Xiong

Albert Xiong
ENGL 1102 B
Dr. Hegwood
23 April 2016
Addressing the Inaccessibility of Surgery in Developing Countries
Abstract:
This essay explores the global issue regarding the discrepancies in access to surgical
treatments between rich and poor countries. This essay analyzes the current situation of the
problem and the causes for said problem through the analysis of various published articles and
online sources. Through research, it is explained that there are roughly five billion people around
the world without access to surgical procedures largely as a result of the lack of human and
technical resources, illustrating the scope of the issue and causes for it. Beyond this, the essay
illustrates why the inaccessibility of surgery is a significant problem and looks into potential
effects that a continue ignorance of this issue may cause by describing the ethical and economic
issues that may arise. The essay lastly offers potential solutions to the problem by means of
various futuristic methods including the development of portable anesthesia machines and longdistance surgeries in order to target each of the problems stated.

Throughout the world, the disparity in healthcare access between developed and
developing countries has grown increasingly larger ever year. Currently, according to the World
Bank, it is estimated that developed countries such as the United States have the ability to spend
upwards of $5000 per capita on health services, while developing countries such as Libya and
Niger allocate roughly less than $400 per capita a year on similar expenditures (Health, 1).

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Because of this monetary discrepancy, these underdeveloped countries lack the ability to provide
myriad minor and major treatments, many of which may be life saving. Several of the treatments
that these countries are in need of require some sort of surgery but it is all to often that surgical
procedures are simply not viable. Whether this surgical unavailability stems from an insufficient
number of qualified surgeons and anesthesiologists present, the lack of infrastructure present, or
the huge costs that often come, millions suffer annually as a result. This inability to perform
necessary treatments has caused the life expectancy to remain relatively low in undeveloped
countries and has the ability to create several potential worldwide problems for humanity as a
whole in the future. Ultimately, the lack of access to surgery is a long-withstanding problem that
poses several ethical and economic problems in the short-term and long-term future, and as such,
technologies in the form of cheap and portable anesthesia machines and wireless long-distance
surgeries should be developed and broadly applied to needy regions.
In order to realize the need for confrontation of this global issue, it is important to better
understand the severity of the issue and the underlying causes for why this problem exists.
According to an article published in BMJ Global Health written by Joshua Ng-Kamstra and
others professionals this month, 5 billion people lack access to safe, affordable surgical and
anesthesia care when needed (Ng-Kamstra et. al, 1). This number is a significant part of the
population, and although not every individual of those five billion actively needs surgical
treatment, it lends to the fact that if any disease increased in prevalence in the future, literally
billions of people would be left to suffer without the necessary care. This number also illustrates
how widespread of an issue inaccessibility to surgeries is, and it also demonstrates that this
problem pervades on a global scale, not just in a single region. Although surgeries may often be
perceived as operations meant for extreme cases or conditions, the reality is that there are many

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more basic but crucial surgeries such as caesarian sections during child births and skin grafts for
burns that are also unavailable because of the overall lack of resources. Actually according to an
article written by CBCnews in April of last year, at least 143 million needed surgical procedures
many for conditions relatively easy to treat are never done, resulting in unnecessary deaths
and economic costs (Safe surgery, 5), illustrating how access to even basic types of surgeries
could help save millions of lives. The fact that millions of lives have been lost because of this
problem and billions of lives are at risk illustrate that this inaccessibility to surgery is currently a
major cause for concern.
. In regards to these surgeries, the lack of proper anesthetic equipment to induce general
anesthesia is a considerable factor for why physicians, even if present, are unable to perform
such operations. Anesthesia, in general, refers to the uses of anesthetics to induce muscle
relaxation or to prevent pain during surgery. As defined by the health library database of Johns
Hopkins medicine, general anesthesia, specifically, refers to the administration of anesthesia
through a breathing mask or through an intravenous tube in order to induce unconsciousness
throughout the procedure (Types of Anesthesia, 7). General anesthesia is indispensable in
many surgeries as these procedures may last for hours on end, and may cause extreme pain or
discomfort for patients that may be awake. However, proper anesthetic procedures can be
expensive when taking into account the costs of the machines, the chemicals and gases needed,
and the cost for physicians. These combined costs make anesthesia and anesthetic procedures a
luxury that many poorer and undeveloped countries may not be able to afford. As specific as this
problem is, the inaccessibility of anesthesia is a significant problem that must be solved in
conjunction with the inaccessibility of surgeries as a whole.

