THE BLOG

Unsafe Surgery Is a Global Crisis Silencing Millions of Women Around the World - Let's Talk About It

07/03/2014 11:12 GMT | Updated 06/05/2014 10:59 BST

International Women's Day is an artificial construct, but so is a banana split. It's still a rare and delightful invitation to sit down with a spoon or a microphone and talk about issues that affect women around the world.

Unsafe surgery is one of them - in fact it's a full-blown crisis - but it is hardly ever discussed.

Up to 80 percent of emergency operations in low-resource settings are obstetric-related, performed on women because they have no choice. Lack of hospital resources and equipment means surgery is often desperately unsafe -but childbirth is too.

A ruptured uterus; an obstetric fistula causing permanent incontinence; violently high blood pressure or uncontrollable bleeding - these are the natural risks of reproduction. And they're almost entirely avoidable with safe and timely surgery.

"Saving a woman's life in an obstetric emergency situation, especially when she's bleeding, is more or less a warfare and must be treated as such," explained Dr Queeneth Kalu, a Senior Lecturer at the University of Calabar Teaching Hospital in Nigeria. "All hands must be on deck."

That's a problem, because out of 234 million operations taking place each year, less than 4% are in low-resource countries. The proportion of women getting emergency surgery sounds vast, but that's because their need is so great and the volume available so small. Actually it's totally inadequate.

Surgery in low-resource settings is both difficult to access and frequently unsafe, as Queeneth noted during an obstetric anaesthesia fellowship abroad. "The early diagnosis and preparation of equipment, blood availability, personnel was such a sharp contrast to what's available in our environment when we see the same condition."

Our bodies expose us all to the same risks, but it's only in certain parts of the world that they are likely to kill us so cruelly.

"Too posh to push" is a disconnected conversation, though not infrequent in the U.K. By its very nature an emergency Caesarean section isn't a luxury, it's a magic equation: one sharp line drawn across the abdomen that saves two lives. In the U.K. there's roughly a 20 percent chance that you'll deliver your first child with surgical intervention. In Ethiopia it's more like 0.6.

There's no absolute minimum recommendation for C-section delivery, but given the risk and result of complications, it's obvious what happens when a woman in obstructed labour doesn't get to surgery.

In the space between those two figures - between 20 and 0.6 percent - are millions of women trapped in a live gothic horror. They can carry their babies safely to term for nine months but they're going to die in delivery.

Or they'll lose the baby and survive with a debilitating, isolating, medieval condition like obstetric fistula: permanent leakage of urine and feces.

"Have you ever met a woman with fistula?" asked Barbara Margolies, founder of IOWD, a charity providing fistula repair surgery to women in Rwanda. "It is absolutely devastating. When they get undressed for medical exams you will see they're wearing so many layers, plus plastic wrapped around them. The smell is so overwhelming some people can't go into the same room. They are completely alone."

It's not always easy to feel part of a global sisterhood, but physiology is a default membership card. Every woman, wherever she is in the world, knows her body and deserves the right to survive childbirth intact; to safely give birth to her baby.

Of course we know this. Reduction of maternal mortality is a key target of the Millennium Development Goals, but still the role of safe surgery is rarely addressed. In fact, it is a "truth universally acknowledged" - and as much quoted in global surgery circles as Jane Austen is in literary ones - that surgery is "the neglected stepchild of public health."

"I'm amazed when I speak to people in the public health domain who talk about the MDGs for maternal mortality but don't recognize that safe surgery must be part of these programs," explained Dr Sherry Wren, Professor of Surgery at Stanford University School of Medicine and a TEDx alumna (watch her talk on the subject of global surgery).

"There will be excess maternal mortality as long as there is no access to safe C-sections."

There will also be breast and cervical cancer; ruptured appendixes; burns, road traffic accidents, violent and sexual assault. All of these conditions require basic surgical treatment for survival - treatment we know how to provide, but have failed to extend safely to millions across the world.

Today the risk of dying from anaesthesia in the U.S. is 1 in 200,000. In some parts of the world it's up to a thousand times higher. For a woman in the fourth day of obstructed labour, exhausted and unable to deliver her baby, an operation may still, perversely, be one of the most dangerous things she can do. But what choice does she have?

Lifebox Foundation is a global health charity focused on making surgery safer in low-resource countries. And for International Women's Day we asked women from around the world to share their stories.

If you've ever had an operation; if you know a woman with a health condition that took away her ability to participate, to contribute, to live - then one of those stories belongs to you too.

Visit www.makeitzero.org or join the conversation at #UnsafeSurgeryIWD.

Unsafe surgery is a global crisis silencing women around the world. We can't sit around for a microphone; we need to start talking now.

2014-03-06-IWDcollage.jpg.jpg