Nthumba Peter M
From Department of Plastic Surgery, AIC Kijabe Hospital, Kijabe, Kenya.
Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn.
Plast Reconstr Surg Glob Open. 2024 Jul 3;12(7):e5953. doi: 10.1097/GOX.0000000000005953. eCollection 2024 Jul.
Modern science has conquered seas, land, and space. Although great strides have been made in technology and infectious diseases, global surgery, which was reborn in 2015, has not made much progress. The burden of surgical disease in low- and middle-income countries remains seemingly unconquerable, and its growth unstoppable. The myriad challenges in meeting the surgical needs of 5 billion people has intrigued the author.
The author collected the views of plastic surgeons on sources and impediments to the scale-up of plastic surgery in low- and middle-income countries, as well as potential strategies for overcoming these obstacles. The author then performed a literature search reviewing the topics that arose from those discussions. The author proposes a strategy using plastic surgery as a model surgical discipline.
A root-cause analysis suggests that the Alma Ata Declaration, with its focus on primary healthcare, is the probable genesis of global surgery (GS) woes. The absence of a clear GS community leader and the fragmented nature of GS advocates who operate in multiple silos, without a clear unified goal, are the primary reasons GS advocates have achieved so little on the ground.
Global surgery requires a business model to sustainably meet the surgical needs of the 5 billion people globally. The proposed and implemented strategies must meet rigorous criteria to ensure sustainability, as quick-fix solutions are counterproductive. The development of centers of excellence offers a viable solution to problems that must be addressed successfully.
现代科学已经征服了海洋、陆地和太空。尽管在技术和传染病方面取得了巨大进展，但2015年重生的全球外科手术却进展甚微。低收入和中等收入国家外科疾病的负担似乎仍然难以攻克，且其增长势不可挡。满足50亿人口外科手术需求所面临的众多挑战引发了作者的兴趣。
作者收集了整形外科医生对低收入和中等收入国家整形外科规模扩大的来源和障碍以及克服这些障碍的潜在策略的看法。然后作者进行了文献检索，回顾了这些讨论中出现的主题。作者提出了一种以整形外科作为示范外科领域的策略。
根本原因分析表明，以初级卫生保健为重点的《阿拉木图宣言》可能是全球外科手术困境的根源。缺乏明确的全球外科手术社区领导者以及全球外科手术倡导者分散在多个孤立领域、没有明确统一目标的现状，是全球外科手术倡导者在实际工作中成效甚微的主要原因。
全球外科手术需要一种商业模式，以可持续地满足全球50亿人口的外科手术需求。所提出和实施的策略必须符合严格标准以确保可持续性，因为速效解决方案会适得其反。卓越中心的发展为必须成功解决的问题提供了一个可行的解决方案。
