The Role and Duty of Global Surgery in Increasing Sustainability and Improving Patient Care in Low and Middle-Income Countries.

Abstract

Global health is one of the most pressing issues facing the 21st century.Surgery is a resource and energy-intensive healthcare activity which produces overwhelming quantities of waste.Using the 5Rs (Reduce, Reuse, Recycle, Rethink, and Research)provides the global surgical community with the pillars of sustainabilityto developstrategies that arescalable and transferable in both low and middle-income countriesand their high-income counterparts. Reducing energy consumption is necessary to achieving net zero emissions in the provision of essential healthcare. Simple, easily transferrable, high-income country (HIC) technologies can greatly reduce energy demands in low-income countries.Reusing appropriately sterilized equipment and reprocessing surgical devices leads to a reduction of costs and a significant reduction of unnecessary potentially hazardous waste. Recycling through official government-facilitated means reduces 'informal recycling' schemes, and the spread of communicable diseaseswhilst expectantly reducing the release of carcinogens andatmospheric greenhouse gases. Rethinking local surgical innovation and providing an ecosystem that is both ethical and sustainable, is not only beneficial from a medical perspective but allows local financial investment and feeds back into local economies. Finally, research output from low-income countries is minimalcompared to the global academic output. Research from low and middle-income countriesmust equal research from high-income countries, thereby producing fruitful partnerships. With adequate international collaboration and awareness of the lack of necessary surgical interventions in low and middle-income countries (LMICs), global surgery has the potential to reduce the impact of surgical practice on the environment, without compromising patient safety or quality of care.