Shortage of Surgeons – part 2 of 2: A Global Epidemic

In sub-Saharan Africa, access to surgical care is extremely limited. Reasons for this tend to be a combination of poor infrastructure and human resource shortages. Although external funding might help, it is unlikely to be sufficient to address a shortage of surgeons that is a growing epidemic.

Surgeons are in extremely short supply. The reasons are mainly deficiencies in training but are compounded by a low pay scale and few opportunities for continuous professional development. In rural areas there is professional isolation and inadequate communication with peers and consultants in the cities, and a significant lack of educational resources.

Africa has a huge deficiency in healthcare workers in general. As a continent it is supported by only 2% of the global health workforce, despite bearing nearly 25% of the global burden of disease (1). The infographic below shows a breakdown of the stats for the number of physicians per 100,000 people, first in areas of Sub-Saharan Africa, and then in the UK, US and Germany (as representation for the West).

One solution proposed, at least in the short term, is to train non-medics to provide some surgical services at the district level. The evidence that this strategy can be successfully employed has been demonstrated in areas of Tanzania, Mozambique and Malawi. However, continuing development and quality monitoring are essential, yet opportunities are largely unrealistic.

The surgical profession is not in agreement over delegating to non-physicians or even to qualified physicians. We also can’t forget that surgery is a team effort requiring staff trained in anaesthesia and surgical nursing – skills which are similarly in short supply.

A more achievable short-term solution may be achieved through better internet connectivity. Today, a huge proportion of education takes place online through reference material and training forums, accessible all over the world. If the Internet was to become globally accessible and easily affordable, it could realistically be considered a tool for medical, and surgical education in developing countries.

In a connected world, mobile technology could have potential to become a conduit for healthcare delivery. After all, more people in the developing world have access to a mobile phone than clean, running water.

Through Touch Surgery, we provide a mobile reference tool for learning and practicing every step of a surgical procedure. In areas where surgical training is limited or non-existent, the benefits of the app to support the education already available are potentially huge. Start #ChangingSurgery.

 

[1] Ozgediz, D., and Riviello, R. “The ‘Other’ Neglected Diseases in Global Public Health: Surgical Conditions in Sub-Saharan Africa.” PLoS Med. 5.6 (2008). Accessed on 29 October 2010.

[2] Kruk, M., et. al. “Economic evaluation of surgically trained assistant medical officers in performing major obstetric surgery in Mozambique.” BJOG. 114 (2007): 1253-1260. Accessed on 5 November 2010.

[3] J.D. Pollock, et al., Is it possible to train surgeons for rural Africa? A report of a successful international program. World J. Surg. 2011;35(3) 493-499.0