Robyn Evans: A crucial time for global surgery

Mid morning on Saturday 18 January, in a dark, slightly indie London theatre, a crowd of distinguished surgery and anaesthesia colleagues gathered to eat Mexican food and talk safe surgery.

Lifebox Day 2014, hosted by Lifebox Foundation (the BMJ’s Christmas charity 2011-13 [1]) saw individuals with a passion for global surgery coming together to share experiences and inspire action. From an obstetrician who piloted her own plane across 26 African countries to raise awareness of unsafe pregnancy, to an anaesthetist with expertise in space medicine, this was an opportunity to focus on the vital role of surgery in global health—and talk openly about the challenges of safely delivering it in a low resource setting.

The same weekend in Boston, other like minded professionals met for the Lancet Commission for Global Surgery, a year long process that aims to drive the push for universal access to safe surgical care. Many of the commissioners have worked for years to support and deliver essential surgical care and training to colleagues around the world.

With individuals, ideas, and tweets flying back and forth across the oceans, it was a busy week for global surgery—at what many believe is a crucial time.

The disease burden in low and middle income counties has seen a significant shift towards non-communicable diseases, maternal deaths, and trauma. Simply put by Lifebox chair and surgeon Atul Gawande, “for the first time in history, you’re more likely to be killed by a surgically treatable condition than a communicable disease.”

And yet, the plight of safe surgery is still largely ignored. Described by Paul Farmer as “the neglected stepchild of global health,” [2] it was essentially omitted from the Millennium Development Goals, grouped with “other diseases” under Goal 6 rather than highlighted individually as a vital component of healthcare.

This is never more apparent than when addressing the maternal mortality rate in low resource settings. Sophia Webster, a specialist registrar in obstetrics and gynaecology was at Lifebox Day to share her experiences of promoting maternal care globally. Recently returned from her journey across Africa with Flight for Every Mother, she focused attention on the contrasting experiences of women giving birth in high and low resource areas: the same risks with very different outcomes.

None of the attendees were under the misconception that surgery is a luxury suited only to high income countries, too complex and expensive for realistic practice in low resource settings. This has been proven, time and time again, not to be the case, with numerous organisations demonstrating successful, cost effective surgical interventions. [3] The bigger problem is lack of training and resources, leading to limited access alongside enormous risk for those who make it to an operating theatre.

Lifebox Foundation, is one of the organisations tackling issues that contribute to the gross global disparity in access to safe surgery. Through targeted distribution of essential medical equipment and training, Lifebox works to provide a sustainable and realistic solution to the global surgical safety crisis.

But risk management isn’t only a surgical concern, and there are a lot of different professions we can learn from. Kevin Fong, specialist registrar in anaesthesia and intensive care medicine and BBC horizon presenter, spoke at Lifebox Day about some of the parallels between NASA and the NHS, particularly regarding risk and how we can learn from our mistakes. [4]

Global surgery involves economics, logistics, and statistics—but often its power seems to lie in the human stories, and at Lifebox Day, delegates were eager to share.

The experiences of an outcast fistula patient whose injury could have been repaired with simple reconstruction surgery (or better yet, prevented with a simple C-section), or a child born with easily repairable congenital problems, make a powerful case for wider access to global surgery.

These were just some of the lives given voice in the second ever UK screening of “The Right to Heal,” a raw, resolute documentary that puts the spotlight on global surgery.  It outlined 15 essential surgeries—basic life-saving and disability-preventing operations that should be safe, affordable, and accessible to communities globally, and the film’s director, surgeon Jaymie Henry, spoke animatedly about her experiences of working across a global setting.

As Lifebox patron Lord Bernard Ribeiro, former president of the Royal College of Surgeons emphasised, this is a progressive time for global surgery.  With the year so new, it’s exciting to see individuals around the world determined that the neglected voice of surgical care will finally be heard in the global health dialogue.

Competing interests: I declare that I have read and understood the BMJ Group policy on declaration of interests and I hereby declare the following interests: Lifebox Foundation volunteer.

Robyn Evans is a support worker at a care home and a volunteer with Lifebox Foundation. She will be starting medical school later this year.


1. BMJ readers raise almost £34,000 for Lifebox BMJ 2012; 344:e2330
2. Paul E. Farmer and Jim Y. Kim 2008, Surgery and Global Health: A View from Beyond the OR
3. J Varieur, 2013, Time for Surgery to Go Global—even cost data support the argument
4. K J Fong, 2010, Risk management, NASA, and the National Health Service: lessons we should learn