1. connecting surgery to the social (justice) network ben bryner the sujal parikh memorial symposium on global health university of michigan March 26, 2011

2. why talk about surgery? it’s “the neglected stepchild of global health” personal experience 234 million operations performed yearly (compare w/ ~137 million births annually)

3. Surgery International health Things surgeons talk about Things global health experts talk about

4. this talk Surgical diseases and disparities What’s different about surgery What’s being tried Traps and possible ways to avoid them

5. burden of surgical disease Trauma accounts for 9% of mortality (WHO) ~50% between 15-44 years

6. An estimation of the global volume of surgery: a modelling strategy based on available data. Weiser, Regenbogen, Thompson, Haynes, Lipsitz, Gawande. The Lancet, 3723:9633, 139-144, July 2008

8. ~1100 units worldwide

9. 77,000 operating rooms worldwide have no pulse oximeter

10. case studies TD: 81yo with diverticulitis, complicated by multiple intraabdominal infections, pneumonia 39 separate operations and procedures 376 days in the surgical ICU 1126 notes

11. how is surgery different? less (directly) reliant on licensing heavy reliance on supply streams, prolonged training facilities / referral networks prehospital care

12. university initiatives HMS – Program in Global Surgery and Social Change OHSU – International Surgery Program International Surgery Research Fellowship UCSF - Global Partners in Anesthesia and Surgery Projects in IT, prehospital responder training Children’s Hospital Boston – Global Surgery Fellowship

13. survey of US surgery residencies Perceived barriers to international rotations: Global Health in General Surgery Residency: A National Survey Sudha P. Jayaraman, Alexander L. Ayzengart, Laura H. Goetz, Doruk Ozgediz, and Diana L. Farmer Journal of the American College of Surgeons Volume 208, Issue 3, March 2009, Pages 426-433

14. survey of US surgery residencies Reciprocal benefits to non-US sites: Global Health in General Surgery Residency: A National Survey Sudha P. Jayaraman, Alexander L. Ayzengart, Laura H. Goetz, Doruk Ozgediz, and Diana L. Farmer Journal of the American College of Surgeons Volume 208, Issue 3, March 2009, Pages 426-433

15. other organizations Canadian Network for International Surgery Bethune Round Table Workshops GHDonline/surgery

16. WHO approach Improving safety regardless of resource availability Safe Surgery Saves Lives / checklist initiative: estimated 500,000 lives per year could be saved

17. traps

18. sticking around Complications, Failure to Rescue, and Mortality With Major Inpatient Surgery in Medicare Patients. Ghaferi, Amir; Birkmeyer, John; Dimick, Justin Annals of Surgery. 250(6):1029-1034, December 2009. FIGURE 1. Mortality, complication, and failure to rescue rates for medicare patients undergoing six major abdominal operations.

19. Sujal’s example