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There are also several global reasons for this issue that prevent progress from being
made. Firstly, there is overall an insufficient number of trained surgeons and anesthesiologists
that are present in the regions that need it the most, and there are many further reasons for this as
specific cause. In general, the majority of trained residents and anesthesiologists reside in more
populated cities in more developed countries, and because of this and other personal reasons,
most of them tend to gravitate towards major cities that can bring in a greater amount of patients
in a well developed area (Bharati et al, 2014). Typically travelling to poorer regions for an
extended period of time is a daunting task that not many trained physicians are attracted to or are
willing to do when there are other options nearby. In addition, working in these underdeveloped
regions provides minimal pay, especially relative to the salary that most surgeons or
anesthesiologists could be making in developed countries such as the United States. As a result,
most people who administer anesthesia in these few procedures that do occur are typically not
physicians or have very minimal training (Bharati et. Al, 2014). The surgeons that do choose to
work in these areas are still somewhat underprepared in a sense as the technology available in
these areas are typically drastically different to the technology they have been trained with and
are comfortable with using.
Beyond this shortage of qualified physicians, the lack of infrastructure and equipment in
underdeveloped countries is a major lasting problem that has prevented many surgeries. In these
needy countries, there are a lack of clean needles, epidural trays, and drugs that are often
considered basic to anesthesia, such as propofol, morphine, and naloxone (Bosenberg, 3). In
addition, unreliable power is constantly a concern that poses a problem for physicians and
patients as power failures can be cause respirators or anesthesia machines to turn off, potentially
killing the patient. In conjunction with this fact, these regions usually also house old machines

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and dated drugs which are not optimal for surgeries. Lastly, the cost of surgeries, in the form of
salaries for physicians, drugs and machines, and tools, are often too much for individuals and
countries as a whole to afford. As such, cheaper alternatives for all of these resources must be
slowly established to allocate to these countries.
This issue poses a threat to humanity on a global scale because of how pervasive issue
already is and because of the many potential detrimental future effects that may arise. According
to the World Health Organization as referenced in an article written by the University of Utah
Healthcare system this month, if surgery were available on a broader scale, approximately 2
million deaths could be prevented per year (Making much needed, para. 4). These two
million lives lost are essentially preventable deaths and should be seen as a call to action to
resolve this issue. Beyond the fact that this substantial loss of life is a tragedy in itself, these lost
lives are significant in that they have potential to effect much change on the global scale in terms
of economic development. It is actually stated in the same article that Investing in surgery
would save developing countries approximately 12.3 billion lost in GDP by 2030 (Making
much needed, para. 3), and this economic growth would prove to be beneficial not only in
furthering the progress in those countries in terms of the standard of living and productivity, but
also in increasing trade across the entire world. The increased healthy population could
contribute to productivity by working in jobs and purchasing goods, further impacting this
economic growth. In addition to this, the increased life expectancy could develop the
demographics of the world population. As seen in population pyramids for underdeveloped
countries, most of the population in these countries tend to be under the age of 30, and beyond
this age, maintenance of health is uncertain because of the lack of access to healthcare. In

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addition, infant mortality rates are high in these countries because of the inability to provide
surgical treatments to deficient babies and birthing mothers.
Continued lack of confrontation of this problem would only exacerbate the already
significant issue present as there would be an increased gap between rich and poor countries in
health care provisions. This growing gap would also further decrease awareness and motivation
in physicians to travel and work in these developing countries. In addition, the worsening
conditions, economically and in terms of living conditions, could affect the worldwide economy
drastically in the future. As such, this problem is a far impacting issue that should be attended to
as soon as possible.
In order to target all of the causes of this issue, a proposed solution includes multiple
technological advances. First, the application and development of compact anesthesia machines
such as the recently developed HYVAN could prove to be beneficial in solving a major portion
of this problem. As previously stated, the lack of anesthesia for various reasons is a major
contributor to why surgeries are inaccessible. The current HYVAN machine is a small, relatively
lightweight, suitcase-sized machine that produces similar results to those of a full anesthesia
machine while being much more simple to operate, much less expensive, and more easily
transportable. The HYVAN machine is easily reparable and requires minimal maintenance and it
is much easier to use and understand because of the simplified controls and its smaller size. As
such, these features could help resolve the issue that there are not enough qualified
anesthesiologists as the HYVAN has controls that are more easily learnable and can be operated
by people with basic understandings. If this machine were further developed to create one button
or generally easier controls, this could allow for even a wider array of people to be able to
operate it. Currently, the machine uses a rechargeable battery that can last up to 50 hours, so this

