In November 2014, ICES will make the case for essential surgery at the the Netherland’s Society for International Surgery’s symposium on surgery in low resource settings. Please click on the link below for more information and to view the full poster.
http://www.surgicalneed.nl/
Surgery has a crucial role to play in achieving universal health coverage and fulfilling the Millennium Development Goals. Sustainable provision of surgical care and anaesthesia is a critical part of integrated primary health care.
These needs are becoming more widely recognized by the international public health community and by global policymakers. For the first time ever, a WHA global heath resolution has been formally proposed for 2015.
In most high-income countries, surgery and anaesthesia are integrated as part of the basic continuum of care. However, throughout much of the developing world, surgical care remains a neglected but critically needed component of universal health coverage. When access to safe essential surgeries is deficient, easily treatable surgical conditions can lead to devastating lifelong disability, social exclusion, economic hardship, and even death. This is the reality for over a third of the global population, which lacks access to basic, cost-effective and life-saving surgical procedures to treat simple conditions such as obstructed labor, maternal hemorrhage, congenital birth defects such as clubfoot and cleft lip, traumatic injuries and accidents, soft tissue infections, and hernias.
In preparation for the 2015 introduction of a WHA global surgery resolution, we encourage all stakeholders to join in advocacy efforts by reaching out to national government representatives, professional associations, and leaders within the field to advocate for surgery and anaesthesia as critical components of universal health coverage.
For more information on the need and role of essential surgery please visit The Right to Heal and check back here on the ICES website for updates.
ICES is a proud partner in the Bay Area Global Health Film Festival- August 19th, 2014 in San Francisco, California.
The 2014 festival will focus on advocating for “Road Traffic Safety Locally…and Globally” a critical issue not only in San Francisco but around the world as the deaths and injuries related to road traffic accidents are slated to surpass the total of those related to HIV/AIDS, Tuberculosis and Malaria.
In simple terms more people will be permanently disabled or die because of an injury than the top 3 infectious diseases COMBINED. The good news is we know how to treat these injuries, we know exactly what we need to do to curb the statistics but we need your help!
We need to amplify our combined voices to encourage the leadership, policy makers and funders to support sustainable capacity building interventions.
The Bay Area Global Health Film Festival is an advocacy event to serve as a catalyst to spark a local grassroots movement with a global impact.
The festival is sponsored by IGOT (Institute for Global Orthopaedics and Traumatology) and the UCSF Orthopaedic Trauma Institute.
The British parliament revisited the role of surgical care in global health with the introduction of a short debate question presented by Lord Ribeiro on 2 July 2014. ICES’ presence through screening the Right to Heal in the Houses of Parliament featured in the both the discussion and the call to action that followed.
Asked by Lord Ribeiro: “The purpose of this debate is to raise awareness of the value of surgery as a means of delivering effective public health.”
“To ask Her Majesty’s Government whether they will support the strengthening of emergency and essential surgical care and anaesthesia by the World Health Organisation to reduce the global burden of disease.”
What followed was a robust discussion about the need for Britain and other governments to support global health efforts by addressing the need for increased access to essential surgeries. Baroness Jolly summarized the debate with her statements and highlighted the importance of participation in the WHO Executive Board Meeting in January 2015.
Baroness Jolly (LD): “The noble Lord, Lord Crisp, and my noble friend Lord Ribeiro, through their work, have highlighted the importance of surgery across the whole world, and indeed it is a key part of disease prevention and treatment, and a public health good. We welcome the All-Party Parliamentary Group on Global Health’s recent activity to highlight this issue, including the film “The Right to Heal”.
We very much support the strengthening of emergency and essential surgical care and anaesthesia in developing countries as a component of universal health coverage, and see it as an issue of great importance. To answer a question of the noble Lord, Lord Hunt, on whether surgery can relieve many of those conditions, yes, indeed—we heard many examples in this debate, including treatment of cataracts, cleft palate and fistula.
The UK supports further consideration by the WHO executive board in January—I say that in response to my noble friend Lord Ribeiro’s first question. Action must be taken to help prevent avoidable death and disability as a result of surgery. Indeed, surgically treatable diseases are among the top 15 causes of disability worldwide. Speakers today have highlighted different examples of the appalling statistics and human suffering resulting from poor training and procedures. This position can be changed by working together. The WHO process is an important part of this work and will help commit the international community to making greater progress in raising awareness, improving data and monitoring, and increasing global collaboration on this issue.”
The full transcript of the debate can be found here.
Priscilla is a student in Kenya. She suffered a fistula following four days of unattended obstructed labour, nine months after she was forcibly sexually violated at age 15.
