Archives

  • 2018-07
  • 2019-04
  • 2019-05
  • 2019-06
  • 2019-07
  • 2019-08
  • 2019-09
  • 2019-10
  • 2019-11
  • 2019-12
  • 2020-01
  • 2020-02
  • 2020-03
  • 2020-04
  • 2020-05
  • 2020-06
  • 2020-07
  • 2020-08
  • 2020-09
  • 2020-10
  • 2020-11
  • 2020-12
  • 2021-01
  • 2021-02
  • 2021-03
  • 2021-04
  • 2021-05
  • 2021-06
  • 2021-07
  • 2021-08
  • 2021-09
  • 2021-10
  • 2021-11
  • 2021-12
  • 2022-01
  • 2022-02
  • 2022-03
  • 2022-04
  • 2022-05
  • 2022-06
  • 2022-07
  • 2022-08
  • 2022-09
  • 2022-10
  • 2022-11
  • 2022-12
  • 2023-01
  • 2023-02
  • 2023-03
  • 2023-04
  • 2023-05
  • 2023-06
  • 2023-07
  • 2023-08
  • 2023-09
  • 2023-10
  • 2023-11
  • 2023-12
  • 2024-01
  • 2024-02
  • 2024-03
  • The launches in London and

    2019-04-16

    The launches in London and Boston were just that; the beginning of an education and advocacy campaign intended to highlight the pivotal role of surgical care in health system strengthening. The formal Commission report, 32 000 words of synthesis, analysis, recommendations, and indicators, is only one part of the initial Commission product. A dozen open-access business-style teaching cases have been published to provide an educational framework focused on global surgery topics. In addition, 61 abstracts were presented at the London launch and published in , and numerous full-length articles are being published in and . This is the greatest volume of academic content published in a synchronised fashion in collaboration with five independent journals ever seen in the surgical community. is publishing a special issue of Comments, Correspondence, and original research Articles linked to Commission on Global Surgery. Presenting work from all over the world, this commitment highlights the importance of international collaboration in combating “surgical marginalisation” in public health, and supports the themes and vision of the Commission.
    Universal access to safe, affordable surgery when needed depends on a sufficient and safe blood supply. This is not the case in most of the world today. The average donation rate in low-income countries (2·8 donations per 1000 population) is an order of magnitude below that of high-income countries (36·4 donations per 1000 population). To put these figures into context, take Ethiopia, which has a blood donation rate of 0·6 units per 1000 population or roughly 56 000 units per year. With just over 3 million births per year in Ethiopia, we know that between 66 000 and 230 000 mothers will require a blood transfusion for postpartum haemorrhage. In the high-income setting, the median transfusion requirement per case of postpartum haemorrhage is three units. In addition to far exceeding the existing blood supply, this cell adhesion molecules nothing for patients with other surgical conditions, trauma, and severe malarial or sickle-cell anaemia. To make the situation even worse, these low donation rates are almost certainly overestimates; they include blood that is unsafe for use, infected with organisms that cause transfusion-transmissible infections (TTIs) such as AIDS, hepatitis, malaria, and syphilis. In fact, up to 52% of blood collected in Nigeria and 14% of blood collected in Mali could be contaminated with malarial parasites and hepatitis B virus, respectively. 19% of blood collected in sub-Saharan Africa is not even tested for hepatitis C virus. In Ethiopia and beyond, patients and providers have few options when in need of a transfusion. One possibility is unbanked direct blood transfusion (UDBT), which involves on-the-spot donation from a family member or volunteer in the community, a screen for TTIs with a rapid testing kit, and a blood type cross-match. UDBT is not ideal: rapid testing kits are not as sensitive as banked blood screening protocols, family and replacement donor blood has a higher prevalence of TTIs, and the potential for coerced donation is high. Another option is commercial blood donation, whereby eligible individuals are paid for donation. Unfortunately, in the setting of poverty, payment creates perverse incentives for donation of unsafe quantities at unsafe intervals. Reports exist of commercial donors presenting to hospitals in hypovolaemic shock. However, when faced with the untenable option: forego a life-saving operation owing to lack of blood, or operate knowing the patient will die without a transfusion, UDBT or commercial donations become necessary choices. The dependence on UDBT and commercial blood donors will exist as long as reasonable alternatives do not. Rather than disregarding or banning these practices, practical interim measures should be implemented to optimise their safety. Offering formal training for providers, developing best practices and formal auditing mechanisms, and ensuring reliable provision of testing kits can be crucial to keeping patients, donors, and providers safe.