The World Health Organization (WHO) recently designated the Department of Anesthesia and Perioperative Medicine, at the Schulich School of Medicine & Dentistry, as a WHO Collaborating Centre. A first-of-its-kind designation for the university, the team was tapped to address the issue of access to safe surgical and perioperative care on a global scale.
WHO recently designated emergency and essential surgery as an emerging pillar of its work based on the fact five billion people around the world don’t have access to essential life-saving surgery, and 30 per cent of the global burden of disease would be preventable through adequate access to safe essential surgical services like C-sections and orthopedic procedures.
“The global burden of disease, because of lack of access to surgery, by far outpaces the global burden of disease for HIV, malaria and tuberculosis combined,” said Dr. Janet Martin, who, along with Dr. Davy Cheng, is a project lead on the WHO Collaborating Centre. “Now, it is our responsibility to shine the light on this problem. The numbers are staggering.”
WHO Collaborating Centres are institutions – such as research institutes, parts of universities or academies – designated by the Director-General to carry out activities in support of the organization’s programs. Currently, there are more than 700 WHO collaborating centres in more than 80 member states working in areas such as nursing, occupational health, communicable diseases, nutrition, mental health, chronic diseases and health technologies.
One of only 28 Canadian centres, the Schulich team is the first collaborating centre in the world to be designated by the WHO to study perioperative surgical care. They will research the gaps in resources, capacity, infrastructure and training in countries around the globe in order to develop evidence-based priorities and put forward recommendations for change.
“It is a huge honour. We are looking forward to fulfilling the task of supporting timely progression towards universal safe and effective essential surgery,” said Cheng, Chair-Chief of the Department of Anesthesia & Perioperative Medicine, as well as Medical Director of Medical Evidence-Decision Integrity-Clinical Impact (MEDICI) Centre at Schulich.
Martin and Cheng already understand what it means to inform health-care policy on a global stage. At the height of the Ebola crisis, they led a team at WHO Geneva to develop evidence-informed guidelines for surgery and anesthesia care in patients with suspected Ebola infection.
That situation was so dire one West African hospital lost half of its surgical workforce because they were exposed to Ebola in a surgical setting.
“The question we needed to answer was how the surgical team manages patients who may or may not be effected by Ebola,” said Martin, an assistant professor in the departments of Anesthesia & Perioperative Medicine and Epidemiology & Biostatistics, as well as MEDICI Director. “We took a look at what level of protection needs to be available for the surgical team and all of the support services in the surgical and perioperative system for patients coming through.”
MEDICI Centre researchers also caught the attention of WHO after a landmark paper they published in the Lancet in 2012. That study examined 21.4 million global surgical procedures, and showed the risk of perioperative mortality has been declining during the past five decades, but only in high income countries. The risk of death after surgery in low- and middle-income countries has plateaued – and is on the rise in some cases.
Martin points to what should be routine surgeries, like open-fracture reduction or abdominal emergencies like appendicitis. In low-income countries, the number of surgeons is 10 times less per capita, and even if a patient has access to a doctor who has excellent surgical technique, the hospitals often lack infrastructure and equipment, such as reliable electricity, sterile water and access to anesthetic drugs.
“Often in low-income countries, surgery is considered a luxury. This is very troublesome, and we want to help figure out how we can build capacity in those countries to access emergency and essential surgery,” Cheng said.
CENTRE OF IT ALL
The World Health Organization (WHO) recently designated the Department of Anesthesia and Perioperative Medicine, at the Schulich School of Medicine & Dentistry, as a WHO Collaborating Centre. Currently, there are more than 700 WHO collaborating centres in more than 80 member states. Canada contains only 28 centres, including:
- Canadian Centre for Occupational Health & Safety, Occupational Health and Safety;
- Canadian Food Inspection Agency, Control and Epidemiology of Rabies in Carnivores;
- Cancer Care Ontario, Occupational and Environmental Cancer;
- Centre for Addiction and Mental Health, Addiction and Mental Health;
- Centre Hospitalier Universitaire de Québec, Environmental and Occupational Health Impact Assessment and Surveillance;
- Centre de Santé publique, Safety Promotion and Injury Prevention;
- Dalhousie University, Mental Health Training and Policy;
- Dalhousie University, Health Workforce Planning and Research;
- Health Canada, Monitoring Chemical Contaminants in Food;
- Health Canada, Standardization and Evaluation of Biologicals;
- Health Canada, Water Quality;
- IRSST – Institut de recherche Robert-Sauvé en santé et en sécurité du travail, Occupational Health;
- McGill University, Research and Training in Mental Health;
- McGill University, Research and Training in Parasite Epidemiology and Control
- McMaster University, Evidence-Informed Policy;
- McMaster University, Primary Care Nursing and Health Human Resources;
- Public Health Agency of Canada, Biosafety and Biosecurity;
- Public Health Agency of Canada, Non Communicable Disease Policy;
- University of British Columbia, Occupational and Environmental Health;
- University of British Columbia, Faculty of Medicine, Complexity Science for Health Systems;
- University of Calgary, Classification, Terminology and Standards;
- University of Ottawa, Knowledge Translation and Health Technology Assessment in Health Equity;
- University of Sherbrooke, Health Science Education and Practice;
- University of Toronto, Bioethics;
- University of Toronto, Governance, Transparency and Accountability in the Pharmaceutical Sector;
- University of Toronto, Health Promotion;
- University of Toronto, Nutrition Policy for Chronic Disease Prevention; and
- Western University, Perioperative Surgical Care.