Disruption — if ever there were a single word that could capture the universal essence of the coronavirus pandemic, it’s that. From grocery shopping and business travel to Thanksgiving family gatherings, virtually every part of life has been impacted by COVID-19.
But as incredibly disruptive as the coronavirus has been for Americans, in many parts of the world, the pandemic has been infinitely more burdensome, most notably for those desperately seeking medical and surgical care.
Dr. Abebe Bekele, a general and thoracic surgeon from Ethiopia and Dean at the University of Global Health Equity in Kigali, Rwanda, commented in an interview with Lifebox on the situation in Africa for patients requiring surgery during the COVID-19 era.
“This means in a continent where the backlog is more than six months, we are adding to this serious backlog,” Bekele said. “Most of our cancer patients are not getting operated [on]. So, delay plus cancer is a close-to-death sentence. Most of our pediatric patients are almost cancelled. So, we are worsening an already existing access to surgery question.”
Additionally, because of the significant dangers posed by international travel and concerns over the spread of COVID-19 in communities with limited health resources, countless medical missions and global health services have been suspended since March, leaving tens of thousands of people waiting for vital health procedures.
“The choice to not provide care to people, either surgery or comprehensive care, is not a benign one. Children are still suffering because of it,” says Dr. Ruben Ayala, the chief medical officer for Operation Smile, an organization whose primary mission is to provide reconstructive cleft surgeries to children around the world.
During the initial height of the pandemic, organizations like Operation Smile made the difficult decision to shift their focus away from their core health care services, instead spending their vital resources on distributing personal protective equipment, food and hygiene supplies.
But as weeks of government shutdowns turned to months, some global health organizations, Operation Smile included, made the important decision to slowly reopen life-saving health care centers and resume surgical treatments in areas where health officials successfully limited the dangers associated with spreading COVID-19.
More than most, global health providers — especially surgeons — understand that waiting for the pandemic to pass completely would cause substantial harm for patients in need of care.
Dr. Bekele was one of many international collaborators who joined together to publish a series of recommendations to preserve the ability to care for surgical and obstetric emergencies in the midst of the coronavirus pandemic.
The recommendations include developing a clear plan for surgical operations during the pandemic, strategies for limiting exposure of COVID-19 among healthcare workers and supporting plans to expand critical care workers and repurpose staff.
While global surgical services do not get as much attention as other forms of health care, surgical care has been proven to have a large impact on communities’ overall health, and even economic and social development. A large collaborative study published in The Lancet in 2015 demonstrated that surgical conditions account for nearly one-third of the world’s burden of disease, and researchers estimate 143 million additional surgical procedures are needed in low- and middle-income countries (LMICs) each year to save lives and prevent disability.
Researchers at the Program in Global Surgery and Social Change (PGSSC) at Harvard Medical School are spearheading initiatives for surgical systems development. In a recent commentary, they argue that essential surgical care should be prioritized because of the impact improving surgical systems has on societies and their health care systems. They further suggest that national surgical, obstetric, and anesthesia plans should be integrated into all universal health coverage packages approved during or after the pandemic. Many countries have already begun these and other similar processes to improve their surgical systems.
As the research published by The Lancet and the initiatives of PGSSC clearly illustrate, putting surgical systems development on hold would have far-reaching and dangerous effects on countries’ health systems. Rather than shy away from developing surgical systems, policymakers and health officials must recognize that the pandemic has exacerbated existing public health problems, making the need for improving surgical care even more vital.
In an interview I conducted with Desmond Jumbam, a health policy expert at Operation Smile, he noted, “Prior to the COVID-19 pandemic, surgical systems in low-income and middle-income countries were in dire need of investments due to the inadequacy of staff, stuff, space, and systems needed to deliver high-quality surgical care. The COVID-19 pandemic has further highlighted the need for investing in surgical systems for two reasons.
“First,” he continued, “surgical systems with its various components — including intensive care units, intensivists, anesthesia providers and nurses — have played a key role in the management of critically ill COVID-19 patients globally. Investments in strengthening surgical systems, in addition to strong public health measures, are essential for preventing mortality and morbidity from COVID-19 and other pandemics.
“Second, the high need for investing in surgical care that existed prior to the COVID-19 pandemic remains,” Jumbam added. “Millions of men, women and children die each year from conditions amenable to surgical care, particularly in LMICs. millions of surgeries were further canceled due to COVID-19 restrictions. The systematic strengthening of surgical systems is needed to prevent this unnecessary mortality and morbidity.”
Many people around the world are in desperate need of surgical care and should not be overlooked because of the pandemic. Hospitals must find a way to create safe environments to protect surgeons and other healthcare workers, but patients in many contexts cannot afford to be prevented from receiving the care they need.
Additionally, lawmakers and health officials must do everything they possibly can to make surgical systems a focus of their larger health care system plans, both now and in the future. Waiting for the pandemic to end, while understandable, is not advisable given the tremendous amount of future harm that could be averted if surgical systems development were to be ramped up as soon as possible.