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aspect could reduce the detriments of power failures as the battery source could work
independently to external electricity sources. As a constantly developing technology, solar power
could be adapted to help power the HYVAN machine in the future in order to store an additional
source of power. However, in the case of any power failure of the machine, the current machine
already allows for manual hand ventilation for respiration just in case (About the HYVAN, 1).
As a whole, a New Zealand new source explains that the HYVAN costs roughly $20,000 which
is significantly less than full machines that achieve essentially the same result but can cost
upwards of $250,000 (Fletcher, para. 12).
In conjunction with the development of the HYVAN, currently, there have been brief
experiments observing the creation of oxygen from carbon dioxide, as according to an article
published by Zhou Lu and more in 2014 titled Evidence for direct molecular oxygen production
in CO2 photodissociation, by precisely measuring the energy and trajectory of the carbon
fragment after CO2 irradiation, O2 formation could be inferred (Lu et al, 1). Based on this
statement, in can be inferred that research and application of these results is sparse, but if this
technology is developed into a fully functional method of producing spontaneous oxygen, the
price and inconvenience of gas tanks could be removed from the equation. The advancement of
the HYVAN machine and the application of this technology could prove to be very valuable in
the future of healthcare for needy nations.
In addition to the development of this portable anesthesia machine, the use of wireless
robotic surgery machines could be extremely beneficial for these regions in the future if the cost
of this technology can be reduced. As previously stated, the lack of availability of qualified
surgeons to actually complete the operations is a major cause for this issue. As such, if this
technology is implemented, doctors across the world could operate on patients thousands of

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miles away in the comfort of their own home or office. With this, if there is a shortage of young
doctors newly graduated from training, experienced surgeons and physicians could take charge
and perform surgeries without having to travel to the patient.
Engineers and doctors have already established the foundations for the future complete
implementation of this technology. According to an article on BBC written by Rose Eveleth in
May of 2014, Dr. Mehran Anvari has already performed 20 operations including colon
operations and hernia repairs from over 400 kilometers away (Eveleth, para. 1). By 2025, the US
Department of Defense plans to create a trauma pod that enables surgeons to carry out
operations on wounded soldiers from a distance away (Eveleth, para. 11). The fact that these
technologies are already established and are being further developed illustrates that this is
honestly a practical application in the future if this issue is realized as a priority. In order to apply
this technology to further help resolve the issue of the lack of physicians as well, once the
machines are implemented, these surgeries could be used as a form of practice for medical
students or residents. In this, residents would have an incentive to perform on these patients as
they would be able to hone their skills on very needy patients without having to travel large
distances for long periods of time while also possibly reducing the costs of the surgical processes
themselves. Ultimately, if long-distance surgeries were fully developed and established
practically around the world, the technology would be able to make significant progress in
making surgery more accessible in developing countries.
The lack of access to surgery is a truly a global problem that currently affects people on
an international scale and has the potential to to become extremely detrimental to both
developing and developed countries in the near future. Because of factors such as a lack of
access to important human and technical resources, developing countries have been stuck in this

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state of helplessness regarding needs for surgical operations for many years. As such, portable
anesthesia machines and long-distance surgery techniques should be developed and applied to
countries that are in need. These proposed solutions have the capability to reduce the need for
highly trained physicians and could also dramatically reduce the cost of these surgical procedures
themselves as well. Ultimately, as significant as technological advancements could be in solving
this issue, a general shift in focus towards this issue is just as important in finally resolving this
global crisis.

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Annotated Bibliography
"About the HYVAN." Hyvan Anaesthesia. N.p., n.d. Web. 22 Apr. 2016.
This source is part of the HYVAN machine informational website as the about section.
The source was mainly used in order to detail the characteristics of the HYVAN machine
in its current development.

Bosenberg, Adrian T. "Pediatric Anesthesia in Developing Countries." Andropoulos/Gregory's

Pediatric Anesthesia Gregory's Pediatric Anesthesia (2011): 1140-151. Web. 22 Apr.
2016.
In this publication, Bosenberg illustrates the reality of the situation and explains how
important access to surgery is by stating how access to pediatric anesthesia can be seen
as a form of indication of the standard of living in a country. The article largely
describes the many challenges that are present in preventing major change on this issue
which include blood safety and pain management. The publication then briefly offers
solutions that may be able to effect improvement in this global problem.

