Global paediatric surgery: meeting an unmet need—the response of the British Association of Paediatric Surgeons

Many of the collaborations in global health have been focused on collaborations between high-income and low-income countries. Collaborations between low-income countries have not received as much attention or support, partly because most resources or programs come from high-income countries. Following the Lancet meeting, GICS was established to bring together surgical staff from low-income countries to come together and establish universal standards of facilities and resources required of health care institutions internationally, to provide surgical care for children at a variety of levels of dependence and acuity of their surgical condition [5]. However, another important request from the LMIC region was short-term training in surgical specialities in a better established region in LMIC (“South to South Training”). Emphasis was on regular short-term training to allow for short-term absence from the home country and avoid loss of trainees to better resourced areas within LMIC. The first South to South Training candidate was Dr. John Sekabira from Uganda who was supported by The Hugh Greenwood Children’s Research Fund to train in paediatric Surgery in Durban, South Africa. Subsequently from funds raised by individual members of the IAC, we have further supported candidates from Malawi, Tanzania, Ghana, and Ivory Coast to receive training in South African paediatric surgical centres.

The IAC continues to liaise with other organisations so that its work is not duplicated but complementary to other organisations. Liaisons have been formed with all the surgical Royal Colleges within the United Kingdom and Ireland, European Paediatric Surgical Association (EUPSA), Canadian Association of Paediatric Surgeons (CAPS), American Paediatric Surgical Association (APSA), Australasian Association of Paediatric Surgeons (AAPS), Global Initiative for Children’s Surgery (GICS) and more closely with the regions through which our courses, fellowships and scholarships are linked, namely PAPSA, COSECSA, ASEAN group, SAARC group and the Middle Eastern Association.

Trainee involvement in international affairs committee has been rigorous. A trainee representative of the IAC engages our BAPS trainees with those from some HIC but mainly from LMIC. These associations have resulted in trainee exchange with LMIC, joint research projects and joint training projects. The trainee representative is the key contact point for our international scholars and fellows.

Measuring the impact of these initiatives is difficult on a number of counts. The scale and complexity of the factors contributing to the deficit in paediatric surgical care in LMIC is so vast that any one action—however beneficial—will only produce marginal change in shifting the burden of surgical care in children, albeit in the right direction. Studies itemising the return on investment in provision of facilities have shown impressive efficiency [6] but statistical analysis is redundant in this field of medicine because of a lack of contextual reference points and proxies need to suffice instead. Surrogates such as retention and growth of the workforce and initiatives which attempt to register the characteristics and volume of surgical disease [7] in LMIC will bring some definition against which change and impact can be measured in the future. In the meantime, and in the absence of any directly linear causal relationship between the actions of bodies such as BAPS and our sister organisations, we should commit to meeting the challenges of supporting paediatric surgical care globally, through advocacy and action, and meet the aspiration of the Denis Browne maxim.