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• W1971303970 abstract "Over 2 billion people, more than a third of the world’s population, live in the tropics and sub-tropics. In most of the countries of these regions, the risks of injury or death from trauma is hugely greater than in the affluent West. Furthermore, obtaining surgery for eminently curable conditions is difficult, expensive, and often hazardous. An estimate has been given that approximately 11% of the global burden of disease is surgically treatable [1]. Simple procedures that could transform a young person’s life (for example, club foot manipulation or even simple childhood inguinal herniotomy) have the potential, at minimal cost, of transforming a life. To change a young person’s crippled existence to full participation in society has the cost–benefit potential of decades rather than years or months. Such analysis appears self-evident for many healthcare workers with first-hand experience in resource-poor countries. Twenty years as a general surgeon in Zimbabwe made this abundantly clear to me. Policy makers, however, do need statistics, and it is a welcome sign that more and more data are emerging to demonstrate that surgery is indeed cost-effective. The World Health Organization (WHO) has recognized the need to roll out surgery for the masses in the developing world [2], noting en passant the dire consequences of trauma, which has reached almost epidemic proportions in many places. Trauma remains largely maltreated or untreated. Its effective treatment is, by definition, surgical. Until recently, surgery was considered an expensive luxury for enthusiasts, but major improvements in care have been shown to be achievable without huge cost inputs [3]. Real medical impact in the tropics was initially sought by dealing with global problems of gastroenteritis, malaria, malnutrition, and, more recently, human immunodeficiency virus (HIV). Immunization programs removed poliomyelitis from the world scene; spraying limited the advance of malaria, and many exotic tropical diseases once endemic have been virtually eliminated. The World Health Organization introduced its highly effective essential drugs program and the World Bank launched its essential clinical package. A Caesarean section is the only surgical intervention within this package, and it remains the commonest necessary surgical procedure worldwide. Nonetheless it is becoming manifestly apparent that a basic list of surgical procedures could be drawn up that would cater to the needs of 90% of cases. The skills of a senior specialized surgeon have been shown in one study to be unnecessary in 86.4% of cases [4]. However, the attitude toward surgery is changing. We may call this surgery for the under-resourced 2 billion of the world ‘‘Tropical Surgery,’’ for want of a better term. But who will direct this new focus on Tropical Surgery? Who will direct its path? Where will the surgeons for the WHO recommendations, for example, for circumcision to diminish the incidence of HIV disease, be found and trained? Training programs in many countries are wedded to oldfashioned Western models that are now inadequate to deal with the exigencies of the demand. The pursuit of specialization leads to well-qualified experts willing only to practice in specifically equipped centers of excellence, usually in private practice. Their contribution to the global surgical need is minimal, and yet they cost their countries vast sums in terms of educational input. Initiatives, such as M. H. Cotton (&) Service de Chirurgie Viscerale, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland e-mail: mikeytha@gmail.com" @default.
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• W1971303970 date "2010-07-07" @default.
• W1971303970 modified "2023-09-26" @default.
• W1971303970 title "The Academic Discipline of Tropical Surgery" @default.
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• W1971303970 doi "https://doi.org/10.1007/s00268-010-0701-3" @default.
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