Spreading Medical Knowledge Abroad Is Necessary and Rewarding

Dr. Smith said he once saw the surgical logbook of a resident who had completed training. The resident had done one laryngectomy, one neck dissection, no oral resections, and no reconstructions-and this was in a developed country. I don’t say this to be critical, but to point out where we may be able to model and help in teaching head and neck surgery, he said.

African Nations Need Assistance

Dr. Smith talked about sub-Saharan Africa to bring into focus the needs of disadvantaged countries.

This area contains 11% of the world’s population. But the region accounts for 24% of the world’s disease and is home to only 2% to 3% of the world’s health workers, Dr. Smith said.

A lack of surgeons in developing countries is a particularly critical problem. Out of the relatively few health workers found in sub-Saharan Africa, a smaller proportion of them are surgeons than is generally found in other parts of the world. Meanwhile, surgical conditions account for 11% of the global burden of disease, caused mainly by trauma.

Most medical students don’t want to go into surgery, Dr. Smith said. It’s hard work. There is very little reward. And if you can go into infectious disease and then get a job-maybe with WHO working on HIV or malaria or something like that-you have the potential opportunity of getting an expatriate salary with much more income.

Ninety percent of the surgical disease found throughout the world is in developing countries, Dr. Smith said. There are 234 million major surgical procedures performed worldwide each year, which is twice the number of births in a year and seven times the number of HIV cases, according to a 2008 study (Weiser et al. www.thelancet.com July 22, 2008).

Although there is such a pervasive need for surgeons, they are not spread around the world evenly. Thirty percent of the world’s population receives 75% of the world’s surgical procedures. The poorest third of the world receives only 3% to 5% of all surgical procedures, that study found.

In some countries, the maternal death rate is as high as 10%, according to the study. It also has been estimated that, in pregnancies, about 10% will require Caesarean section and yet, in these countries, only about one in 20 women who need a C-section will have it available. So you can see that surgical disease qualifies as a major public health issue, Dr. Smith said.