AAOS Bulletin - August, 2006

WHO puts spotlight on emergency, essential surgical care

By Lynne Dowling

Emergency and essential surgical care have not been considered traditional public health priorities in developing countries, but that may change under a new initiative by the World Health Organization (WHO).

Introducing GIEESC

At a recent meeting in Washington, D.C., Dr. Meena Cherian, WHO medical officer/essential health techniques clinical procedures, announced the WHO Global Initiative for Emergency and Essential Surgical Care (GIEESC). The overall objective of the GIEESC is to improve collaborations among organizations, agencies and institutions involved in reducing death and disability from road traffic accidents, trauma, burns, falls, pregnancy-related complications, domestic violence, disasters and other emergency surgical conditions by strengthening a nation’s capacity to deliver effective emergency surgical care at the first referral level.

The specific objectives of the initiative are to strengthen the capacity to deliver effective and appropriate emergency and essential surgical procedures and to link equipment in resource limited health care facilities, thus improving the quality of care as well as training and education programs for health care personnel. (For more information, visit www.who.int/surgery)

The role of surgical interventions in poor and developing countries has been considered as minimal, because of perceived high costs and limited resource availability. As a result, these countries experience significant mortality, morbidity and disability. However, recent studies support the belief that surgical treatment of some common pathological conditions in developing countries may be more cost-effective than previously thought. The results provide evidence for including surgery as part of the basic public health armamentarium in developing countries.

The connection to AAOS

The GIEESC ties neatly into a new initiative under consideration by the AAOS International Committee. The committee hopes to develop an ongoing series of four-year phased education programs that would begin in Ghana, West Africa, and would rotate every fourth year to another region in Africa. Ultimately, the committee hopes to expand the program to other continents.

The program objectives include:

1. Teaching best practices at appropriate skill levels to the primary musculoskeletal care givers

2. Establishing a core curriculum in orthopaedics that can be adopted nationally and taught locally over time

3. Identifying a subset of future leaders and educators from the course participants and giving them the opportunity to teach their countrymen what they have learned

4. Expanding the total number of qualified personnel available to administer quality musculoskeletal care

5. Expanding the number of patients who receive appropriate and timely musculoskeletal care and disease intervention

6. Decreasing the rate of disability-adjusted life years resulting from poor, negligent or absent musculoskeletal care

AAOS program developers would incorporate the WHO educational materials into the program curriculum, and work with WHO to help spread orthopaedic education and improve the frequency and quality of essential orthopaedic surgical care services.

Miguel Cabanela, MD, chair of the International Committee, and Kamal Ibrahim, MD, chair of the West Africa education program, agree that the WHO initiative couldn’t have come at a better time.

“We are hopeful it will make for a good partnership and an even stronger, long-lived orthopaedic education program that will benefit patients worldwide,” said Dr. Cabanela.

“We will follow due diligence to ensure that the WHO finds our program model acceptable and will endorse it,” said Dr. Ibrahim. “This will not be achieved overnight, but working toward that goal from the beginning will help us with our road map to success.”

The committee also hopes that the WHO will help serve as a bridge and catalyst among the Ministries of Health in various countries, and those organizations and agencies interested in working with them to foster improved emergency and essential care surgery interventions. The result will be improved quality of life and economic stability for emerging economy nations.

Lynne Dowling is director of the AAOS international department. She was a participant in the WHO meeting where the GIEESC was announced. She can be reached at dowling@aaos.org

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