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Global surgery

Global surgery

Global Surgery 

Many of the most serious threats to health – such as trauma, cancer, and complications from childbirth – can be successfully treated with surgical intervention, but there are vast inequalities in access to safe, essential surgical care worldwide. Despite the proven benefits and feasibility of delivery of surgical services in low-and middle-income countries (LMIC’s), there is a scarcity of academic and policy focus on improving the provision of quality surgical services. Overall, there has been lack of political support, funding, and little development of policy mechanisms to create equitable and scalable surgical systems worldwide.

The Centre for Global Health’s focus on Global Surgery started in 2012, with the aim of contributing in the following ways:

  • Play a leading role internationally in the field of global surgery and global health
  • Provide education and training opportunities in global surgery
  • Build a surgical component into our health partnerships
  • Conduct research in the area of global surgery

Internationally leading

The Centre plays a key role in the Lancet Commission on Global Surgery. The Commission, launched in 2014, seeks to ‘develop and assemble the best evidence on the state of surgery worldwide, to study the economics of surgical and anesthesia care delivery, and to develop strategies for improving access.’
Source: http://www.lancetglobalsurgery.org/#!background/z4c08

Andy Leather, Director of the King’s Centre for Global Health, was appointed one of the Commission’s three co-chairs.

Upon launching, the Commission outlined 5 key objectives:

  1. Examine the current state of surgery within the global health agenda
  2. Characterize the role, nature and spectrum of essential surgery within functional healthcare systems in LMICs.
  3. Identify critical health systems barriers that prevent universal access to safe, high quality surgical care in LMICs.
  4. Define scalable priority actions that must be taken to overcome these barriers
  5. Define the roles of governments, international bodies, academic institutions, surgical colleges, NGOs, health funders, health care providers and local communities in the attainment of these goals.

The result of these objectives were detailed in the landmark report Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development, which describes the role of surgical and anaesthesia care in improving the health of individuals and the economic productivity of countries. Centre Director Andy Leather was joint first author of this report, which was developed by a multidisciplinary team of 25 commissioners and collaborators from over 110 nations.

Education and Training

  • MSc in Global Health with a specialist pathway in Global Surgery – the first programme of its kind.
  • Online teaching through the Medicine Africa Platform – which supports the improved delivery of high quality patient care, the building of strong healthcare systems, and better health for all by connecting the global healthcare workforce online. 
  • Quarterly meetings for UK surgical trainees interested in surgery in middle and low income countries, run by the Global Anaesthesia, Surgey & Obstetric Collaboration (GASOC).
  • In 2012, a taught Student Selected Component (SSC) course in Global Health for year 4 medical students at King’s was launched.
  • Our intercalated BSc in Global Health for medical students, has taught sessions on Global Surgery within two modules (‘Global Burden of Disease’ and ‘Health Systems and Policy’). Students are also encouraged to explore surgical topics in the Library Projects module.

Health Partnerships

Our health partnerships in Sierra Leone, Somaliland and Zambia all have a surgical component including:

  • Undergraduate surgical education (teaching, faculty development, assessment, curriculum design, external examinations)
  • Postgraduate surgical training (development of training programmes)
  • Distance support for undergraduates and surgical interns (teaching and mentoring)
  • Surgical research capacity building
  • Research projects (see under research)
  • Service development (eg surgical check list introduction, wound management)

You can find out more on our health partnerships webpages.

Research

  • Cost-effectiveness of surgical services at district hospitals in SSA
  • Development of surgical services and the human resources to staff them in LMICs
  • Mapping the burden of surgical disease in LMICs
  • Global Surgery advocacy

