has a high rate of cure if you get it right first time, dropping dramatically with each further attempt.

Is it hard not to get emotionally involved in these cases?

It’s certainly a very moving surgery to be part of. These women have been ostracized completely from society – very often they’re barred from home, left in an outhouse and someone brings them food. Corrective surgery restores their dignity and their place in society. They can socialize, take a bus, go to market. They can finally get rid of the stench of stale urine.

How do the women respond to this second dramatic change in circumstances?

We try to have a ceremony on the ship for the ladies who have had successful fistula surgery, as a way of showing that they are valued, appreciated. We give them a new dress, symbolizing a new start. There’s applause and dancing – it’s incredibly moving, after the many years of hardship they’ve suffered.

And it’s powerful to see how generous they are in their love and affection for each other. The women who haven’t had successful surgeries nearly always participate. They know how much it means, and their hope of that is so great that they are still willing to rejoice.

What’s the reality for surgery on the mainland, when you leave the ship’s hospital?

It’s not only about access to surgery – people also have to survive their operation, and there are some very practical problems. Many hospitals don’t have access to clean running water or electricity to sterilize the equipment. They don’t have antibiotics, everything disposable is reused.

Everything compromises the safety of surgical care, even the unreliable lighting – it’s very difficult to do a good repair when you can’t really see what you’re doing.

What does this mean for someone with a surgically-treatable condition?

It means they endure with pain, exhaustion, incontinence. For the woman particularly there are economic and social implications – if her husband takes another wife he may reject the infants from the first wife. If she takes the children she may not have the means to look after them.

There’s a lot of social stigma attached to disability, but if we turn a mirror back on ourselves we can see that we take a similar view in the west – we just hide it better.