Surgical delivery in under-resourced settings: building systems and capacity around the corner and far away.

Abstract

Service to patient and community has always been the sacred vow of every physician. Certainly for those marginalized in society—by poverty, plague, isolation, or disaster—our obligationtakesonrenewedimportance.As thephysicianFrancis Weld Peabody wrote in his classic essay “The Care of the Patient,” “One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.”1 During the past decade, this focus oncommunities inneedhasbeenreinforced in thesurgicaldisciplines by the growing interest in global surgery. Global surgery is the practice of surgery—and the development of systems for surgical care—in resource-limited settings. We now seeanewgenerationof traineespursuingcareers inglobal surgeryandanexplosionof fellowships, training tracks, andclerkship opportunities focused on global surgery.2 Additionally, there have been a number of collaborative,multi-institution, multinational efforts to incorporate surgical care into global public health discourse. Some recent examples include the publication of a volume on surgery in the third edition of Disease Control Priorities3 as well as the development of a Lancet commission on global surgery.4 Global surgery as a discipline has, to date, focused on the provision of surgical care in resource-limited settings— largely in impoverished countries around theworld—by trainees and practicing surgeons from the United States and other resource-rich settings. It is equally important, though, to recognize that resource-limited settingsdonot exist solely in lowandmiddle-incomecountries; they are also abundant as “deserts of care” in high-income countries such as the United States.5 As the field of global surgery further develops, a number of key issues are crucial to consider and emphasize, including a need to focus on systems development and capacity building, locally driven care, public health challenges and solutions, and the ethics of global surgical work.