Several years ago, researchers calculated how many people were affected by the global shortage of surgeons, and the numbers were stunning: 17 million people a year die. How did health leaders miss this story for so long?
The answer: No one had a body count.
That changed in the mid-2000s, thanks largely to Haile Debas, a surgeon who once described himself as a "living example of brain drain."
Debas was born in what today is Eritrea, which once was part of Ethiopia on the Red Sea coast. As a young man, he wanted to be a fighter pilot but eventually turned his attention to medicine. He moved to Canada where he received his medical degree. The University of California San Francisco eventually recruited him to take over its surgery department, and he eventually became the university's chancellor.
In the early 2000s, the World Bank asked him to write a chapter about the state of global surgery. He and his colleagues knew on an anecdotal basis that many countries lacked access to surgeons, he said.
"We expected there would be very little data, but we didn't expect there would be almost no data. We were very surprised."
Debas and his colleagues embarked on a worldwide survey and published their results in 2006: 11 percent of the world's diseases and injuries and other health problems could be treated by surgeons. Eleven percent represented an incredible amount of suffering when applied to the world's population, said Debas, adding that he knew the estimate was probably conservative.
But it was the first time researchers had put a number on the problem, and doing so clarified the issue's importance. Other researchers used that to do further studies.
In 2008, a Harvard team thought studying the availability of pulse oximeters might be revealing. Hospitals without these simple fingertip oxygen monitors couldn’t properly do surgeries. Why not find out how many hospitals had these devices? Do that and you’d have another way of measuring the surgical deficit.
After poring over data on pulse oximeter availability in 92 countries, they came up with another powerful number: An estimated 2 billion people worldwide had no access to surgery.
One of the study’s authors was Atul Gawande, who would later write: “Surgery is an indivisible, indispensable part of health care, but it is treated as a luxury.”
Another Harvard-led team came up with the first estimate of the total number of surgeries done every year across the world — a staggering 234 million operations. Researchers then examined where these procedures were done. They discovered that the richest third of the world’s population accounted for 75 percent of the surgical procedures while the poorest third made up just 4 percent.
The conclusion was unmistakable: In many places, surgery was the province of the wealthy. More recently, the Lancet Commission on Global Surgery estimated that 5 billion people lacked access to safe and affordable surgery, and that this deficit will create a $12 trillion drag on the world's economy by 2030.
"Trauma itself kills 5 million people," Debas said. "And especially in Africa, these are often people who are young and in productive stages of their lives."
More than 500,000 women die every year in labor, often because no surgeons were available to treat birth complications.
Debas, also the founder of UC San Francisco Global Health Sciences, said he hopes government and major global health funders focus on the shortage of surgeons with the same vigor as they did with HIV/AIDS, malaria and tuberculosis. The surgical deficit, he said, "is a huge and silent epidemic."