Jan 17, 2014 — There are large proportions of the world population who aren’t getting access to high quality surgical care. The mission of the University of Utah’s School of Medicine’s Center for Global Surgery is to change that. The chair of the Department of Surgery at the University of Utah School of Medicine, Dr. Samuel Finlayson, says sharing the medical knowledge we have in the United States with those low-resource countries will help provide higher quality, better surgical care for fewer dollars.


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Interviewer: At the University of Utah School of Medicine, there is a Center for Global Surgery whose mission is to help the world get better surgical care, and in the process, maybe we can learn how to provide better care for our citizens here in the United States. Dr. Finlayson, Chair of the Department of Surgery at the University of Utah Hospital. Let's talk about the Center for Global Surgery. Why are you so passionate about it?

Dr. Sam Finlayson: The Center for Global Surgery was something that existed here before I arrived. It's run by Dr. Catherine deVries, who's a Pediatric Urologist in our department, and Dr. Ray Price, Associate Director. They came together with this recognition that there are large proportions of our world populations who aren't getting good access to high quality surgical care. I'm passionate about it because I, too, recognize that there are things that we've learned here in the United States that we can share with parts of the world that have very few resources that might be able to help them provide higher quality, better surgical care, with better access, basically, through the things that we've learned about how surgical care is delivered.
Going back in time, if you think about the way that our engagement surgically with low resource countries, the approach was really to send a surgeon there to set up a hospital and take care of people, which was a wonderfully helpful endeavor. It reaches a lot of people, but it doesn't solve the problem locally. We cannot just export all of our surgeons to take care of the surgical problems of the world.

Interviewer: And what is the problem locally?

Dr. Sam Finlayson: The problem is that they have very few resources. They tend to have few surgeons. They tend to have not a lot of dollars to build hospitals or to provide all of the things that you need to deliver surgical care. So, as I mentioned, the first approach was just to go there, send money, send doctors, and do surgery. It was pretty clear that that's not a generalizable solution to the worldwide problem.

Interviewer: And we were doing it our way? The way we would do it here, we're just doing it there.

Dr. Sam Finlayson: Right.

Interviewer: That doesn't always work out.

Dr. Sam Finlayson: Exactly. Right. So the next approach was to say, "Well, you know, these are problems that the local countries need to solve by themselves if only they would recognize what a big problem it is." So there was a lot of research done subsequent to that to try to identify where the holes were. Is it that you don't have enough surgeons? Is it that there's not enough dollars? Where is the problem? And then bring that to the attention of various countries' ministries of health to try to get some attention.
The problem with that approach is that these ministries of health of these other countries have very few resources. So anything that they decide to devote to such as providing better access to surgical care is naturally going to be pulling away from other important programs such as malaria or maternal and child health.
Where global health or global surgery is going right now is trying to figure out a way to deliver more with less. If you think about it, that's really the problem that we have in the United States. It's that we're using a huge amount of resources to deliver, you know, our basic medical care more than any other country in the world. The most recent efforts in the United States are to figure out how it is that we can provide more care and better care for less dollars. If you think about it, that's the exact same problem that these other countries are dealing with.

Interviewer: It's an interesting paradigm. It's kind of, like, when you get out of college and you don't have a lot of money, you live on that budget, but as you start making more and more, it's still difficult to live within that budget even though you're making twice as much as you did.

Dr. Sam Finlayson: Right. Right. Absolutely.

Interviewer: So in that paradigm shift, what have you learned?

Dr. Sam Finlayson: One of the things that we've learned is that, and I'll use an economic term here, there's opportunity cost. There's opportunity cost every time that surgical care is delivered badly. If somebody has to stay in the hospital for five or six extra days because they had complications, when you have limited resources, somebody somewhere didn't get hospitalized and didn't get the care they had because what would have been dollars spent for their care was instead being spent for somebody who had complications.
So a lot of the focus right now in terms of delivering more for less is focused on how to make care better to deliver higher quality care and fewer complications. There are a lot of things that we've learned in the United States about delivering surgical care, keeping track of outcomes, putting in place processes that prevent complications from occurring, and we're starting to export some of these ideas to help some partners overseas.

Interviewer: And what are some of the other things that you've learned through this process?

Dr. Sam Finlayson: One of the amazing things about humans is that when their backs are against the wall, they become remarkably resourceful. Some of the things that we've seen overseas are just incredible. For example, there's a surgeon in Africa who didn't have a centrifuge, which is a machine that spins rapidly to separate components of blood for analysis, and he engineered his own centrifuge from a bicycle. The hospital didn't have enough energy to heat the hospital, so he created a cistern below the hospital in which they threw all of the, and this doesn't create a great image, placentas from births into there, and they would then ferment and create flammable gasses which they then used to heat the hospital. It's just amazing things like that.
Another example is that there's a certain kind of vacuum-based dressing that's used to treat chronic wounds. Those in the United States are quite expensive, but in limited resources settings, people have engineered them at much lower cost using cheaper components. Some of these ideas are filtering back to the United States. We're not going to start building cisterns in which we throw placentas, I don't think, but these ideas of, "How can you get the same result with much lower cost?" And some of these ideas, for example, the wound dressing is what we're calling a reverse innovation. That is going the opposite direction. We're not taking innovations overseas. They're innovating, and we're bringing it back to the United States.

Interviewer: What would you want the general public to know about the Center for Global Surgery?

Dr. Sam Finlayson: Some people first think that it's sort of a silly ideas, you know, these poor countries, how can they possibly afford surgery? But, really, what we're discovering is that poor nations cannot afford not to pay attention to surgery. It used to be that the major causes of death were infections. As the world has evolved and industrialized, infections are going down on the list of killers and instead, you know, the main killers are things like cancer, heart diseases, and industrial accidents and injuries. So as these countries are evolving, surgery is becoming more important. The Center for Global Surgery provides a group of committed academic surgeons and their allies to focus attention on how we can solve the problems of delivering these much needed services in settings that have limited resources.

Interviewer: It sounds kind of, like, a self-absorbed question, but there are some altruistic people. That's great that we're helping people around the world. There are some people in America that might think, "How does it benefit us in the end other than maybe getting some of these reverse engineered innovations?"

Dr. Sam Finlayson: It sounds tripe, but the world is very small. What happens overseas in Africa, in South Asia, affects us. We can't anymore live in a vacuum that when there's disease, death, unrest, and epidemics overseas, economies suffer. And when economies suffer overseas, we're going to suffer as well. We can't think of ourselves as disconnected from them anymore.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, the University of Utah Health Sciences Radio.

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