Module 7: Other Surgical Needs

Plastic Surgery

Though historically global health has not been concerned with plastic surgical needs, plastic surgery is emerging as a global health issue. The need for plastic surgery is great. 66% of the surgical disability-adjusted life years (DALYS) are caused by injuries, malignancy, or congenital anomalies, which are the three categories most often treated with plastic surgery. According to WHO data, in the Southeast Asian Region alone, there are over 6.5 million DALYs per year lost to burn injuries.  In Africa, almost 2 million DALYs are lost per year because of burns, leading to a loss of $2.6 billion because of this problem. Cleft lip and palate affect about 189,000 newborns each year, representing a substantial number of people whose lives can be restored to normal with good plastic surgical care. Economic modeling on cleft lips also showed that there is substantial economic gain rendered by plastic surgical repairs, amounting to $13,000 per lip repair and $30,000 per palate repair. Hand problems and congenital problems are also amenable to plastic surgery, but it is harder to measure their incidence due to a lack of statistics. Nevertheless, it is clear that globally there are unmet plastic surgical needs. There are far fewer practitioners able to address the plastic surgical global burden of disease than the demands. “What is known about the extent of these problems indicate a massive need in the developing world that contributes significantly to poverty and the more apparent lack of physical well being. Answering this need will not only require continued efforts from the plastic surgery community but also greater recognition of the problems such that they can be addressed at the policy level.” (1)

Pediatric Surgery

Childhood surgical conditions are a significant public health problem, but unfortunately, surgical care is not considered an essential component of most child health programs. Children are not “small adults”; they develop their own distinct surgical conditions, and have unique anesthetic challenges. In many developing countries, inadequate surgical care leads to congenital anomalies that go unrepaired, and treatable injuries turn into lifelong disabilities. In developing countries, the estimated cumulative risk for all surgical conditions was 85.4% by 15 years, which suggests that a significant portion of children require surgical care at some point during their childhood. Injuries are the most common surgical problem affecting African children. In rural East Africa, injuries are the third highest cause of mortality in children, behind diarrhea and malaria. Armed conflicts also take their toll on children. It is estimated that 120,000 to 200,000 child soldiers are currently participating in such conflicts, and they often sustain bullet and shrapnel wounds, burns and land minor injuries, which require surgical care. Thus, it is important for pediatric surgical care to be included on the public health agenda, both in a preventative and curative manner. (2)

Footnotes

(1) Corlew, D. “Perspectives on Plastic Surgery and Global Health.” Annals of Plastic Surgery. 62.5 (2009): 473-477.

(2) Bickler, S., Rode, H. “Surgical services for children in developing countries.” Bull World Health Organ. 80.10 (2002).