Surgery and Healing in the Developing World - Dartmouth-Hitchcock

CHAPTER 1
CHAPTER 17
Training to Serve the Unmet Surgical
Needs Worldwide
Robert J. W. Blanchard, Ronald C. Merrell, Glenn W. Geelhoed,
Olajide O. Ajayi, Donald R. Laub and Edgar Rodas
This chapter derives from the Panel sponsored by the International Relations
Committee of the American College of Surgeons and presented on October 25,
2000 at the 86 th Annual Clinical Congress of the American College of Surgeons.
Introduction
At the beginning of the third millenium after Christ, the world’s population
passed the six billion mark. An estimated one-third of our world—2 billion people—
still lack basic surgical care! In this chapter we attempt to address the question,
“How best may surgical needs be met in a sustainable manner within resources
available for training in less-developed populations?” Our goal is to raise awareness
of the enormous unmet needs for surgical care in less-developed regions and to
suggest alternate training methods to help meet the needs. In many developing countries,
surgical training programs are patterned after North American or European
programs. This tends to encourage subspecialization and may not produce surgeons
adequately trained to manage the broad spectrum of surgical needs for which people
attend their local district hospitals. A complete roster of surgical specialists cannot
be made available in most district hospitals throughout the world. Therefore, the
surgeons serving in these hospitals require training and experience that encompasses
a broader range of surgery than is provided by the usual programs for training general
surgeons.
Global Surgical Need in an Education Context
Robert J. W. Blanchard
Surgeons set the agenda for surgical training and, hence, surgical care throughout
the world. We may not always get it right and that is why we should review these
issues.
Part of the problem is that surgeons like to pursue the more complex technologies
and specialization. This pursuit does not match the needs in many parts of the
world because in less developed regions there are far too few surgeons to care for the
populations’ needs, let alone pursue advanced technologies. Ethiopia, Tanzania, and
many other countries and regions have 1% of the number of surgeons than Canada
has per unit population. This severe lack of surgeons results in a corresponding lack
of surgical care provided to the population. For example, using the most conservative
estimates of need for Cesarean sections, over 90% of women requiring Cesarean
Surgery and Healing in the Developing World, edited by Glenn Geelhoed.