Global Neurosurgery, WHO and the Growing Global Surgery Movement

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World Health Organization Headquarters, February 3, 2020

For many decades after the creation of the World Health Organization (WHO) in 1948, the efforts in international health were related to communicable diseases. Surgeons, anesthesiologists and other providers of emergency and trauma services, however, have long been working to convince the world’s political leaders that surgery is an essential aspect of public health.(1) Indeed, in 2008, global health thought leaders and physicians Paul Farmer, MD, PhD, and Jim Kim, MD, PhD, referred to surgery as the “neglected stepchild of global public health.”(2) When Dr. Kim was nominated in 2012 to become President of the World Bank, the first physician and public health advocate to hold this office, the stage was set for change. The World Bank Challenge was issued, which asked the world’s surgeons to make the economic case for global investment in surgery. The Lancet Commission Report on Global Surgery presented a compelling case when published in April 2015.(3) At the 2015 World Health Assembly in Geneva, all member nations of the United Nations (U.N.) voted by consensus to strengthen emergency and essential surgery, as a component of Universal Health Coverage. The Global Surgery movement had gained the support of the world’s political leaders. Now, there is an obligation to report every two years on their progress in providing access to timely, affordable and quality surgical care.

Hall of Nations, World Health Organization Headquarters, February 3, 2020

Neurosurgery Leading the Way

Neurosurgery has been a leader in responding to this challenge. The World Federation of Neurosurgical Societies (WFNS), is one of 100+ organizations in “official relations” with WHO, as a so-called non-state actor, or NSA. The American Association of Neurological Surgeons (AANS) is both a national and continental member society of the WFNS. As such, AANS members are represented at WHO by WFNS. In late 2017, Gail Rosseau, MD, FAANS, was named chair of the WFNS-WHO Liaison Committee. The group has been active and highly visible, growing to over 60 members. The WFNS-WHO Liaison Committee monitors the activities of the WHO and the U.N. and meets jointly with other stakeholders in the Global Surgery movement. (Figs. 1-3)

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Each year, a delegation of volunteer neurosurgeons attends the World Health Assembly in Geneva, at their own expense, to advocate for improved access to quality neurosurgical care. These efforts are published each year by the Journal of Neurosurgery Publishing Group.(4,5) In addition, a more detailed and illustrated report has been distributed to WFNS member society leaders and published on the WFNS website (Figure 4). The Committee holds bimonthly meetings, some virtual and some in-person, at regional and global neurosurgery meetings. The committee works closely with the WHO Global Initiative in Emergency and Essential Surgery Care (GIEESC). This important function was filled by neurosurgeon Walter Johnson, MD, FAANS(L) from 2015 to 2019. During his tenure, important initiatives in traumatic brain injury and stroke prevention and treatment were launched. Partnerships between university departments, so-called “twinning” or “dyads,” have been encouraged to promote bilateral benefits in training young neurosurgeons. The WFNS-WHO Liaison Committee also communicates with other WHO departments, including injury prevention and rehabilitation.

World Health Assembly 2015 (WHA 72) Report from the WFNS-WHO Liaison Committee published at www.wfns.org.

The WFNS-WHO Liaison Committee also works with groups like the G4 Alliance, an NGO representing over 70 organizations that champion the four ”SOTA “ specialties:

  • Surgery
  • Obstetrics
  • Traumatology
  • Anesthesia

The focus of this group is advocacy for surgical patients, bringing together many of the groups that work in critical care areas of hospitals, such as operating rooms, intensive care units and emergency departments. Many low- and middle-income countries (LMIC) focus on trauma in their contributions to the neurosurgical literature.(6)(Fig. 5) In the area of prevention of surgical conditions, the WFNS-WHO Liaison Committee is actively engaged with pediatric neurosurgeons, basic scientists and nutritionists in advocacy for optimal global folate fortification strategies to prevent spinal dysraphism. The committee chair reports in-person on WHO and Committee activities at a number of regional and global WFNS conferences and symposia. 

The WFNS-WHO Liaison Committee welcomes the activities of the newly formed Global Neurosurgery Committee, which is charged with setting global strategies and benchmarks for the Global Neurosurgery movement. All neurosurgeons are welcome to join in these efforts. To return to the message of Drs. Farmer and Kim, in their 2008 article, “Clearly, we do not want surgeons to be dragged out of the operating room to manage logistics, supply chains, the training of paraprofessionals and financing. But we do need the support and attention of surgeons if progress is to be made.”(2)

There has never been a better time to become involved in Global Neurosurgery.

Graph depicting increase in publications on neurosurgery in low and middle income countries.[6]

References

1. Wright, I. G., Walker, I. A., & Yacoub, M. H. (2007). Specialist surgery in the developing world: luxury or necessity? Anaesthesia62(s1), 84–89. doi: 10.1111/j.1365-2044.2007.05308.x

2. Farmer, P. E., & Kim, J. Y. (2008). Surgery and global health: a view from beyond the OR. World Journal of Surgery32(4), 533–536. https://doi.org/10.1007/s00268-008-9525-9

3. Meara, J. G., Leather, A. J. M., Hagander, L., Alkire, B. C., Alonso, N., Ameh, E. A., … Yip, W. (2015). Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. The Lancet386(9993), 569–624. doi: 10.1016/s0140-6736(15)60160-x

4. Rosseau, G., Johnson, W. D., Park, K. B., Sánchez, M. A., Servadei, F., & Vaughan, K. A. (2018). Global neurosurgery: current and potential impact of neurosurgeons at the World Health Organization and the World Health Assembly. Executive summary of the World Federation of Neurosurgical Societies–World Health Organization Liaison Committee at the 71st World Health Assembly. Neurosurgical Focus45(4). doi: 10.3171/2018.7.focus18295

5. Rosseau, G., Johnson, W. D., Park, K. B., Hutchinson, P. J., Lippa, L., Andrews, R., Servadei, F. & Garcia, R. M. (2020) Global neurosurgery: Continued momentum ant the 72nd World Health Assembly. Journal of Neurosurgery, 1-5.

6. Weiss, H. K., Garcia, R. M., Omiye, J. A., Vervoort, D., Riestenberg, R., Yerneni, K., … Rosseau, G. (2020). A Systematic Review of Neurosurgical Care in Low-Income Countries. World Neurosurgery: X5, 100068. doi: 10.1016/j.wnsx.2019.100068

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