Because of her fistula, a condition that caused her to leak urine and feces, she was marginalized, cast aside by family and friends. Priscilla’s fistula, and the 50-100,000 new cases experienced by women every year, are totally preventable with access to essential surgery and trained medical personnel. Because Priscilla didn’t have timely access to Emergency Obstetric Care at her District Hospital her baby died and she suffered a debilitating injury that forced her to leave school and lose the support of her family and community. One in five women giving birth face these same risks.
Fistulas can be prevented with access to essential surgery during labor and delivery and can be repaired with basic surgery for as little as USD$400. Non-physician clinicians at District Hospitals, who are found to be performing about 70-80% of basic surgical procedures in countries like Malawi and Tanzania can be trained to prevent and correct fistula and perform other lifesaving procedures such as emergency Cesarean section.
Priscilla, recently underwent fistula repair surgery to correct the damage done by her labour. You can hear more about her story here.
Please join ICES and the Right To Heal in making sure all women have access to safe and essential surgery.
On May 21st, ICES co-hosted a private reception along with other civil society partners in Geneva in support of the World Health Assembly side event “Improving Safe Emergency and Essential Surgical Care and Anaesthesia.”
Hosting partners and sponsors included: International College of Surgeons (ICS), World Federation of Societies of Anaesthesiologists (WFSA), International Federation of Surgical Colleges (IFSC), Gradian Health, Operation Smile, The Right to Heal, Johns Hopkins University, Alliance for Surgery and Anaesthesia Presence (ASAP), Humanity First, International Federation of Medical Students’ Associations (IFMSA), Association of Surgeons in Training (ASiT), and The Lancet Commission on Global Surgery
“Surgical conditions kill more in our countries than infectious diseases”
This was among the common and pivotal messages shared by the leadership of Zambia, Rwanda, Nigeria, Ghana, Bangladesh, and representatives from other LMICs earlier in the day at the official WHA side event attended by more than 200 individuals from over 45 member states; statements supported by the governments of USA, Australia, Egypt, and Mongolia, among others. This message was reiterated by the voices of those suffering from untreated surgical conditions through a screening of The Right to Heal later in the evening reception.
There was also a commitment to taking action and agreement on strategies to move the agenda to increase surgical access forward. Strategies included:
Not only is now the time for surgery to be included in the health policy agenda- “We’re 30 years too late,” The Honorable Rwandan Minister of Health Dr. Agnes Binagwaho strongly stated at the WHO side event.
There was also acknowledgement by the speakers and attendees that a lack of surgical access to emergency and essential surgeries has been an issue impacting advances in global health for more than thirty years. Without increased global access to safe anaesthesia and essential and emergency surgeries, advances in universal health coverage will be incomplete.
There was agreement between the stakeholders who gathered at the Global Surgery and Anaesthesia reception that it was time to take collective action to ensure access to safe anaesthesia and emergency and essential surgery regardless of economics or geography. It was also emphasized that although momentum is growing, we should not be complacent. The Executive Board meeting next week will ultimately decide if the proposal will move up to be considered as a resolution at the WHA 68 next year. Continued advocacy is important from all stakeholders.
ICES and The Right to Heal supported the case for making essential surgery a global health priority to an audience of the House of Parliament in London on April 3rd, 2014.
The All Party Parliamentary Groups (APPG) on Global Health and on Population and Development and Reproductive Health joined forces to host a panel on essential surgery and a screening of The Right To Heal. The Right to Heal is the documentary by ICES co-founder Jaymie Ang Henry that puts the spotlight on the people who are sentenced to death and disability due to a lack of access to safe and timely basic surgical care – and those who are working to change this.
The session was opened by Lord Bernard Ribeiro, vice chair of the APPG on Global Health, as he welcomed the audience to the Houses of Parliament he stated, “We’re here today to talk about surgery, not as a luxury, but as something that changes lives.”
The panel included:
• Dr Jaymie Ang Henry, Director and Executive Producer of ‘The Right to Heal’ and Executive Director, ICES • Mr Michael Cotton, Chairman of the Board, ICES • Dr Iain Wilson, Past President, Association of Anaesthetists of Great Britain and Ireland and Board Member, Lifebox Foundation.
The room was full of leaders in the field – the Royal Society of Medicine (RSM), the Association of Anaesthetists of Great Britain and Ireland (AAGBI), The George Institute, Tropical Health and Education Trust (THET), Lifebox, and The Lancet Commission on Global Surgery, among other distinguished guests.
The panelist introduced the philosophy behind the making of The Right to Heal, which included a discussion about why there is global inequity in access to essential surgery and explored some of the reasons for this phenomenon.
The statements that followed made a compelling case as to why the Global community must make essential surgery part of the public health dialogue and a public health and funding priority. Among them:
“People are dying unnecessarily, and with great suffering,” said Michael Cotton, surgeon, co-founder and chair of the International Collaboration for Essential Surgery (ICES). “It’s not necessarily complicated or expensive to deliver essential surgery, it’s a cost-effective, one-off intervention with life-long results. These are the things that really need to be done.”
