In 2015 the Lancet Commission on Global Surgery was convened with the goal of trying to achieve a comprehensive and thorough understanding of the challenges that impact the delivery of surgical care on a global scale as well as start to map a plan that addresses solutions. It is estimated that somewhere between four and five billion people may in fact lack adequate access to surgical care around the world. Death from this lack of access significantly outpaces the combined burden of malaria, TB and HIV annually.
While that may seem at first glance implausible, if one steps back and thinks of ‘surgery’ beyond the more simplistic notion of having a room with some equipment, someone available to perform the surgery and another to provide anaesthesia it starts to makes sense. My experience last year in Malawi working with Dignitas International supports this. To really be able to deliver complete surgical care includes addressing the issues of timeliness, expertise, safety and cost. A hospital needs to be able to evaluate acuity in the community, bring that patient in for assessment, have them medically optimized for the OR and then have a team ready to perform what is needed both safely and effectively. While absolutely essential to addressing many health challenges, surgery, when not properly considered or implemented can prove lethal. A summary of the Lancet Commision findings can be seen in this short video:
It was with this in mind that I made a visit to Baraka Hospital in Narok County, which resides in the magnificent Maasai Mara region of Kenya. With 21 years of consultant surgical experience in practice and a reasonable understanding of the factors that drive surgical outcomes I travelled to learn, provide some teaching, reflect a little and then aim to learn some more
Baraka Hospital is one of the indisputable jewels of the extraordinary We organization. With two decades of experience in the developing world it is a Canadian-based organization that works to try and improve the lives of communities around the world. Many Canadians are familiar with the passion and commitment of its founder, Craig Kielburger. The remarkable story of how he came to be an incredible driver of postive change around the world is worth exploring. We’s mission is rooted in the philosophy of enabling communities over time to become independently sustainable. By providing a ‘hand up’ and not a ‘hand out’ it relentlessly pursues a vision anchored on a belief that this can be achieved through five crucial pillars of community building. By focusing on education, heath, food, water and ultimately economic opportunity, entire communities can strive to be lifted from the hopelessness of oppressive poverty. A further understanding of this unique organization's philosophy and mandate can be found here:
Baraka Hospital, central in its location within this region of Kenya, has developed as an anchor that now provides healthcare to several of the communities that have been supported by We. From a simple clinic at the beginning to a hospital designation over the last few years, it has now reached the point where both an inpatient suite and two operating rooms have been developed. With the launch of surgery services set for next month, I went to Kenya hoping to evaluate what was being planned, provide some education to the staff and identify any obvious issues that may not have been addressed. I also wanted to see how Baraka was developing its surgery program in the context of the larger issues that plague surgery globally.
What I found was impressive. It was really exciting to be able to get some insight into a surgical program at its beginning. I met Michelle Hambly, the country director and many of the clinical staff that work in this hospital. It is through her leadership that a level of dedication, willingness, passion and commitment to good patient care exists across the facility. Correctly, the hospital has targeted only the bellwether surgical procedures that are recognized as essential in providing surgical care in low and middle income countries. If only C-Section, laparotomy and fracture surgery can be made available, millions of lives can be potentially saved around the world. Currently a mother labouring at Baraka who fails to progress must be taken down rocky road by ambulance to another facility an one hour away to undergo C-section. This can now be delivered on site and potentially earlier in labour, reducing both complications of childbirth and maternal mortality. Similarly, expertise in performing laparotomy to address common conditions such as appendicitis and fracture surgery to treat the large number of injuries secondary to motorcycle accidents will be performed. I found at Baraka a good understanding of the need for at least some form of a preoperative evaluation process. Finally the surgical and anaesthetic staff seemed adequate for what was being planned
Perhaps what was most gratifying was witnessing what seemed to be an almost at insatiable desire to learn, embrace a culture of safety and respect in the operating room and an excitement to get the project started the right way. The most well-received talk I gave was on the surgery safety checklist and the need to empower all members of the team to speak up and if needed hold the start of a case if a problem is identified. With this in mind I think Baraka will be successful, allowing We an opportunity to hopefully scale it with time. It is very much in line with the principles that were outlined in the 2015 Lancet commission.
Community Outreach Team
With Michelle Hambly
I look forward to tracking its success as I continue to explore the massive surgical challenges that will continue to affect so much of this world. I will be in Uganda next week and will aim to write about a urology experience while there.