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The Center for Global Surgery: Addressing the Need for Affordable, Accessible Surgical Care Around the World

Center for global surgerySurgery is one of those specialized fields that takes years of study, practice, and hard work to perform properly. It is an area of study that is often pursued by some of the strongest academic minds, and ultimately, it is a resource that too few people around the world have access to.

This is something that the University of Utah’s Center for Global Surgery [CGS] is hoping to change through the revolutionary work they are doing involving extreme affordability, cross-discipline international projects, and hard fought advocacy for the importance of surgery within the field of global health.

The Center for Global Surgery existed as a concept as early as 2008 according to CGS Associate Director, Ray Price, but was officially funded in 2011. The center has a number of ongoing research projects across the world, with two of their largest programs taking place in Mongolia and Ghana.

“Our goal in starting the Center for Global Surgery was to create the next generation of surgical leaders, helping them to be able to address the issues of quality and access to surgical care around the world,” Price said.

According to CGS Director, Catherine deVries, there are roughly 5 billion people in the world who do not have direct access to surgical care. Because of this, part of what the Center for Global Surgery strives for is advocacy.

“We have been very engaged with advocacy in the governmental and world health area as members of the G4 Alliance, advocating for surgical safety standards and accessibility on a global scale,” deVries said. “We’re not just working here at the university, we are very much engaged globally in advocacy and research.”

The efforts of the CGS extend beyond advocacy as well. Not only does the center regularly partner in collaborative projects with other educational and health institutions around the world, but also actively engages in education-based endeavors including teaching opportunities as well as continuing research into areas of surgical benefit for both the international community and the University of Utah.

“We want to build a framework for the study of surgical care globally. The study of the needs of surgical care and how it is put together is something that has not been studied in the realm of global health,” deVries said. “A lot of what we do involves collaboration, but we do work with education as well. The education we participate in is not provision of service like medical volunteerism, but when we are actually teaching surgery in foreign service, we do so by actually performing surgery with our foreign colleagues.”

Unlike surgical training here in the United States, the educational training provided through the CGS varies, mainly in that it must adapt to the complex needs of the country where it is being applied. While this necessary versatility can be challenging at times, deVries explained that it is not only possible, but has proven to be highly successful.

One of the ways that the Center for Global Surgery goes about adapting their teaching techniques for countries with fewer resources is by compacting the very lengthy training provided for surgeons here in the United States.

“Other countries may not have the luxury of extended training, so young people without much experience are given great responsibility,” deVries said. “So we must distill our teaching down into tight bundles that allow us to instill the essentials of surgical care during a short time period.”

One of the primary goals of the CGS is to take a closer look at the department of surgery and find a way to synergize and innovatively design solutions to problems that exist around the world.

One example that Price gave was of the work the Engineering Department has done in Mongolia. The goal was to find a cost-effective manner for performing laparoscopic surgery in a country where the majority of the nomadic population had little to no access to effective surgical care.

“Our goal was to see if we could redesign products such as surgical light or laparoscopic instruments and rather than make them for thousands of dollars, see if we could make them for $50,” Price said.

According to the Center for Global Surgery’s 2013 annual report, in Mongolia 30,000 people end up traveling abroad to seek healthcare, due to the lack of accessibility in their home country.

The resulting study on laparoscopic gallbladder surgery in Mongolia has shown remarkable results over the last nine years.

Prior to the CGS’s partnership with the Health Sciences University of Mongolia for the project, only 2% of gallbladder surgery was being done via laparoscopic surgery.

Center for global surgery“After we began teaching our classes, we found that both open and laparoscopic gallbladder surgery had increased by 17% each year,” Price said. “By 2011, non-invasive, laparoscopic surgery became the primary way of removing the gallbladder in Mongolia.”

Much of the success the Center for Global Surgery has seen through projects such as these have come through the center’s dedication to seeking out partner institutions with which to collaborate. In doing so, the goal is not only to teach proper technique and safety, but to ensure that knowledge is spread as effectively as possible.

“We’ve really worked on not just teaching surgery, but looking more deeply at what the method is for teaching surgery, and what is the best way to go about that. As a result our students now have taken our model to other [Mongolian] states to establish it,” Price said.

In the end, the results speak for themselves. Not only is Price pleased with the success of projects such as the research into laparoscopic surgery in Mongolia, but he has high hopes that the work there will have a lasting impact across the globe.

The work done in Mongolia by the University of Utah in partnership the Health Sciences University of Mongolia, has garnered the attention of the Lancet Commission on Global Surgery, which has shown interest in the successful precedent shown by the research project.

The Lancet Commission on Global Surgery estimates that $12.3 trillion could potentially be lost by 2030 due to unaddressed surgery in 88 of the world’s lower income countries, but that by putting roughly $420 billion into said countries, they would be able to very cost effectively counteract this, and help to improve these country’s surgical rates by the standard set through Mongolia’s success.

“This is an impact that is being talked about by universities around the world,” Price said. “It’s being talked about by ministries of health, all because of a lot of the work that was being done here at the University of Utah.”

As for the future of the Center for Global Surgery, both deVries and Price remain hopeful that the center will become a highly integrated part of the University of Utah’s increased focus on Global Health.

“Obviously surgery is only one aspect of global health, but we hope that by helping to strengthen the rest of global health, we can strengthen the university as whole,” Devries said.