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Erica Frenkel

Director, Business Strategy, UAM Global

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How do we make safe surgery part of the global health agenda?

Excluded from the Millennium Development Goals and most funders’ priorities, surgical and postoperative care is desperately lacking across health systems in low-income countries, as I discuss in my TED talk. In a 2008 article, Drs. Paul Farmer and Jim Kim state this problem bluntly: “surgery may be thought to be the neglected stepchild of global public health”.
Research shows that the need is great and growing throughout the developing world with increased incidence of road accidents, infrastructure-related injuries and non-communicable diseases such as cancers, diabetes and cardio-vascular diseases.

So why has surgery been so overlooked as a public health priority? How do we make safe surgery part of the global health agenda? What does it mean to improve access as well as safety? What players need to be involved in these efforts?

This Live Conversation will start on Feb. 23, 2012, 1:00pm EST/ 10:00am PST

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Closing Statement from Erica Frenkel

Thank everyone for a good conversation. Perhaps not surprisingly more questions were raised than were answered. Some of the salient points were raised though - is it cost-prohibitive to offer safe surgery? How do you train enough people to carry out all the roles related to surgery? How do you measure outcomes? Whose responsibility is it?

I would welcome the chance to follow up with anyone. Please feel free to email me on my profile page on TED.com.

Here's to safe surgery (and anesthesia!) everywhere, for everyone!

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    Feb 23 2012: Team approaches in the OR and beyond the hospital improve surgery safety. Does this conversation and commitment begin with surgeons and their teams? Can there be bottom up approaches?
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      Feb 23 2012: This is critical- not just internationally, but everywhere. We don't currently have teams in the OR. Imagine eleven football players showing up at the stadium to play a game and they are just meeting each other. That's what we currently do. I was Chief of Surgery at a University, but I quit so we can start a new model based on a bottom-up team approach. Loving our patients and being humble is the key to patient safety (got this from Peter Pronovost, but it is exactly what we are doing and teaching at our new academic medical center).
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        Feb 23 2012: Bruce, I'd love to hear more about the "bottom up approach" and how you were able to get funding/support internally and externally. Do you think yours is a model that would work internationally?
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          Feb 23 2012: Sorry for the delayed response- I was boarding a plane. I think it will work anywhere- construct a group of passionate people around a patient problem (our group that is farthest along is constructed around hernia disease). The group includes patients and family members and evolves into a care community. I wish I could say we have had great support, but it has not been easy- this model goes against all established organizations that have benefited from the status quo fee for service model and hierarchy and vertical department silo approach. We are now in a start-up academic medical center and have only raised some initial seed funding. But, we do have some partnerships (with a local hospital, surgeon practice group and community college) and a funded surgery residency program starting this July.
          It is interesting that we can do a more efficient job of fixing hernias at a Mission in the Dominican Republic than we can in a hospital in the US.
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        Feb 23 2012: Yes, I attended a lecture with Dr. Provonots (I'm a med student) and he talks about the power of informal authority to spur change. Simple checklists save lives and empower everyone to pay close attention. Many thanks for responding.
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      Feb 23 2012: Kathering, you make a great point - that safe surgery is not confined to the OR. I would think all actors - obvious and not obvious - would need to be involved this conversations. Naturally surgeons and their teams need to perform the surgery itself, but if we think about before and after an event in addition to during, there are a host of opportunities to strengthen the team approach that would need to begin with a strong health system. I'm thinking about referral systems and transportation to permitting timely surgery, intake/triage plans at the hospital to help prioritize patients, perioperative and recovery support/infrastructure, among many others.

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