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Five billion people 'have no access to safe surgery' - BBC News

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Five billion people 'have no access


to safe surgery'
By Tulip Mazumdar
Global health reporter
27 April 2015

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The study said a third of all deaths in 2010 were treatable with surgery

Baltimore ca
Two-thirds of the world's population have no access to safe and
affordable surgery, according to a new study in The Lancet - more
than double the number in previous estimates.
It means millions of people are dying from treatable conditions such as appendicitis
and obstructed labour.
http://www.bbc.com/news/health-32452249[4/28/2015 6:49:09 PM]

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Five billion people 'have no access to safe surgery' - BBC News

Most live in low and middle-income countries.


The study suggests that 93% of people in sub-Saharan Africa cannot obtain
basic surgical care.

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Previous estimates have only looked at whether surgery was available.


But this research has also considered whether people can travel to facilities within
two hours, whether the procedure will be safe, and whether patients can actually
afford the treatment.
One of the study's authors, Andy Leather, director of the King's Centre for Global
Health, said the situation was outrageous.
"People are dying and living with disabilities that could be avoided if they had good
surgical treatment," he said.

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"Also, more and more people are being pushed into poverty trying to access
surgical care."
The study suggests a quarter of people who have an operation cannot in fact afford
it.

Call for investment


Twenty-five experts spent a year and a half gathering evidence and testimony, from
healthcare workers and patients, from more than 100 different countries as part of
this report.

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They are now calling for a greater focus on, and investment in, surgical care.

2:10

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http://www.bbc.com/news/health-32452249[4/28/2015 6:49:09 PM]

Five billion people 'have no access to safe surgery' - BBC News

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Surgeons scrub up before performing surgery - but more investment is needed

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They say a third of all deaths in 2010 (16.9 million) were from conditions which
were treatable with surgery.
That was more than the number of deaths from HIV/AIDS, tuberculosis and malaria
combined.
The authors suggest the cost to the global economy of doing nothing will be more
than $12 trillion between now and 2030.
They are calling for a $420bn global investment.

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These are enormous figures and - as is nearly always the case - the greatest need
is in the poorest countries.

Numbers of trained surgical specialists per 100,000 people


UK: 35
US: 36
Brazil 35
Japan 17
South Africa: 7

http://www.bbc.com/news/health-32452249[4/28/2015 6:49:09 PM]

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Five billion people 'have no access to safe surgery' - BBC News

Bangladesh 1.7
Sierra Leone (before Ebola): 0.1
Source: The Lancet study

'Surgery not just for urban elite'


A key challenge is training enough surgeons, anaesthetists and obstetricians.
In higher income countries such as the UK, there are around 35 surgical specialists
per 100,000 people, whereas in Bangladesh there are 1.7 per 100,000 population.
Lead author John Meara Kletjian, professor in global surgery at Harvard Medical
School, said: "Although the scale-up costs are large, the costs of inaction are
higher, and will accumulate progressively with delay."

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"There is a pervasive misconception that the costs of providing safe and accessible
surgery put it beyond the reach of any but the richest countries," he added.
Experts in the field say surgery is a basic and crucial health need that has been
largely ignored by the global health community, with tragic consequences.
"The agenda has been so much focused on individual diseases and, because
surgical care is spread across so many diseases, it's been missed off," said Andy
Leather said.
"There's a myth there isn't a burden of surgical disease, that it's too costly and it's
just for the urban elite."

'People have given up'


London-based consultant obstetrician and gynaecologist, Shane Duffy, has
recently returned from a surgical training camp in central Uganda.
There he has been teaching local doctors how to carry out very specialised
'fistula repair surgery'.
This is for women who have had obstructed labours.

http://www.bbc.com/news/health-32452249[4/28/2015 6:49:09 PM]

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Five billion people 'have no access to safe surgery' - BBC News

Most sufferers lose their babies during child birth and are left with a damaged
bladder, or bowels, which can leave them incontinent and rejected by their families.
"Unfortunately a lot of people have given up on the hospitals because they can't
find surgeons there," said Dr Duffy.
"People are living in the community with debilitating conditions and they just can't
find the skilled people to help them."

Facts on global surgery


313 million operations are carried out worldwide each year.
Just one in 20 operations occur in the poorest countries, where over a third of
the world's population lives.
There is a global shortfall of at least 143 million surgical procedures every year.
Source: The Lancet

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King's College London - King's Centre for Global Health


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