Dr Sandra Leal

“Latin America shares many things, among them a strong regard for family – which constitutes the center for society” SandraRead more →


Erica Frenkel

“Retweeting and liking aren’t enough. Change happens when large groups of passionate, committed people make it happen.” Erica Frenkel isRead more →


Dr Sandra Leal

“Latin America shares many things, among them a strong regard for family – which constitutes the center for society”

Sandra has been anesthesiologist at the Social Security Maternity Hospital in El Salvador for 20 years. She is past president of the Anesthesiologists Association of El Salvador.

How does safe surgery for one woman have a positive impact on more than one life?

Latin America shares many things, among them a strong regard for family – which constitutes the center for society.  In this context women are acknowledged as the bond that holds this nucleus together, and more often than not, are the sole providers of the family income.

Many an individual, call it parents, spouse or offspring, depend on her either emotionally, economically or even both.  Under this perspective, it can be understood why their safety and well-being becomes so important, why safe healthcare is a vital cornerstone.

Access to safe surgery and anaesthesia is essential, though not always possible.

Latinoamérica comparte muchas cosas, entre ellas resalta un fuerte vínculo con la familia, la cual constituye el centro de la sociedad. En este contexto las mujeres son reconocidas como como el lazo que mantiene este núcleo unido, y con frecuencia son el único sostén económico familiar; a menudo muchos individuos, entre padres, cónyuges e hijos, dependen de ella emocionalmente, económicamente o más aún ambos. Bajo esta perspectiva, puede comprenderse por que su seguridad y su bienestar se vuelven tan importantes, y proveerla con servicios de salud seguros es un pilar para ello.

Why is that?

Resources are relatively scarce and sometimes just not available; distances are in many instances broad, or transportation is an issue, which can mean that access to surgery, even if safe, comes too late or doesn´t come at all.

In El Salvador, anaesthesia still plays a significant role in many adverse events for women; most surely, without safe, solid, anaesthesia equipment and anaesthesia provider, no surgery can come out a success.

El acceso a cirugía y anestesia seguras es esencial, pero no siempre posible. Los recursos son relativamente escasos y a veces simplemente no están disponibles, las distancias en muchos casos son amplias, o el transporte es difícil, lo que puede ocasionar que el acceso a la cirugía, aún si es segura, sea alcanzada con retraso o no pueda accesarse en lo absoluto. En El Salvador,la anestesia todavía juega un papel importante en muchos eventos adversos maternos: indudablemente, sin un equipo y un proveedor de anestesia sólidos y seguros, no puede haber cirugía exitosa.

What are some of the other barriers to safe surgery?

To this scenario, we have to add cultural issues, in many instances so strongly attached that they will work against any conscious and well-intended attempt to deliver good quality healthcare.  This raises the stakes and potentially turns what could have been a routine and relatively safe procedure, into high risk, full blown major surgery and/or anaesthesia for which neither the personnel nor the patient are prepared.

These type of settings are more frequent in rural areas, where education is poor, sanitary facilities are few and hospitals almost always lack even the basics.  It is here where young doctors and paramedics start their practice, which raises their main concern: who or where to go for consultation, and what to do when the resources needed are not available?

A este escenario, debemos agregar aspectos culturales en muchos casos tan fuertemente arraigados que actuarán en contra de cualquier intento consciente y bien intencionado de proveer salud de alta calidad, elevando los riesgos y potencialmente volviendo lo que pudo ser un procedimiento seguro y rutinario en una cirugía y/o anestesia de alto riesgo y grandes proporciones, para la cual ni el personal ni la paciente suelen estar preparados.

Este tipo de situaciones son más frecuentes en las áreas rurales, donde la educación suele ser pobre, las instalaciones sanitarias escasas y casi siempre carecen incluso de lo básico. Es aquí donde los jóvenes médicos y paramédicos inician su práctica, lo que da paso a su principal preocupación: a donde o a quien acudir por apoyo o para consultar, o que hacer cuando los recursos necesarios no están disponibles?

What can we do to change this?

To address these issues we have to understand that it is essential to provide not only the much needed equipment , but also to stimulate a continued medical education program.  Together with a public-oriented education program, this will allow all parties involved to work together and make the most of what they have at hand.

Para poder abordar estos tópicos primero debemos comprender que es esencial proveer no solo el tan necesitado equipo, sino también estimular un programa de educación médica continuada junto con un programa de educación orientado hacia la población que permita a todos los involucrados trabajar juntos y sacar el mejor partido de lo que disponen.



Erica Frenkel

“Retweeting and liking aren’t enough. Change happens when large groups of passionate, committed people make it happen.”

Erica Frenkel is the Vice President, Business Strategy for Gradian Health Systems, a nonprofit social enterprise dedicated to promoting safe surgery and safe anaesthesia worldwide. She holds a MPA in Development Studies from Princeton University’s Woodrow Wilson School and lives in New York City.

What’s the impact of gender when it comes to surgical need?

Safe surgery – and reliable, consistent access to it – is an important issue (a human right!) for everyone, every day. Injury, congenital malformations, cancers and many other issues that require some form of surgical treatment impact men and women, adults and children.

However there are certain surgical conditions uniquely experienced by women and which, when performed unsafely (or when unavailable) uniquely affect their health and very survival: obstructed labor, post-partum hemorrhage, obstetric fistula, cervical and uterine cancers, to name just a few. International Women’s Day is a chance for us to call attention to the need to make those surgical interventions safe and available for all women everywhere.

Your work focuses on bringing an environment-appropriate piece of technology to low-resource settings.   What role can technology play in supporting access to safe surgery?

Certainly in my job, my answer tends to be that medical technologies (when functional and properly used) facilitate those interventions inside the operating theatre.

But today, on International Women’s Day, the technology I’m using technology to support access to safe surgery is this platform, and Twitter, and Facebook, and every platform I can find to call attention to this vitally important topic.

Retweeting and liking aren’t enough. Change happens when large groups of passionate, committed people make it happen. And these platforms can help individuals create a network – like this one – to catalyze action.

What should people know about unsafe and inaccessible surgery around the world?

For starters, some of the statistics. Approximately 1/3 of the world’s population cannot reliable access safe surgical care. Two million women across Africa alone are estimated to be living with (and often ostracized because of) obstetric fistula.  Common estimates about the number of women die in childbirth each year hover around 287,000

But those are just statistics.

One of the greatest challenges I have found in the course of this work, particularly around advocacy on this issue, is making the staggering statistics resonate. 287,000 is an unconscionable number of women needlessly dying. But it’s only a number. It does not illustrate who each of those 287,000 women were, or what dreams they had, or who they left behind.

So where do we take it from here?

Safe surgery does not occur in a vacuum. It relies on a sufficient numbers of trained health care providers (from community health workers to physician specialists); large-scale infrastructure investment beyond the hospital (such as roads and electrical grids and telecommunications capacity); efficient supply-chains with strong oversight (ensuring that disposables, medicines and other items are in regular supply); and much, much more.

The challenge seems daunting – and unfortunately that’s what keeps a lot of people from acting. But today, on International Women’s Day, let’s flip the narrative. With such a big challenge, there are roles for all of us to play.

So let’s do our homework. Let’s use this powerful technology called the Web to connect to all of the great work being done around the world to make sure that every woman – and man and child – has access to reliable, safe surgical care whenever they need it.