Countries with developing economies have not considered surgical care to be a public health priority, yet surgically treatable conditions—such as cataracts (Javitt 1993); obstructed labor (Neilson and others 2003); symptomatic hernias (Olumide, Adedeji, and Adesola 1976; Rahman and Mungadi 2000); osteomyelitis (Bickler and Rode 2002; Hilton 2003); otitis media (Smith and Hatcher 1992; Whitney and Pickering 2002); and a variety of inflammatory conditions—add a chronic burden of ill health to populations. These acute and chronic conditions take a serious human and economic toll and at times lead to acute, life-threatening complications.
Inadequacies in the initial care of injured patients (Hyder and Peden 2003; Jat and others 2004; Mock 2003; Mock and others 1995); of women with obstructed labor; and of children with treatable congenital anomalies, such as clubfoot (Ponseti 1999; Turco 1994) lead to preventable deaths or to chronic disabilities that make productive employment impossible and impose dependency on family members and society.
The role of surgery as a preventive strategy in public health needs to be studied and measured far more extensively than is currently the case. Another key reason for this study is that virtually all countries are developing their economies, and as a result, developing nations are increasingly facing a double burden—that is, the infectious diseases that have historically been so relevant and the conditions that emerge with economic development (for example, trauma from motorcycle, truck, and car accidents). The inclusion of a surgery chapter in this book recognizes that surgical services may have a cost-effective role in population-based health care. Recent studies (for instance, McCord and Chowdhury 2003) show that basic hospital service, which requires no sophisticated care, can be cost-effective, with a cost per disability-adjusted life year (DALY) that is much lower than might have been expected, and can be on a par with other well-accepted preventive procedures, such as immunization for measles and tetanus and home care for lower respiratory infections (Armandola 2003; Dayan and others 2004; Moalosi and others 2003; Ruff 1999).
We have identified four types of surgically significant interventions with a potential public health dimension: (a) the provision of competent, initial surgical care to injury victims, not only to reduce preventable deaths but also to decrease the number of survivable injuries that result in personal dysfunction and impose a significant burden on families and communities; (b) the handling of obstetrical complications (obstructed labor, hemorrhage); (c) the timely and competent surgical management of a variety of abdominal and extra-abdominal emergent and life-threatening conditions; and (d) the elective care of simple surgical conditions such as hernias, clubfoot, cataract, hydroceles, and otitis media.