Finding surgery’s place on the global health agenda

Abstract: Billions of people worldwide do not have access to even the simplest surgical procedures. But a new global initiative has launched that hopes to change the situation. Bridget Huber reports. Joshua Bukenya was barely a week old when he started having convulsions in March, 2014. His worried parents took him to be prayed over at a church near their home in eastern Uganda’s Buyende district. At first, it seemed to work, said his mother, Mera. But, with time, it became clear that the child’s head was growing abnormally large. In November, his mother brought him to the CURE Children’s Hospital in the city of Mbale for treatment. There, doctors explained that he had infant hydrocephalus, a life-threatening accumulation of fluid in the brain, in his case likely caused by the infection that was also responsible for his seizures.

Joshua was luckier than most African children with hydrocephalus. His family lives close enough to a charity hospital that has pioneered a new treatment for the condition and provides the neurosurgery regardless of a family’s ability to pay. But in sub-Saharan Africa, most children in need of such surgery for hydrocephalus-an estimated 250 000 each year—don’t get it, and their prospects are dim. About half will die, in pain, by 2 years of age and most of those who survive will be severely disabled.

Even people who need a simple operation often go without; globally, about 5 billion people have no access to surgical care, according to the Commission on Global Surgery published on April 27. That means conditions that could be treated surgically, like obstructed labour or appendicitis, can become a death sentence. And something as simple as a broken bone can disable a person for life. Scaling up basic surgical services in low-income and middle-income countries could save an estimated 1·5 million lives per year in these countries, according to the most recent edition of Disease Control Priorities.