Investing in Surgical Capacity Protects Us All
Written by Jodi Grahl
The COVID-19 pandemic starkly illustrates how the health of any individual in the world, and the quality of healthcare in any region of the world, can impact all of us. We already understood this in some ways. For example, most of us understand that polio remains a threat for the entire planet until every outbreak is eliminated. Therefore, it is in everyone’s best interest to continue to invest in vaccination campaigns even in faraway countries we ourselves may never visit. It makes sense—vaccinations are for the overall collective health of a community, not just an individual.
But can investment in surgical capacity in one faraway hospital affect the health of my community here in the U.S.? That may sound counterintuitive—a surgery treats only one person at a time, benefitting that person and perhaps their family and community. As worthy as that effort may be, how does that affect the rest of the world?
Dr. Kee Park of the Harvard Program on Global Surgery and Social Change (HPGSSC) argues that investing in surgical capacity throughout the world is actually one of the “best buys” to prepare for pandemics like the one that has currently spread across our planet, killing hundreds of thousands and plunging millions into extreme poverty. A recent webinar hosted by the HPGSSC invited doctors from hospitals in the U.S., England, Brazil, Pakistan and Rwanda to share their experiences responding to COVID-19 outbreaks. The ability of each hospital to respond was closely linked to the strength of the hospital’s surgical capacity, specifically in four categories of surgical preparedness: the hospital’s surgical staff, stuff, space, and systems. Hospitals that had full and well-trained surgical teams (nurses, surgeons, anesthesiologists, sterilization and cleaning staff); sufficient O.R. supplies (PPE, anesthesia supplies, equipment); ample operating rooms (with corresponding ventilation systems, furniture, installations), and well-established protocols and procedures (for hygiene and sterilization, interdisciplinary teamwork), were able to quickly convert that same staff-stuff-space-systems to manage and treat patients afflicted with the novel coronavirus. As noted by Dr. John Meara, Director of the HPGSSC, a hospital’s surgical capacity and workforce serve as a reservoir of critical care capacity for pandemic response.
a surgeon dons the protective materials needed for working in the O.R.
Specific examples of rapid OR-to-ICU conversion from the countries featured in the webinar include: adapting O.R. anesthesia towers to use in lieu of scarce ventilators, overseen by anesthesiologists stepping in for respiratory therapists; converting positive pressure O.R.s to negative pressure spaces by retrofitting existing ventilation systems; tapping surgical gowns, masks, and goggles to protect from viral exposure; reassigning O.R. nurses (experts in maintaining sterility) to oversee safe patient care, etc. Leaders and researchers at the HPGSSC even affirm that surgical and anesthesia care preparedness is an indirect indicator for pandemic preparedness.
COVID-19 is currently ravaging our brothers and sisters in Bolivia. We are distributing available resources on the ground to support our peers and partners there and we must continue to support their fight. The world is now painfully aware of the need to strengthen healthcare capacity in all countries, for the benefit of all. The coronavirus respects no borders or boundaries, and we affirm that access to healthcare should not either. We all breathe the same air, and we all need and deserve the same quality of care.