Abstract
Global surgery is the provision of surgical care in resource-constrained settings, usually in underdeveloped areas or countries. The context of this care creates a situation in which ethical issues are different from, and arguably, more frequent than, ethical issues in resource rich settings. The focus of this chapter is on global surgical missions in which providers from resourceful settings travel to settings with poor or limited resources to provide surgical care. This chapter begins with a description of the burden of surgical disease worldwide and a discussion of the value of making the treatment of surgical disease in low- and middle-income countries (LMICs) a priority. It then describes the benchmarks which organizations should strive to achieve in developing and reviewing global surgical missions. Finally, it presents a methodology for identifying, addressing, and resolving ethical issues that do arise during global surgical missions.
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References
Meara JG, Leather AJM, Hagander L, et al. Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569–624. https://doi.org/10.1016/S0140-6736(15)60160-X.
Bowman KG, Jovic G, Rangel S, Berry WR, Gawande AA. Pediatric emergency and essential surgical care in Zambian hospitals: a nationwide study. J Pediatr Surg. 2013;48(6):1363–70. https://doi.org/10.1016/j.jpedsurg.2013.03.045.
Wall AE. Ethics in global surgery. World J Surg. 2014;38(7):1574–80. https://doi.org/10.1007/s00268-014-2600-5.
Debas HT, Donkor P, Gawande A, Jamison DT, Kruk ME, Mock CN. In: Debas HT, Donkor P, Gawande A, Jamison DT, Kruk ME, Mock CN, editors. Essential surgery: disease control priorities, Third Edition (Volume 1); Washington, DC: The World Bank; 2015. https://doi.org/10.1596/978-1-4648-0346-8.
Cometto G, Belgrano E, De Bonis U, et al. Primary surgery in rural areas of southern Sudan. World J Surg. 2012;36(3):556–64. https://doi.org/10.1007/s00268-011-1403-1.
Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. Samet J, editors. PLoS Med. 2006;3(11):e442. https://doi.org/10.1371/journal.pmed.0030442.
Corlew DS. Estimation of impact of surgical disease through economic modeling of cleft lip and palate care. World J Surg. 2009;34(3):391–6. https://doi.org/10.1007/s00268-009-0198-9.
Ozgediz D, Kijjambu S, Galukande M, et al. Africa’s neglected surgical workforce crisis. Lancet. 2008;371(9613):627–8. https://doi.org/10.1016/S0140-6736(08)60279-2.
Muntz HR, Meier JD. The financial impact of unrepaired cleft lip and palate in the Philippines. Int J Pediatr Otorhinolaryngol. 2013;77(12):1925–8. https://doi.org/10.1016/j.ijporl.2013.08.023.
Curci M. Task shifting overcomes the limitations of volunteerism in developing nations. Bull Am Coll Surg. 2012;97(10):9–14.
Farmer PE, Kim JY. Surgery and global health: a view from beyond the OR. World J Surg. 2008;32(4):533–6. https://doi.org/10.1007/s00268-008-9525-9.
Riviello R, Ozgediz D, Hsia RY, Azzie G, Newton M, Tarpley J. Role of collaborative academic partnerships in surgical training, education, and provision. World J Surg. 2010;34(3):459–65. https://doi.org/10.1007/s00268-009-0360-4.
Mock C. A banner year for global surgery: now how to make it make a difference on the ground. World J Surg. 2015;39(9):2111–4. https://doi.org/10.1007/s00268-015-3154-x.
Mock CN, Donkor P, Gawande A, et al. Essential surgery: key messages from disease control priorities, 3rd edition. Lancet. 2015;385(9983):2209–19. https://doi.org/10.1016/S0140-6736(15)60091-5.
Price R, Makasa E, Hollands M. World Health Assembly Resolution WHA68.15: “strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage”—addressing the public health gaps arising from lack of safe, affordable and accessible surgical and anesthetic services. World J Surg. 2015;39(9):2115–25. https://doi.org/10.1007/s00268-015-3153-y.
Kwok AC, Funk LM, Baltaga R, et al. Implementation of the World Health Organization surgical safety checklist, including introduction of pulse oximetry, in a resource-limited setting. Ann Surg. 2013;257(4):633–9. https://doi.org/10.1097/SLA.0b013e3182777fa4.
Bainbridge D, Martin J, Arango M, Cheng D, Group FTE-BP-OCORE. Perioperative and anaesthetic-related mortality in developed and developing countries: a systematic review and meta-analysis. Lancet. 2012;380(9847):1075–81. https://doi.org/10.1016/S0140-6736(12)60990-8.
Hoover EL, Cole-Hoover G, Berry PK, et al. Medical care on the brink: the need for re-engineering healthcare services in sub-Saharan Africa. J Natl Med Assoc. 2005;97(3):397–404.
Sharma K, Costas A, Shulman LN, Meara JG. A systematic review of barriers to breast cancer care in developing countries resulting in delayed patient presentation. J Oncol. 2012;2012(8):1–8. https://doi.org/10.1155/2012/121873.
Choo S, Papandria D, Goldstein SD, et al. Quality improvement activities for surgical services at district hospitals in developing countries and perceived barriers to quality improvement: findings from Ghana and the scientific literature. World J Surg. 2013;37(11):2512–9. https://doi.org/10.1007/s00268-013-2169-4.
Gulland A. Medical students perform operations in Syria’s depleted health system. BMJ. 2013;346(may14 2):f3107. https://doi.org/10.1136/bmj.f3107.
Wall AE. Benchmarks for international surgery. Arch Surg. 2012;147(9):796–7. https://doi.org/10.1001/archsurg.2012.696.
Groen RS, Kamara TB, Dixon-Cole R, Kwon S, Kingham TP, Kushner AL. A tool and index to assess surgical capacity in low income countries: an initial implementation in Sierra Leone. World J Surg. 2012;36(8):1970–7. https://doi.org/10.1007/s00268-012-1591-3.
Wall A. The context of ethical problems in medical volunteer work. HEC Forum. 2011;23(2):79–90. https://doi.org/10.1007/s10730-011-9155-8.
Jonsen AR, Siegler M, Winslade WJ. Clinical ethics. 8th ed: New York, NY: McGraw Hill Professional; 2015.
Lo B. Resolving ethical dilemmas. Philadelphia: Lippincott Williams & Wilkins; 2013.
DuBois JM. A framework for analyzing ethics cases. Ethics in Mental Health Research; 2008.
Kleinman A, Benson P. Anthropology in the clinic: the problem of cultural competency and how to fix it. PLoS Med. 2006;3(10):e294. https://doi.org/10.1371/journal.pmed.0030294.
Wall AE. Ethics for International Medicine. UPNE; 2012.
Childress JF, Faden RR, Gaare RD, et al. Public health ethics: mapping the terrain. J Law Med Ethics. 2002;30(2):170–8.
Wall A, Angelos P, Brown D, Kodner IJ, Keune JD. Ethics in surgery. Curr Probl Surg. 2013;50(3):99–134. https://doi.org/10.1067/j.cpsurg.2012.11.004.
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Wall, A.E. (2019). Ethics in Global Surgery. In: Ferreres, A. (eds) Surgical Ethics. Springer, Cham. https://doi.org/10.1007/978-3-030-05964-4_14
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DOI: https://doi.org/10.1007/978-3-030-05964-4_14
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