The panel facilitated questions and a discussion that resulted in the following points of consensus:
• Education and training is vital for providers in LMICs who are already performing surgeries; regardless of whether they are clinical officers, doctors in training or other community workers. • There is a need to drive the Essential Surgery agenda forward and make it take its right of place in the Public Health forum amongst the sustainable development goals (SDG’s). • There is a need for integrated ethical training for medical electives in overseas environments, where there is opportunity to develop clinical/surgical skills. • Raising awareness about essential surgery as a form of primary care in communities afflicted by shortages is critical to increasing access to care. • Governments have a responsibility to be receptive to change and to acknowledge essential surgery as being necessary to meeting the Public Health agenda for non-communicable diseases.
The message of the film needs to be carried forward and out into the wider public domain – Dr. Henry discussed initiatives that have already successfully done so, as well other future plans.
Lord Riberio concluded the discussion, by stating that “there is a need to take this message forward and that there needs to be a plan to enable this to happen”. With the MDGs expiring in 2015 it’s a vital time to get surgery on the international agenda and Lord Riberio called for support from the Lancet Commission and the British Medical Association (BMA).
The message is clear; a lack of access to safe surgery is a global health crisis, but like tackling polio or HIV, increasing surgical capacity not an impossible undertaking. ICES is working to contribute the solution through increasing awareness, education of policy makers, research and innovations in surgical training models.
Presentation at ASIT (Association of Surgeons in Training) Belfast, UK 29th March 2014.
Thanks to the invitation of the outgoing president, Mr Andi Beamish, The Right to Heal was screened at the Association of Surgeons in Training (ASiT) conference, the only UK-wide surgical trainee conference for all specialties. Professor Michael Cotton, Chairman of ICES gave an abbreviated outline of the purpose and goal of ICES. This was followed by a presentation by Dr. Jaymie Henry, Executive Director of ICES, of the global advocacy efforts around Essential Surgery via the 15x15 campaign.
Over 600 delegates had gathered in Belfast’s spacious auditorium, where only a few months earlier, US President Barack Obama had adressed the G8 summit. Your ICES presenters felt not just a little awed at the prospect of speaking to such a large audience, which included all four presidents of the British and Irish Royal Colleges of Surgery, rarely present all together at any one event.
This was thus a huge privilege, as well as a great responsibility.
During the showing of the Right to Heal film the audience was hushed in rapt attention: indeed, when the viewing had finished, you could have heard a pin drop. Furthermore, during both talks, the same fixed concentration was virtually palpable throughout the auditorium.
Numbers of surgical trainees afterwards presented their compliments, and registered their keenness to get involved.
There was no doubt that the UK Surgeons of the future were as enthusiastic for the aims of ICES, as they were afterwards at jiving to the excellent sounds of the medical band, the Arythmics, in the grand replica dining hall of the Titanic, recreated in Belfast’s dockland.
The International Community Calls for a “Right to Heal” to improve child and maternal health, to save lives and for Essential Surgery to become a health priority for the global agenda for the post-2015 Sustainable Development Goal. “Surgical interventions play a major role in helping to prevent death and chronic disability. Despite this fact, surgical interventions are not accessible by everyone.”
On February 6, 2014, the International Collaboration for Essential Surgery (ICES) hosted its first UN Side Event in conjunction with the 8th and final Open Working Group on Sustainable Development Goals (post-2015). This official UN event focused on how women and children are unnecessarily suffering from health issues easily remedied by essential surgery.
The event also included a special screening of the Right To Heal.
The lack of essential surgery is a worldwide problem that is often hidden from view and is impacting the ability of women and children to fully participate in their economies and communities. Two out of every seven people on the planet lack access to basic surgical care, and most live in low- and middle-income countries. Women in developing countries who survive obstructed births are often disabled and injured due to obstetric fistula and infection- conditions that damage the reproductive tract and structures near the birth canal, causing incontinence and pain. These women are abandoned, outcast by society and denied their fundamental rights to health and wellness. Children who are born with severe disabilities are robbed of their potential in infancy. By increasing access to the most essential surgeries, these issues can be addressed. By ensuring their “right to heal,” these women and children will be empowered to reach their full potential as productive and equal members of society.
Without a focus on essential surgery, the crisis is one of access and priority. Speaker after speaker emphasized how women are dying and suffering from conditions associated with obstructed labor and pregnancy. Speakers at the event included:
Ms. Anita Sharma, Senior Director, Millennium Development Goals Initiatives, Every Woman, Every Child, UN Foundation welcomed the group and reiterated UNF’s commitment to women and children. She linked the need for essential surgery to the global movement to improve the health of women and children around the world and spoke of the importance of meetings such as the side event that unite leaders from government, the private sector and civil society in prioritizing women's health.
