KARACHI - Pakistan’s poorest citizens and those living outside major cities face the greatest challenge in accessing emergency and essential surgical and anaesthesia care, according to speakers at Aga Khan University’s 4th Annual Surgical Conference Global Surgery: Bridging the Gap.

The country has an annual deficit of 17 million surgeries, according to the World Journal of Surgery. These include lifesaving caesarean sections, orthopaedic surgeries that prevent lifelong disability, and simple procedures to treat cataracts, clubbed feet and cleft palates that dramatically enhance a person’s quality of life.

“Pakistan suffers from widespread disparities in surgical care caused by geographic, socioeconomic and political dynamics,” said Dr Sadaf Khan, conference chair and an associate professor of surgery at AKU. “These intricate and interlinked challenges are key contributors to the annual backlog of surgical procedures and call for researchers, practitioners, academics and policymakers to come together to develop interdisciplinary, innovative solutions.”

Speakers at the event noted that while the country’s National Health Vision 2016-2025 recognises the need to address such inequalities and inequities in access to healthcare, the strategy doesn’t mention the role of surgery and anaesthesia in achieving the country’s public health goals.

This is surprising since the burden of four out of seven of Pakistan’s leading causes of death – cardiovascular diseases, injuries, cancer and diabetes – can be reduced through access to timely, safe and affordable surgeries at different points of a person’s life. Yet, most hospitals outside the country’s major cities lack the infrastructure, trained surgeons and anaesthetists, and systems to treat these common diseases and conditions.

Experts at the four-day conference cited The Lancet Commission on Global Surgery’s recommendation of ‘two-hour access’, or the availability of a hospital that can conduct emergency surgeries within two hours. This is particularly important in the case of cardiac illnesses, or cases of life-threatening bleeding often caused by road traffic accidents.

Speakers noted that while ensuring timely access to care is vital, capacity constraints also need to be addressed. While there may be a hospital nearby, it may not have a trained surgeon or an experienced anaesthesiologist available. This results in delays in receiving care and leads to a patient and his attendants having to restart the search for a hospital.

They emphasised that district hospitals across the country must have the facilities, processes, systems and manpower to conduct 44 emergency and essential procedures noted in the World Health Organization’s Disease Control Priorities Edition 3. If a hospital is able to perform three procedures: emergency exploration of the abdomen, caesarean section and treatment of open bone fractures then it will have the capability to conduct 28 emergency surgeries, speakers added.

Once these facilities are available, hospitals can then focus on the remaining 16 essential procedures that have the greatest impact on reducing mortality and morbidity, according to the WHO.

The conference included a policy debate on Pakistan’s challenges which saw researchers, academics and policy experts highlight the need for the country to expedite development of its first-ever National Surgical, Obstetric, and Anaesthesia Plan.