Newswise — Global surgery is often referred to as the neglected stepchild of global health, but Gregory Peck, DO, assistant professor of surgery at Rutgers Robert Wood Johnson Medical School, is trying to change that through a global surgery fellowship program that unites surgeons and non-surgeons in health systems based research and development.
While it’s estimated that five billion people lack access to basic surgical care worldwide, for years global health mainly focused on containing and eradicating communicable diseases. Both surgery and epidemiology programs, however, have been grossly underfunded and under-appreciated for their role in preserving public health with respect to non-communicable disease i.e., cancer and injury.
“I thought that if I saved one patient at a time, that would be enough. But if we can affect the entire health system, both the public health system and the hospital system, we have the potential to prevent life loss and to save thousands of lives day to day,” says Dr. Peck, who is also the associate director of the acute care surgery fellowship at the medical school.
“The goal of the acute care surgery and global surgery electives is to assess the country and or state level challenges of surgical system components —finance, governance, workforce expansion through education and training, healthcare service delivery, infrastructure, and information management—while using the same language across the world to prioritize and link such,” Dr. Peck explains. “With population data, we can to build an intact surgical system, one that derives value from improving outcomes and lowering cost.”
One of the building blocks of this framework are informed by the Lancet Commission on Global Surgery’s six core surgical indicators targets. “The six core surgical indicators guide governments’ understanding of their baseline system ability and gaps in population care,” Dr. Peck says. “Right now, there are little universal data points to compare across the world. With countries evaluating themselves against the same points, we can compare apples to apples, be aggressive in transparency, to then implement a collective best systems-based practice.”
“There’s a gross lack of systems thinking everywhere because of many sociopolitical factors that affect the optimal care of the patient. The indicators and components create the fundamental language to look at such metrics and improve them,” he adds. While there’s a shortage of surgeons, Dr. Peck explains, there’s also a maldistribution of specialty-trained surgeons that are systems thinkers. The majority of surgeons are clustered on coasts and in major cities, leaving rural and low- to middle-income communities vulnerable. Further, it’s thought that clinicians in other countries often move to the United States for training, creating a shortage, in countries abroad, he says, if trainees decide not to return home to share these systems management skills.
To make strides in improving Indicator 2—density of emergency and essential surgical providers (Anesthesia and Obstetrics included) —Dr. Peck has championed the Rutgers Acute Care Surgery Fellowship as a way to provide formal global training to acute care surgery fellows—trainees who address emergency surgery.
Global surgeons often have a societal and population view of healthcare delivery and an interest in becoming multi-sectoral administrative and collaborative leaders.
To prepare these surgeons for global roles, the fellowship participants may conduct international rotations in essential and emergency surgery and trauma systems improvement, in partnership with San Vicente Hospital in Medellín, Colombia, and the Universidad de los Andes, in Bógota Colombia, and others.
The global surgery fellows and team recently helped develop the Latin American Research Indicator Collaboratory to drive data collection, analysis, and interpretation around the six indicators. The effort seeks to merge institutions of a high-income country with one in a low- to middle-income country, usually in the form of a research fellow working one-on-one with a faculty member at both institutions. There are currently four of these units at the medical school that are aligned to conduct systems research with Colombian cities and elsewhere. Surgeons and non-surgeons in these programs are now in process development conversations with the Colombian Ministry of Health.
While Dr. Peck is passionate about improving surgical systems with Latin American colleagues, he says that the lessons learned by the co-development team there can and should be easily applied in the New Jersey and United States. “There are vulnerable populations throughout our country,” says Dr. Peck. “The United States spends more money on health care than any other country, yet it ranks roughly 30th in life expectancy and in quality indicators. Why is there this discrepancy? How are we spending so much money, yet outcomes in the socioeconomically disadvantaged populations equal those in [low- and middle-income communities]?
The key, he says, is a multidisciplinary tapping of health systems science to drive better outcomes at lower costs. The care that’s delivered must be timely, safe, and affordable. Whether the academic and management road map to do so is developed in Latin America or in North America, the result is a shared language and process for effectively assessing and informing the way surgeons and non-surgeons can work together to generate a complete health system responsibility.
Robert Wood Johnson Medical School and Robert Wood Johnson University Hospital, an RWJBarnabas Health facility and the medical school’s principal affiliate, comprise one of the nation’s premier academic medical centers. Clinical services are provided by more than 500 faculty physicians in 200+ specialties and subspecialties as part of Rutgers Health, the clinical arm of Rutgers University. To learn more about Rutgers Robert Wood Johnson Medical School, visit rwjms.rutgers.edu.
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