Ms. Ellen Maduhu- Second Secretary of Social Humanitarian and Cultural Issues, Women, Children in Armed Conflict, Refugees, IDPs, a representative from the Tanzania Permanent Mission to the United Nations; set the tone for the UN-approved side event on the role of surgical access and women’s equity. She then made a proposal on behalf of the Tanzanian Government that essential surgery be included as a sustainable development goal in the post-2015 agenda within the framework of universal healthcare.
Official Statement from the Government of Tanzania
Maya Azucena - Global Singer, Cultural Ambassador and human rights activist spoke on the right to hope and that no woman should ever be a burden, but allowed to achieve their truest potential.
Gillian Slinger – Campaign to End Fistula, United Nations Population Fund, spoke passionately about the public health crisis of fistula and the real dangers faced by women with fistulas during subsequent deliveries. She further emphasized that these women are the most marginalized people in society, denied of their basic right to live and work where they choose because of their condition.
ICES' cofounder, Jaymie Ang Henry, MD, MPH emphasized that half of the world is female and that neglected conditions treatable by surgery are becoming a leading cause of death globally. “It’s imperative that we take action to ensure that women and children have access to essential surgery. Women and children are dying in childbirth and from other conditions because they don’t have access to the most basic surgeries like caesarean section- surgeries that can and do save lives during obstructed births. I myself survived childbirth because I had access to essential surgery. No woman should fear injury or death during childbirth.”
“Despite global achievements and our commitments, actions need to be taken beyond 2015 to ensure that women do not die while giving birth. Governments such as mine (Tanzania) despite our good intentions and commitments are very much constrained. We still need the support from different stakeholders like the United Nations system, our development partners, the private sector and civil societies to look for an effective workable strategy beyond 2015 that will end preventable deaths among children and women.” said Ms. Maduhu.
All speakers called for universal support for essential surgery as a global priority. Representatives from the governments of the USA (Health and Human Services, HHS), Tanzania and Belgium convened with a community of NGOs, academia, and corporate leaders working to address maternal mortality and to explore how to advance access to essential surgery to women and children. The HHS expressed their continuing support for surgical care at the World Health Assembly and outlined their efforts in drafting a resolution for surgical care and anaesthesia in collaboration with stakeholders across multiple sectors.
The event was hosted by the International Collaboration for Essential Surgery, International Federation of Surgical Colleges, and the Association of Surgeons of Great Britain and Ireland with Johns Hopkins University as a collaborating partner. The UN Foundation provided the venue for the event.
Attendees include representatives from:
Operation Smile, Kupona Foundation, Doctors Without Borders/Médecins Sans Frontières, Smile Train, Lifebox, Gradian Health, Johnson and Johnson, Jhpiego
For over a decade, the Millennium Development Goals (MDGs) have been a guiding force on many issues affecting global health. Progress has been made in improving maternal health, reducing preventable childhood deaths, and in lowering the transmission rates of communicable diseases. There is also a shared understanding and awareness of the linkages between health and poverty. That being said, much work remains – both on the unfinished and continuing agenda of the MDGs and in addressing critical issues not adequately covered by the MDGs.
The lack of access to essential surgery for the world’s poor is one of the biggest global health problems that no one has ever heard of and is conspicuously absent from the MDGs and the post-2015 Development Agenda.
The disease burden in low- and middle- income counties has seen a significant shift towards non-communicable diseases and trauma. According to the World Health Organization, 2 billion people in the world have no access to basic surgical care. 180 million people globally suffer from the conditions essential surgical iInterventions can easily treat. Simply put, for the first time in history, you’re more likely to be killed by a surgically-treatable condition than a communicable disease in certain parts of the world.
The MDGs are set to expire in the year 2015, and, while the focus needs to remain on continuing to achieve progress on these goals, individual citizens and development actors alike are already thinking about what the next era of development – post-2015 – should look like.
ICES is firmly committed to ensuring that global health- and that the wellness of women and children – remain at the centre of the next development agenda, as they have been with the MDGs.
We believe that it is time to expand our sense of urgency beyond communicable and infectious diseases and to articulate specific essential surgical goals and measures for the next development agenda. We call for urgency in addressing a second global scourge: the diseases of modern times which can be easily treated through increased access to essential surgery.
Let us look with hope and determination to a time when no family grieves the loss of a mother because her labour was obstructed, where no mother suffers the pain of burying a child whose burns and wounds were not properly treated, and no one needlessly suffers a lifetime of disability from easily treatable conditions.
Tomorrow, we are engaging with UN agencies, governments, NGOs, humanitarians, and all humans alike who believe that it is time to talk about essential surgery and their role in empowering women and children in the post-2015 era. People lie at the heart of sustainable development and it is time to include them in the conversation.
