Across the world, surgical practises and standards vary remarkably. In some regions and for some people, cost is no object and the latest technological or pharmaceutical advancement is available in plush surroundings, delivered by professional, well-trained surgeons. In other regions, the provision of surgical care is an on-going battle to do the best possible with limited resources and personnel. These disparities mirror the world-wide socio-economic imbalances which sadly persist in 2019.
One might argue that those in the more economically-developed setting have a responsibility to reduce inequality. A new service might be developed by training local surgeons through exchange programs, for example. In appropriate contexts, perfectly functional hardware deemed surplus elsewhere may find utility in resource-poor environments. Crucially, however, the exchange is not one-way and we must be sure to steer well clear of any ‘white-saviour’ complexes. Surgeons in resource-poor environments have much to teach those in economically-developed regions, where perhaps innovation and creativity of a certain form has been dulled.
Some lessons are practical. A Nepali neurosurgeon without a specialised spinal retractor modified a simpler tool, added a counter weight, and arguably made a more effective tool for the job. A Vietnamese surgeon, without access to the panoply of bovine or porcine dural graft materials to which some are accustomed, was far more adept at harvesting and using autografts. Such skills and resourcefulness are translatable and valuable in resource-rich settings. Some lessons are human: the concept of health is profoundly different across the world. Appreciating the extent of this variety can help surgeons everywhere to better tailor their care of the patient in front of them; and perhaps to think beyond established local dogma.
Opportunities abound that enable exchange and collaboration, both in person and online. GlobalSurg was established to represent practising surgeons from around the world and support collaborative international research into surgical outcomes by fostering local, national and international research networks. The Edinburgh Surgical Sciences Qualification (MSc in Surgical Sciences) is run jointly by the Royal College of Surgeons of Edinburgh and the University of Edinburgh and has a truly global student population that interact via online discussion boards. At eoSurgical, we too strive to have global reach and impact. We hope that we are democratising access to surgical simulation and our global online community of users highlights their common ground.
Surgeons around the globe have an opportunity, and perhaps even a responsibility, to promote the exchange of people and ideas that can drive a global surgical enlightenment.
Clinical Lecturer in Neurosurgery, University of Edinburgh