Association for Academic Surgery (AAS)

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Integrating Global Surgery Into Academic Surgery

While surgeons have advocated for improved surgical care in low- and middle-income countries for decades, it has only been the last few years that surgical care has been accepted as an essential part of health care globally.  With this recognition, conversations about global surgery have progressed.  Unfortunately, while the science and advocacy focus in global surgery have evolved, the role of global surgery in many academic organizations has not. It is now incumbent upon academic global surgeons and those who support them to rethink and reframe where the field is going and how best to integrate it into the larger academic surgical community.

It was only 13 years ago that surgery was described by Paul Farmer as the neglected stepchild of global health1 because international health care funds supported work in communicable diseases and primary care, but not surgical care.  Thus, the surgeons who recognized the essential role surgical care plays in human health in all settings had to focus on making the argument that they should be included in discussions about health system strengthening and allocation of global health spending.  For academic global surgeons, this meant partnering with epidemiologist and economic modelers to establish the burden of surgical disease and perform cost analyses that highlighted the economic value of surgical care.  While work remains to understand the surgical needs and capacity in many areas of the world where standard data collection systems are limited, the publication of Disease Priorities 3, the Lancet Commission on Global Surgery, and passage of the World Health Assembly’s resolution 68.15 in 2015 signified that this foundational work had successfully made the case for surgery as essential for the health of all populations around the world.

This recognition opened the opportunities for academic global surgeons to broaden their research and advocacy.  Global surgical studies expanded their focus to look at quality and outcomes, developing surgical infrastructure and national policies, improving educational opportunities, and building technical innovations for low-resource settings.  With this expansion, the needs of young academic global surgeons have evolved and there are many more opportunities for collaboration. Within academic surgery, global surgery has often been viewed as a research track, similar to health services research, translational science, basic science, and surgical education.  But global surgery is not a distinct type of research like these categories, rather it is a subtype of all of these types of research. To continue to grow the field, strengthen equity-focused research and drive scientific innovations it is time for global surgery to integrate with each of these fields in academic surgery.

It is undeniable that academic global surgeons frequently work in settings with unique challenges. Thus, researchers early in their career must have mentors with global experience who can help them address these obstacles.  But, like most young academic surgeons, a team of mentors who can support different aspects of career development is key. Academic surgeons who have not previously considered their US-based research expertise relevant in global surgery are needed to mentor and collaborate with those trying to build a research career focused on improving surgical equity around the world.

I love the amazing and dedicated group of surgeons who I have grown to know over the years as we congregate at the “global sessions” of the academic surgical conferences. But to drive the field forward, global surgery research at academic conferences should not simply be discussed in separate sessions for the like-minded.  Instead, it should be integrated across all types of surgical research and topics. Global surgery focuses on ensuring equitable access to quality surgical care in all settings, local and international. There is much that researchers in these diverse settings of global surgery can learn from one another. Knowledge gained on how to best train surgeons in research and technical skills in low-resource settings can inform how we educate trainees in the US.  Successfully addressing issues of equity in care in international and rural settings can provide insights for those striving to achieve surgical equity in high-income settings. The epidemiology of different diseases in global populations provides an opportunity to develop and test novel therapeutic approaches that are applicable to patients in all settings around the world.  In essence, it is time to stop treating global surgery as the stepchild of academic surgery, with little to contribute to traditional researcher areas. Rather, we should be asking how the academic surgical community can best foster collaboration among surgeons around the world and combine their different areas of expertise across many research areas to generate the knowledge needed to achieve equity in surgical care for all.

References:

  1. Farmer, P. E., & Kim, J. Y. (2008). Surgery and global health: a view from beyond the OR. World journal of surgery, 32(4), 533-536.
Rebecca Maine

Rebecca Maine

Dr. Maine is a trauma surgeon and an assistant professor of surgery at the University of Washington. Her global surgical work over the last 15 years has focused on surgical outcomes, quality, and access in Ecuador, Rwanda, and Malawi. She and her colleagues at the UW Program for Global and Rural Surgery (PRoGReSs) work in several countries and underserved areas in the US focusing on improving equity in access and outcomes for all people who need surgical care. She is excited to bring her interest in improving bidirectional research learning opportunities to her work as the Global Affairs Committee Chair this year.
Rebecca Maine

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