According to the Declaration of Human Rights and the World Health Organisation (WHO) the attainment of the highest standard of health is a fundamental human right.1,2 In a world of increasing inequalities it seems that we are far from achieving this.
In terms of global health, surgery has been neglected due to the high cost of its activities and on consideration that its ability to reduce the global burden of disease is relatively low. The global burden of disease is a comparative magnitude of health loss due to diseases, injuries and risk factors according to age, sex and geographical location in specific moments in time.3,4 However, surgical treatment is necessary to reduce this burden up to 30%. Countries with higher disease burden are less able to manage this.5,6 Difficulty of access, the high costs of treatment or inequalities between high income and lower-middle income countries are the main restricting factors.3,7,8 Lack of qualified healthcare personnel and the use of obsolete or damaged instruments reduce quality and increase complications.3 On the other hand, high quality surgery is cost-effective, increasing patients’ quality of life and reducing the economic impact of disease in low and middle-income countries.9,10
Surgical associations participate in the implementation of training campaigns, in the development of surgical campaigns or by creating bilateral agreements and relationships with fellow international associations. From its Humanitarian Collaboration Group (GCH for its initials in Spanish), the Spanish Association of Surgeons (AEC for its initials in Spanish) promotes training initiatives, alliances and project sustainability, solidifying the role of the surgeon within Global Surgery. The relationship of its members with humanitarian collaboration needs to be known in order to report actions and establish priorities. To this end, a 20-question survey was designed to ask about participation in projects, as well as the perceived importance and training in international cooperation and humanitarian collaboration ((ICHC).
The survey received 570 responses. Respondents were mostly practicing specialists (80,4%), the majority of whom were women (51%), and performed general surgery 62%) or coloproctology (12,5%). Mean age was 46 years. By age groups there was an increase in the presence of women of new generations. Seventy-three per cent of those who had participated in a humanitarian collaboration campaign had done so in surgical projects. There was a difference between the age groups in terms of participation and a strong interest in taking part in a project amongst those who had not already done so (Table 1).
Fifty-eight per cent of those who had participated in a surgical project were male. Only 28% of female surgeons had participated in surgical projects, compared with 40% of males. Fifty per cent of female surgeons had not participated in any surgical project but would like to do so. There was an upward trend in female participation in ICHC projects among the new generations (Fig. 1).
Ninety per cent stated their desire to be part of a project in the future. It was considered essential (52%) or at least important (37%) to be trained and/or have participated in ICHC projects at some time.
Pre-participation training was considered important for dealing with challenges and problems during campaigns (71%). There was a preference for training between the last years of residency and the first years as a specialist, and it was to include the development of skills in other specialties, such as gynaecology, urology or traumatology (65%). Courses should be imparted by the AEC (82%).
It is important to facilitate participation from residents in the projects, although the introduction of a specific rotation in the training programme of the speciality was not considered essential (66%).
The training of local staff is one of the basic pillars of the surgeon’s actions in the field (81%), together with care work (88%) or action in humanitarian crises (56%). Ninety-eight per cent supported the creation of professional or academic exchange programmes with subsidiary regional hospitals. Traditional models based on donations and the transfer of patients into our environment were less important.
AEC support for ICHC initialise, either financially or organisationally (98%) or through webinars/chats (95%), is of great interest. The issues arousing the greatest interest are the development of care activities in low-resource areas, the resolution of emergency pathology and the legal and organizational aspects of projects.
The results of this survey demonstrate a high level of support for ICHC projects. We can state that the training of the assistant surgeon and the training of healthcare staff in subsidiary areas are priority. The GCH of the AEC should aim at developing specific actions to improve global health through surgery, supporting and encouraging the role of AEC members in this endeavour.
FundingNo funding was received for this article.
