Global medical volunteerism is vastly rewarding and an antidote to burnout, but it requires more than medical expertise and a desire to volunteer, according to Catherine R. deVries, MD, MS, who presented the annual John Duckett Memorial Lecture on Sunday at AUA2017.
Since her first volunteer surgical workshop in 1992 in Honduras, Dr. deVries has advocated for improving surgical and urological care in Africa, Asia, Central America and the Caribbean. To that end, she founded a nonprofit to support urological training in more than 30 countries.
Dr. deVries said that more than 24 percent of the global disease burden is in Africa. And of the African disease burden, 28 to 32 percent is from surgical conditions, more than malaria, tuberculosis and HIV.
“This is a surprise to our public health people,” said Dr. deVries, professor of Surgery (Urology) and adjunct associate professor of Public Health at the University of Utah. “[The World Health Organization] doesn’t know this, but they are starting to find out. We have not really done the metrics. We haven’t done the advocacy. We are just starting to find out how important surgical disease is to the world’s population and how we need to start engaging.”
Dr. deVries said surgery has been on the periphery of global health, primarily because of the perceived expense and lack of advocacy by surgeons. However, the problems related to performing surgery in underserved locations are not primarily related to the expense of surgical care, she said.
“It’s things like laundry,” she said. “You can’t do surgery if you can’t get the laundry done. Why can’t you get the laundry done? You don’t have electricity. Why don’t you have electricity? You don’t have electricity because there is politics, there’s corruption. There may be not enough fuel to run the generators. There are 100 different ways you don’t have what you need and those come down to external features.”
Differences in culture, family support and spirituality may also play a role in the treatment decisions surgeons make in underserved areas. For example, many cultures don’t allow stomas, Dr. deVries noted.
“If they don’t accept stomas, that limits what you can think about doing for a patient with a vesicovaginal fistula or any other condition that might, in our system, benefit from stomas,” she said.
Surgeons in the U.S. and Europe also benefit from nurses who are trained not only in patient care, but also in adeptly managing the business of an operating room, including supply chain, technology and human resources.
The good news is that surgery has become more commonly referenced in global health literature, and global health is now recognized as a subspecialty of surgery.
“One of the most critical things has been The Lancet’s publication in 2015 of ‘Global Surgery 2030.’ That has started to bring together the economic evidence that makes it possible to talk to ministries of health and say we need support for surgical care,” Dr. deVries said.
Through the work of the G4 Alliance and the World Health Assembly, efforts are being made to get the message out, and provide training and resources to help countries develop a framework to include surgery in their public health plans. In 2015 the World Health Assembly passed a resolution to make emergency and essential surgical care part of public health coverage.
“It’s the first time surgery has been acknowledged as a component of universal health. We consider this a big victory,” Dr. deVries said.
The Lancet Commission on Global Surgery has also developed a template for countries to include surgery into their national plans.
“The more you know about these issues, the more you can advocate for the 5 billion people who don’t have access to surgery right now,” Dr. deVries said.