Surgical Care in Developing Nations - BORGEN - Borgen Project

LINCOLN, Nebraska — There are 5 billion people worldwide that do not have access to safe or affordable surgical care. The lack of surgical and anesthetic care is worst in low and middle-income countries. Around 90% of people do not have access to basic surgical care. The Borgen Project spoke with Dr. Edgar Rodas, MD and co-director of Virginia Commonwealth University's program for global surgery. He has focused much of his career on improving access to surgical care in developing nations.

Global Access to Surgery

Global health has improved significantly in recent years. However, one lacking area is access to surgery in low-income and middle-income countries (LMICs). Without access to surgical care, the fatality rates for easily treatable and common conditions like appendicitis, breast cancer, hernias and bone fractures are high. The need for access to surgical care in developing nations will only increase in the coming years. Projections have determined that cardiovascular diseases, road traffic injuries and cancer in LMICs could increase until 2030.

According to Dr. Rodas, one of the significant issues with surgical access is that for decades the World Health Organization (WHO) and other health agencies focused on malaria, HIV and tuberculosis. These infectious diseases get a lot of media attention. Many celebrities donate to the causes. Additionally, many concerts and charities aimed to lessen their impact. However, Dr. Rodas said that "surgical disease accounts for a greater problem than all these three infectious diseases combined."

Surgery as a Public Health Concern

Lack of access to surgical or anesthetic care is a substantial public health concern. As Dr. Rodas said, surgery is something that touches every part of health care, beginning with pregnancy. Dr. Rodas told The Borgen Project that "there are certain surgical interventions that are done to preserve pregnancy, or just think about in-vitro fertilization, then a C-section is a surgical procedure, there's surgery for pediatric, you know, for the pediatric population, and then trauma." He continued, "And so with surgery, you treat a lot of traumatic diseases, and trauma is a disease of the young and healthy as well as, you know, of every age level." Dr. Rodas also made an important observation that if young and healthy individuals undergo a traumatic event, they cannot produce for their country, which is a massive reason that access to surgical care is so important.

Furthermore, Dr. Rodas mentioned that his father was one of the commissioners of the Lancet Commission. The Lancet dedicated its article on global surgery to his father, Edgar Rodas Sr., a surgeon and founder of the Ecuadorian medical charity called Cinterandes. Edgar Rodas Sr. pioneered a path of access to surgical care in developing nations with the start of the Cinterandes Foundation.

The Cinterandes Foundation

The Cinterandes Foundation officially began in 1990. However, it began with Edgar Rodas senior's goal of providing medical care to the poorest populations in his home country of Ecuador. According to his son, Dr. Rodas, MD, "he would organize different mission trips with medical students, his residents and other faculty from the local university and go out to faraway places in the rural regions."

For many years, Edgar Rodas Sr. provided care to those in remote villages by either walking or riding a donkey to get to his destination. However, one particular incident in which a friend's pregnant daughter died of a perforated appendix in a remote village without access to healthcare resulted in Rodas Sr. fighting for change. Rodas Sr. was extremely upset by the outcome of this event because appendicitis is easily treated. If this woman had access to surgical care, she would have survived. 

Inspiration from "MASH"

Following this traumatic event, Rodas Sr. became inspired by his favorite television show, "MASH." He built an operating room in the back of a truck. Rodas already had a system in place for minor medical procedures. With the addition of a truck in 1994, he and his team could provide more complex surgical procedures. The Mobile Surgery program allowed the Foundation to provide an average of 350 free surgeries per year. It completed more than 9,000 surgeries for those living in 20 of the 24 provinces in Ecuador. The Foundation also implemented other health programs that focus on vaccination, nutrition and child care.

Providing Access to Surgical Care

While speaking with The Borgen Project, Dr. Rodas mentioned other programs that provide services similar to those at the Cinterandes Foundation. He also mentioned the benefits of these mobile health care units. According to Dr. Rodas, these programs "benefit a lot of people that normally wouldn't have access. Additionally, you serve a greater population when compared to a fixed operating room. The cost of a fixed operating room is pretty high. So the mobile units cost us probably a 10th of that. And you serve not only one location, but you can move it to different places."

Two Programs That Make A Difference

1. The Train of Hope: Since 1994, the Phelophepa I, or "Train of Hope," has traveled across South Africa, providing medical care and educational opportunities for those living in remote and rural areas. In a country where the ratio of patients to doctors is 5,000 to 1, the train's work is vital. That is why, in 2012, the Phelophepa II launched, and a third edition is on the way. Since its first trip, the "Train of Hope" has helped an astounding 23.5 million people.

2. Flying Eye Hospital: The Orbis Flying Eye Hospital has been providing countries worldwide with access to eye care and education on eye care in its fight to end avoidable blindness since 1982. With this plane, Orbis has reached doctors in need of training. In addition, it managed to help those that otherwise do not have access to health care. It utilized state-of-the-art training facilities to help eye care teams learn new skills and gain confidence.

Overall, the lack of access to surgical care in developing nations is astounding. These are just a few examples of the people and programs fighting to make a difference. "If the global health community wishes to address ongoing inequities and the growing burden of disease, improving access to surgical care cannot be ignored."

– Trystin Baker
Photo: Flickr