Why Pediatric Surgery Plays a Critical Role in Global Health Work



By: Drew Reynolds, PhD, MSW, MEd, Program Director, Childspring International


“Do people give you a hard time when you tell them you focus on surgeries?” I asked.


Alison Fussell, my Executive Director and new boss, looked at me quizzically. “Why?”


“Because you can probably save more lives per dollar when you focus on infectious disease, primary care, or other global health interventions. I responded. “Do people ever dismiss the work for not taking on many of the other big challenges in global health?”

She paused, almost surprised. “You know what, children need surgeries,” she said.


This was my first lesson of soon to be many more when I started my new position as Program Director at Childspring International. My task was to coordinate our international programs that have spanned 52 countries and (as of this writing) have provided nearly 5,000 pediatric surgeries since our founding. And by the end of my first year, we had supported 694 surgeries and strengthened critical partnerships in Haiti, India, Honduras, Colombia, Sierra Leone, and beyond. But to accomplish this, I knew then that I needed to know why we did this work when so many other global health organizations in Atlanta and throughout the country had focused on different priorities.


Of course, my question was not entirely without merit. Surgical care has often been viewed as a neglected component of global health work. The reason for this begins with the complex nature of surgical work which requires among other things a surgeon, an anesthesiologist, facilities, and a long list of medical supplies. Some surgeries are costly, like heart surgeries. There’s also the stigma of some surgical conditions like hernias and colorectal malformations that make them a more delicate topic to discuss with potential donors. And there’s a long-held wisdom that fighting well-known high-mortality diseases like malaria, tuberculosis, and HIV are more deserving of our resources and attention. If we intend to save lives, should we not begin with more well-researched and proven areas of global health practice? Should we not focus on what we know already works?


But I started meeting the children and families we serve and soon found the need for surgical care to be simply overwhelming. We serve children who have been living with painful hernias and untreated cleft palates well into their teens, suffering from incredible pain and social stigma that would be unimaginable in most Western countries. We serve children who have mangled limbs from auto accidents and animal attacks. We provide care to children who are agricultural workers and family breadwinners, but were taken from the fields after suffering accidents and injuries. We find treatment solutions for children with facial masses, unexplained growths, and painful gastrointestinal conditions. We provide orthopedic surgeries for children who struggle to walk so they can enroll in school for the first time. In short, we work to serve untreated children on the margins, children who for one reason or another simply cannot access medical care because of the circumstances of their birth. We serve children who need surgeries because we believe in the inherent dignity and worth of every single child. Or in the words of my boss, because “children need surgeries.”


I soon learned that I also had many misconceptions about surgery as a critical component of global health work. Yes, surgical care is cost effective, comparable even to vaccination programs. Yes, we can do complex surgeries at often very competitive prices in some of the most resource-poor regions of the world. Yes, we can build programs that help support and sustain health care infrastructure, so that we can both treat individual children and also contribute to the building of a broader health care ecosystem that will provide greater health care access to children in the future.


And so, what should our priorities be in global health work? Perhaps part of the solution might come from the recommendation of the Lancet Commission on Global Surgery: 80% coverage of essential surgical and anesthesia services by 2030. And though we’ve learned so much about how to make surgery affordable, cost-effective, and accessible, our guiding principle should be the same one I learned in my first days at work: we do it out of respect for the dignity of children. Or perhaps stated more bluntly: children simply need surgeries.


Sources:

1 - Farmer, P. E., & Kim, J. Y. (2008). Surgery and global health: A view from beyond the OR. World Journal of Surgery, 32(March), 533–536. https://doi.org/10.1007/s00268-008-9525-9


2. Ozgediz, D., Langer, M., Kisa, P., Surg, M., & Poenaru, D. (2016). Pediatric surgery as an essential component of global child health. Seminars in Pediatric Surgery, 25(1), 3–9. https://doi.org/10.1053/j.sempedsurg.2015.09.002


3. Chao, T. E., Sharma, K., Mandigo, M., Hagander, L., Resch, S. C., Weiser, T. G., & Meara, J. G. (2014). Cost-effectiveness of surgery and its policy implications for global health : A systematic review and analysis. Lancet Global Health, 2, 334–345. https://doi.org/10.1016/S2214-109X(14)70213-X


4. The Lancet Commission on Global Surgery. (2018). Global Surgery 2030. Retrieved from https://www.lancetglobalsurgery.org/

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