New Horizons in Global Surgery and Beyond
“Try not to become a man of success, but rather try to become a man of value.”
-- Albert Einstein
Last week, the interplanetary space probe New Horizons, which was launched by NASA in 2006, captured photos of the most distant world ever visited by spacecraft. Its 13-year odyssey culminated in data collection from the edge of our solar system and gave astrophysicists and stargazers alike new ground for discovery. NASA’s monumental accomplishment was achieved from a clear, focused mission with the vacuum of space as the stage to pursue it. Meanwhile on Earth, endeavors are rarely as straightforward. This is illustrated by the current U.S. federal government shutdown, which emphasizes that foundations like a functioning government cannot be taken for granted.
It is common to be pulled into the inertia of a change process and lose sight of the most important piece of the puzzle—the outcome. The world is not an objective, sterile laboratory, and as such, even scientists and researchers can become consumed by the complexities of methods and forget to re-assess the impact of the work they carry out. Self-reflection and accountability are key; we must ask ourselves: Why are we doing the work in the first place? Are our motives ethical and—more importantly—are the outcomes ethical? What impact does our work and our presence in this landscape have on the environment around us? Furthermore, ethics and what constitutes ethical outcomes must be continually redefined. At its core, this means considering all potential effects that the actions of an individual or group may have on a place.
The Center for Global Surgery Evaluation (CGSE) is a new project founded by Massachusetts Eye and Ear and PGSSC faculty members Dr. Mark Shrime and Dr. Blake Alkire, both otolaryngologists and health systems researchers. In an effort to clarify the path to social change and work toward universal access to safe, affordable surgical care, the CGSE will produce outcomes research focusing on impact evaluation in global surgery. It aims to develop new scientific methodology in outcomes research and to use a systems approach to the multifactorial decisions involved in health policy, all of which lead to transitive repercussions across multiple domains.
In a 2017 study published in the World Journal of Surgery, Dr. Shrime and Dr. Alkire state that “with the crescendo of cost-effectiveness analyses in global surgery has come vast disparities in methodology, with only 15% of studies adhering to published guidelines. This has led to results that have varied up to 150-fold” (Shrime et al, 2017).
Although interventions in global surgery are begun with good intentions, complexities arise when an unintended effect of the study—often unrecognized and unaddressed—emerges. One example of incidental negative consequences is highlighted in a 2016 study in PLoS One, which explains how the two Sustainable Development Goals of ending poverty and equitably provisioning healthcare can directly conflict with each other due to the often-catastrophic costs associated with health seeking (Shrime et al, 2016). Dealing with these consequences may be difficult, but it would be impossible without first identifying them.
This is why CGSE promotes a systems-based approach to conducting global surgery research. We live in a world where global health providers are not always held accountable to systematic outcomes and the distance between intent and impact runs a deep chasm. Let’s change the expectation. New Horizons may have taken 13 years to journey to the edge of our solar system, but the outcome is monumental and marks the birth of a dramatic chapter in space exploration. The timeline may take longer here on Earth as we are faced with navigating cultures, not planets, but surely, we can hold each other accountable to scientific values and assess the larger impact that we inevitably make in the world every day.
Leah Moody, MPH works for the Center for Global Surgery Evaluation and previously led health education programs with the local Somali immigrant community in her hometown of Columbus, Ohio. You can follow CGSE on Twitter @GlobalSurgEval.
1) Shrime, M. G., Alkire, B. C., Grimes, C., Chao, T. E., Poenaru, D., & Verguet, S. (2017). Cost-effectiveness in global surgery: pearls, pitfalls, and a checklist. World journal of surgery, 41(6), 1401-1413.
2) Shrime, M. G., Sekidde, S., Linden, A., Cohen, J. L., Weinstein, M. C., & Salomon, J. A. (2016). Sustainable development in surgery: the health, poverty, and equity impacts of charitable surgery in Uganda. PloS one, 11(12), e0168867.