Chowdhury, Tumul, Nishkarsh Gupta, Doug Maguire, Bernhard Schaller, Sachidanandjee

Bharati, and Ronaldb Cappellani. "Anaesthesia in Underdeveloped World: Present
Scenario and Future Challenges." Nigerian Medical Journal Niger Med J 55.1 (2014): 1.
Web. 22 Apr. 2016.
In this publication, the authors explore the anesthesia-related mortalities around the world
and describe several potential causes for this issue. As such, the authors note the lack of
human and technical resources and education as significant reasons for why this

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discrepancy exists. The article also goes into depth about potential future challenges that
may arise when targeting this issue.

Eveleth, Rose. "The Surgeon Who Operates from 400km Away." BBC. N.p., 16 May 2014. Web.
22 Apr. 2016.
In this article, Eveleth describes the work of a surgeon by the name of Mehran Anvari
who is trained to perform long-distance surgeries through robotic technology.
Furthermore, Eveleth describes the types of surgeries that have been performed and
Anvari also depicts his experiences performing such operations. The article also goes
into detail about potential future applications of long-distance surgery.

Fletcher, Jack. "Canterbury Health Innovator Wins Award for Compact Anesthesia Machine."
Stuff.co.nz. N.p., 16 Mar. 2016. Web. 22 Apr. 2016.
This article describes the recently created HYVAN machine, which is a portable
anesthesia machine meant to complete low-cost anesthesia operations in developing
countries. This article briefly discusses the technical aspects of the machines and also
give some statements from the creators of the machine of their intentions. The article
also compares the cost of the machine to full anesthesia machines.

"Health Expenditure per Capita (current US$)." World Bank Group. N.p., n.d. Web. 22 Apr.
2016.
This website was used solely for the health expenditure costs per capita in each country.
Because the website presented the costs for every country, developing and developed

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countries could be compared in terms of their allocations of funds towards health care.

Lu, Z., Y. C. Chang, Q.-Z. Yin, C. Y. Ng, and W. M. Jackson. "Evidence for Direct Molecular
Oxygen Production in CO2 Photodissociation." Science 346.6205 (2014): 61-64.
Science. Web. 22 Apr. 2016.

This publication largely detailed the results of the experiment performed to split carbon
dioxide molecules into carbon monoxide and oxygen. In this article, the procedures for
achieving such results are described by the use of high-energy ultraviolet lights. The
authors conclude that the formation of oxygen gas could be inferred and that the results
may prove to be important for abiotic oxygen production in the future.

"Making Much Needed Surgery Accessible to Billions Across the Globe." Making Much Needed
Surgery Accessible to Billions Across the Globe. N.p., 6 Apr. 2016. Web. 22 Apr. 2016.
This article is mostly an informational source used to informed people about the current
situation of the lack of surgery accessibility in many nations around the world. The
article quotes several doctors and professionals who give statements on the severity of
the issue and potential problems that may arise in the future. Lastly, the article describes
several actions that are being made in order to address the issue and hopefully lessen the
gap of surgery accessibility between rich and poor countries.

News, CBC. "Safe Surgery Unavailable to 5 Billion People, Study Finds." CBCnews.
CBC/Radio Canada, 27 Apr. 2015. Web. 22 Apr. 2016.

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This article is an information article that describes the problem in its current state. The
article illustrates how the problem stems from treatable conditions that require only basic
surgical services. The article then compares the conditions of developing countries to
those of developed countries in order to emphasize the disparity that exists.

Ng-Kamstra, Joshua, Sarah L. Greenberg, Fizan Abdullah, Vanda Amado, Geoffrey A. Anderson,
and Matchecane Cossa. "Global Surgery 2030: A Roadmap for High Income Country
Actors." BMJ Global Health (2016): n. pag. Web. 22 Apr. 2016.
The main purpose of this publication is to outline the goals that have been established to
close the gap in surgical access by 2030. The article first discusses the status quo of the
issue and developments that have occurred in addressing the issue beginning from the
the 1980's. The article then reports new findings and gives suggestions on how to solve
old and new problems.

"Types of Anesthesia and Your Anesthesiologist." Johns Hopkins Medicine, Based in Baltimore,
Maryland. N.p., n.d. Web. 22 Apr. 2016.
This source was mainly used because of its information on anesthesia and various forms
of anesthesia administration. The source describes local anesthesia, regional anesthesia,
and general anesthesia and lastly describes important factors that affect calculations in
amount of anesthesia necessary.

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