Key publications

  1. Dare AJ, Lee KC, Bleicher J et al. Prioritizing Surgical Care on National Health Agendas: A Qualitative Case Study of Papua New Guinea, Uganda, and Sierra Leone. PLoS Med. 2016 May 17; 13(5): e1002023. doi: 10.1371/journal.pmed.1002023
  2. Ng-Kamstra JS, Greenberg SLM, Abdullah F, et al. Global Surgery 2030: a roadmap for high income country actors. BMJ Global Health 2016 Apr 6; 1: e000011. doi: 10.1136/bmjgh-2015-000011
  3. Grimes CE, Billingsley ML, Dare AJ, et al. The demographics of patients affected by surgical disease in district hospitals in two sub-Saharan African countries: a retrospective descriptive analysis. SpringerPlus 2015 Dec 1; 4: 750. doi:  10.1186/s40064-015-1496-3
  4. Lily Gutni L, Dieleman J, Dare AJ, et al. Funding allocation to surgery in low and middle-income countries: a retrospective analysis of contributions from the USA. BMJ Open 2015; 5: e008780. doi:10.1136/bmjopen-2015-008780
  5. Meara JG*, Leather AJ*, Hagander L* et al. *Joint first authors. Global Surgery 2030: Evidence and Solutions for Achieving Health, Welfare and Economic Development.Lancet 2015 Aug 8; 386(9993): 569-624. doi: 10.1016/S0140-6736(15)60160-X. Epub 2015 Apr 26
  6. Alkire BC, Shrime MG, Dare AJ, Vincent JR, Meara JG. Global economic consequences of selected surgical diseases: a modelling study.  Lancet Glob Health 2015; 3 (S2): S21–27 DOI: http://dx.doi.org/10.1016/S2214-109X(15)70088-4
  7. Shrime MG, Dare AJ, Alkire BC, O’Neill K, Meara JG. Catastrophic expenditure to pay for surgery worldwide: a modelling study. Lancet Glob Health 2015; 3 (S2): S38–44 doi: 10.1016/S2214-109X(15)70085-9
  8. Dare AJ, Bleicher J, Lee KC, et al. Generation of national political priority for surgery: a qualitative case study of three low-income and middle-income countries. Lancet 2015 Apr 27; 385 Suppl 2: S54. doi: 10.1016/S0140-6736(15)60849-2
  9. Grimes CE, Billingsley ML, Dare AJ, et al. The demographics of patients affected by surgical disease in district hospitals in two sub-Saharan African countries: a retrospective descriptive analysis. Lancet 2015 Apr 27; 385 Suppl 2: S3. doi: 10.1016/S0140-6736(15)60798-X.
  10. Sullivan R, Alatise OI, Anderson BO, et al. Global cancer surgery: delivering safe, affordable, and timely cancer surgery. Lancet Oncol 2015 Sep; 16(11): 1193-224. doi: 10.1016/S1470-2045(15)00223-5
  11. BoughtonO, JonesGG, LavyCBD, GrimesCE. Young, male, road traffic victims: a systematic review of the published trauma registry literature from low and middle income countries. Sicot-j.org 2015; 1: 4. http://dx.doi.org/10.1051/sicotj/2015007
  12. Henry JA, Bem C, Caris Grimes C, et al. Essential Surgery: The Way Forward. World J Surg 2015 Apr; 39(4): 822-32. doi: 10.1007/s00268-014-2937-9
  13. Dare AJ, Grimes CE, Gillies R, et al. Global surgery: defining an emerging global health field. Lancet 2014 Dec 20; 383(9961): 2245-7. doi: 10.1016/S0140-6736(14)60237-3
  14. Leather AJ, Grimes C, Lavy C. RCS conference triggers Lancet global surgical think tank. Ann R Coll Surg Engl (Suppl) 2014 Mar 3: 96(3); 89. doi: 10.1308/003588414X13814021678394
  15. Meara JG, Hagander L, Leather AJ. Surgery and global health: a Lancet Commission. Lancet 2014 Jan 4; 383(9911): 12-3. doi: 10.1016/S0140-6736(13)62345-4
  16. Grimes CE, Mkandawire NC, Billingsley ML, Ngulube C, C Cobey JC. The cost-effectiveness of orthopaedic clinical officers in Malawi. Tropical Doctor 2014; 44(3): 128–134. DOI: 10.1177/0049475514535575
  17. Grimes CE, Henry JA, Maraka J, Mkandawire NC, Cotton M. Cost-effectiveness of Surgery in Low- and Middle-income Countries: A Systematic Review. World J Surg 2014; 38: 252–263. DOI 10.1007/s00268-013-2243-y
  18. Maraka J, Grimes C, Henry J, Cotton M. Cost-effectiveness of Dental Surgery Procedures: A Call for Strengthening the Evidence: Reply. World J Surg 2014 Sep; 38(9): 2486. doi: 10.1007/s00268-014-2550-y
  19. Grimes CE, Lane RJS. Surgery and the global health agenda. J Roy Soc Med 2013 Nov; 106(11): 431-431. DOI: 10.1177/0141076813511179
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