“The burden of surgical disease in the developing world, reflecting a multitude of infectious, noninfectious, and injury-related pathologies, has received inadequate attention to date. Among the world’s poorest, a single procedure — amputation — is frequently the definitive therapy for a variety of unrelated processes such as trauma, infection, or gangrene; many die without any care at all. It is increasingly evident that access to surgical services must be rapidly scaled up — in tandem with the development of primary health care infrastructure and programs for maternal and child health and for infectious diseases — to reduce the global burden of disease.”
Although surgical care has not been seen as a priority in the international public health community, surgical disease constitutes a significant portion of the global burden of disease and must urgently be addressed. The experience of the nongovernmental organizations Partners In Health (PIH) and Zanmi Lasante (ZL) in Haiti demonstrates the potential for success of a surgical program in a rural, resource-poor area when services are provided through the public sector, integrated with primary health care services, and provided free of charge to patients who cannot pay. Providing surgical care in resource-constrained settings is an issue of global health equity and must be featured in national and international discussions on the improvement of global health. There are numerous training, funding, and programmatic considerations, several of which are raised by considering the data from Haiti presented here.