PreGA on global Surgery

PreGA on global Surgery

Hello everyone,


I just finished a wonderful three days of PreGA training on the theme of global surgery.


Those three days have been amazing. I really do learn a lot on this subject. I always have find surgery not as humanitarian as a general practice. I thought that surgery, unless general surgery, can’t be exported to another country and I can’t practice it during crisis situation with NGO’s, such as MSF or Médecin du Monde, nor in rural areas.


But I think that this pre-GA kind of change a little bit my mind. I learnt a lot and I am really excited to say that we came up with plenty of projects to do at the end of the workshops.


Let me start by presenting a little bit the background. Global surgery means surgery for trans border ethical and accessible care for everyone. It has always been a neglected topic in global health. The surgical and anaesthesia care are distributed unequally among the world. Just as everything else.

The poorest 1/3 of the world population only receive 3,5% of the total amount of surgery. 11% of global burden diseases could be treated by surgery.


Global surgery is a really wide topic. There are many sub-aspects.


1-lack of surgical materials and ressources

We first had a simulation of real life of the surgeons in low or middle income countries. Some surgeons need to operate in the light created by the Nokia phone of the nurse, some surgeons need to operate an appendicitis without anaesthesia, some other need to operate without mask, or need to amputate a leg because the patient, who had a wound, walked for 3 days before being able to get to the hospital.


In these simulation, I realised and felt by my self how those surgeon need to fight for the life of their patient even in a huge lack of resources and sometime, they even need to choose between the life and death of their patient. For example, I had to operate the appendicitis, without any anaesthesia. My patient is the father of five children and he needs to survive. For me, who live in Canada, appendicitis seems to be a such small surgery, but in the case of this simulation, my patient screamed so hard for his pain (he is also simulating his pain) that I don’t even know if in real life I would still perform this surgery. It’s completely unfair and unethical that there are still doctors who work in those conditions and patients who suffer that much during their surgery.


2-ethical procurement

A second topic that we have touched is ethical procurement. Seriously, I have no idea of the meaning of this word. It’s like fair trade for food and clothe, but in the field of medical materials (from srubs, to scalpels).


Can you imagine your little brother of 12 years old working 16 hours a day in front of a machine to flatten your scalpel? Without any lights?


Well, this is happening now, in Pakistan and a lot of other countries. Who ever thought about where does materials come from? And all those plastics that we are wasting every time? (sorry, this is only a comment for how much our hospitals contribute to the pollution and global burden of climate change).



There should be also an ethical procurement of our medical materials. The usual questions from people will be :” how expensive will be ethical materials, our hospital is already on a budget”


Well, the answer will be, the more hospitals get together to buy fair-trade materials, the more their purchase power will be big and the better the negotiation power will be high. Please see the case of Sweden.



3- Task shifting


In a lot of countries, because of lack of surgeons and the brain drain (migration of the doctors to other countries), 80% and more of minor to major surgeries are performed by non-physician technicians. In Tanzania, they train nurses (3 years of bachelor) for 3 more years so they can perform C sections and others. They find that the success rate or complication rate is similar to the trained surgeons. Furthermore, it cost 5 time less.



4- our project: international education


Jordan, Quebec and China, we are 4 delegates working for a project which aims to contribute to the international training of the surgeons.


This project will have a short term activities and long terms. For the short term, we are going to share the videos of surgeries on a platform, so surgeons in developing countries can access to them and learn online. Furthermore, webinars, and online supervising programmes will be established. We are also going to create a data base in which we will be assessing the needs and the offers from the surgeons.


For the long term, it will be ideally an exchange programme for surgeons or resident.



That’s it.



Oh and the sessions that I gived for climate change went very well, I received really positive feed back. I am really proud that I learn the subject about climate change and migration in a short period of time and being able to build a workshop on it J


I also presented the project My planet my health to the participants of the preGA on climate change and health.