Clearly there is no good time for a Global Pandemic but the timing for the Global Surgery movement could arguably not have been worse. Surgery was at last featuring in the manifestos of major organisations associated with Universal Health coverage. In March 2019 Dr. Tedros Adhanom Ghebreyesus, Director General of the World Health Organization, addressed national and regional leaders for the South-East Asia, Western Pacific, Africa, and Eastern Mediterranean Regions during the National Surgical Obstetric and Anaesthetic planning meeting in Dubai, hosted by the Harvard PGSSC. He emphasised the fact that surgery is an essential part of Universal Health coverage and that nine of the thirteen targets of SDG 3 would not be attained without improved surgical care. He went on to say that as part of the WHO transformation policy, the WHO would enter into dialogue with countries to see how surgical systems could be strengthened.

In September 2019, the United Nations held a high-level meeting in New York on Universal Health coverage and as a result of some effective lobbying from the Global Surgery movement, surgery was included in the subsequent declaration. This was ratified by the General Council in October 2019 and section 35 pledges to:

Scale up efforts to address the growing burden of injuries and deaths, including those related to road traffic accidents and drowning, through preventive measures as well as strengthening trauma and emergency care systems, including essential surgery capacities, as an essential part of integrated health-care delivery.

As little as three months after the UN General Council resolution the world is faced with a pandemic and very appropriately the world’s attention has been diverted to the control and management of COVID 19, at the expense of many routine and emergency surgical programmes. However, we must not allow our mission to be more than momentarily obstructed and use this time constructively to plan for a Global Surgical Strategy for the post pandemic era. This will mean continuing to engage with the WHO, WHA, UN and other organisations to ensure that surgery remains high on the agenda. We should not be deterred by the announcement that the USA will pull out of the WHO nor by the recent editorial in the New York Times that the WHO should return to just dealing with infectious disease. This may have been its principle role at its inception in 1948 but as early as 1980 Dr Mahler, the third director general of the WHO, stressed the importance of strong surgical systems and this has been reiterated by the Lancet Commission and WHA article 68.15.

It is predicted that over 70% of routine surgeries will have been cancelled, as a result of the pandemic, some 28.4 million cases across all specialities. In neurosurgery, we also have a perceived annual deficit of 5 million cases and so it would appear as though the task is unassailable. However, if we take a moment to consider the post pandemic world, solutions may come to us.

The traditional methods of providing Global Surgery support and education have already undergone some radical rethinking with strategies moving away from the ‘Surgical Mission’ model to one that strengthens surgical systems and improving training and education. This was one of the guiding principles when Jim Johnston and I set up InterSurgeon. We wanted to create a mechanism whereby those interested in providing and receiving help could be put in contact with each other to create long lasting collaborative partnerships. Teaching, research and the development of training programmes are fundamental to our objectives and will remain so after the pandemic. Our partnership with the G4Alliance has already led to the creation of an NGO platform on the InterSurgeon website and we hope that more and more NGOs, Professional and Academic Bodies will join to strengthen the Global Surgery movement.

But what will the post pandemic world look like? Sadly, I do not have a crystal ball but my guess is that travel will become more difficult, more expensive and take considerably longer than in the past, especially to the more remote corners of the world. In addition, many institutions suffering from the financial aftermath of the pandemic may find it difficult to support members of the surgical team financially to achieve their Global Surgery Goals. This will provide further challenges to the Global Surgery movement but this is where digital technology can help us and where InterSurgeon has been concentrating its efforts during lockdown.

We are currently working with a technology company based in Jim’s home town of Birmingham, Alabama to give all InterSurgeon members free access to technology which allows the merging of two streamed video feeds. This means that a mentor at one location can provide real time help to a mentee elsewhere in the world. This could be in the operating room, the clinic or during educational sessions. This is a superlative tool whose development has been greatly accelerated by the pandemic, as it has proved indispensable to the service industry. We will be announcing roll out of this to all InterSurgeon members in the coming weeks. In addition, we are working with one of our NGO members, Ohana One, on a project using this technology in conjunction with Smart glasses and we hope that this will also offer potential in the future.

In another development, we are working with a tech company to create a case discussion app for use by InterSurgeon members. This will again be free but by building it specifically around the clinical specialities within InterSurgeon, as well as using the same clinical categories, we hope that it will be really easy to use. This will take a little longer before it is available to you all but we hope it is something that will prove useful.

In summary, the future is digital. Global Surgery provision has changed and InterSurgeon sees itself as a prime mover in this. Help us to spread the word!

William Harkness & Jim Johnston
Co Founders of InterSurgeon