First of all, I want to share this short video from the TedxStanford gathering. It features Dr. Sherry Wren, a surgeon, discussing the need to change the commonly held dogma that surgery should not be considered part of global public health. People often view surgery as too expensive to possibly be an effective means of curing disease, which is entirely untrue. She touches on some important issues including the topic of personell (simply not enough surgeons in places like Africa or South America).
A main point of interest to me is that of personell. Our program at FACES is interesting because we continually go back to the same location in Peru, which has made our organization almost a permanent fixture in the local health economy. FACES differs from somewhere like Smile Train, which goes to one place with a huge team and then doesn’t return. We (as does Smile Train) emphasize the training of local hospital staff including surgeons, nurses and anesthesiologists (medical students, too). But, there is a major issue when training local hospital staff in a specialty surgery like cleft lip and palate. We’re working at a governmental hospital where patients who are fairly poor can obtain treatment. We invest in training programs to help the local doctors become better at providing comprehensive cleft care to these patients. But, once a local doctor is fully trained in this specialty care it becomes increasingly difficult to keep them at the governmental hospital. Their new skills make them a lucrative hire for private clinics, or provides a means for them to start their own private practices, which means they will from then on treat only patients who can pay the big bucks. This brings us back to square one because our goal is to treat patients who absolutely can’t pay for this service. So the problem is: How do you train local medical practitioners in specialty services and then retain them? Local training is key to long-term sustainability, but this problem comes up over and over again. I think one important component is finding the right person to train, someone who has a drive to succeed in medicine, but also dedicate some of their time to humanitarian work. But, it’s a bit more difficult to conceive of this combination in a developing country when incomes aren’t that high, even for doctors. The other solution I see is for the local government or an international organization to subsidize the income of these trained personell, to encourage them to treat people who really need the surgery.