Safer surgery is fundamental to solving global poverty

Millions face financial ruin to afford surgery. 

That's why Mercy Ships is helping to implement the WHO Surgical Safety Checklist in Africa, with the knowledge that such projects will mean the difference between a life of poverty and a life with hope.

Mercy Ships is an international charity, running a state of the art hospital ship which offers free medical care and humanitarian aid to some of the world’s poorest people. Since the charity’s creation in 1978 it has transformed the lives of more than 2.42 million people across the world.

The charity understands that safe surgery changes lives but the cost and limited access to healthcare makes surgery unobtainable for millions. 5 billion to be precise, that’s how many people in the world currently have to weigh up the dilemma of financial ruin to afford surgery.

Many people continue to be ostracized for aliments and disfigurements that surgery would quickly fix. To help address this problem Mercy Ships aims to leave a lasting legacy and a sustainable healthcare system that will benefit communities for years to come.

Developing these local health care systems and training local doctors and nurses is a major part of what the charity does. The Mercy Ships Safe Surgery team works tirelessly to improve the education surrounding safer surgery, training local healthcare workers to promote the World Health Organisation (WHO) Surgical Safety Checklist.

The WHO Surgical Safety Checklist was developed to decrease errors and adverse events during routine surgery, as well as helping to increase teamwork and communication. The 19-item checklist has proven extremely effective at reducing both morbidity and mortality and is now used by a majority of surgical providers around the world.

However, as with any new tool, one of the biggest challenges has been to ensure successful implementation of the WHO Surgical Safety Checklist. The checklist team usually comprises half a dozen Mercy Ships volunteers and several local doctors who together have been developing training programmes to help implement the WHO Checklist.

It’s been shown that using the WHO checklist system and giving health professionals a pulse oximeter, a simple piece of medical equipment for monitoring a person's oxygen levels in their blood steam, reduces deaths by a staggering 47%.

It’s such a straight forward way to make surgeries significantly safer and give local health care providers the power to change lives and transform health services which in turn helps to transform nations. 70% of operating rooms in sub-Saharan Africa don’t have a pulse oximeter. During last year’s Mercy Ships field service in Madagascar the checklist team visited 27 hospitals in Madagascar to provide training, implement the WHO Checklist project and donate Lifebox pulse oximeters.

The Madagascar Ministry of Health has recently ratified new steps towards the further development of their national surgical plan. This year the Mercy Ship is in Benin and will provide the WHO Checklist training in at least 20 hospitals throughout the nation.

With millions of people facing ruin from the cost of vital surgery it’s not difficult to understand how inextricably linked to global poverty the lack of affordable health care is. The checklist project is a small yet highly effective way to encourage and support health care professionals in the developing world who work in challenging conditions.

The safety checklist has been proven to improve surgical outcomes but the best methods for its implementation are still being carefully considered. A recent article in Global Anesthesia and Perioperative Medicine on research undertaken on the Africa Mercy concluded that team training was more effective than training a single professional (White and Muillimouno, 2016: 158-161). Cultural awareness and understanding hospital hierarchy also seems important in maximizing impact.  

Therefore, there are still many improvements to be made to the checklist system but we hope that  by developing the training alongside what Mercy Ships offers in provision of surgeries on-board ship, we are able to inject hope into situations that often seem hopeless as well as making surgery safer. Such training programmes improve and strengthen the surgical ‘eco-system’ within a much bigger national health plan.

Additionally, we hope to expand training on the correct sterilisation of instruments. Mercy Ships has provided training for this on a small scale and hopes to continue to increase this sort of training during our hospital visits in West Africa, where the Africa Mercy is currently docked.

Simply put, safe surgery saves lives.  It transforms people’s lives and gives them not just healing but offers hope and ability to work again.  Making surgery safer in the developing world isn’t just a health issue, it’s an economic one as well. Safe and affordable surgery is one of the most vital ways in which we can support developing nations and improve global public health.

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