The Amsterdam Declaration on Essential Surgical Care · Surgical infections Incision and drainage...

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The Amsterdam Declaration on Essential Surgical Care World Journal of Surgery (article in press) Matthijs Botman, Rinse J. Meester, Roeland Voorhoeve, Henning Mothes, Jaymie Ang Henry, Robert H. S. Lane, Michael H. Cotton, Hugo A. Heij, Edna Adan Ismail Introduction On behalf of the supporting organisations and all participants of the international symposium ‘Surgery in Low Resource Settings’, November 2014, in Amsterdam, we present the ‘Amsterdam Declaration on Essential Surgical Care’. The situation with regard to a lack of surgical capacity in LMICs is untenable and urgent action is required to alleviate the situation. Many thousands of patients are dying unnecessarily every day because there is no one trained to operate on them. As a consequence, the death toll of surgical conditions in low resource settings currently outnumbers the death toll of HIV, malaria and TB combined. Rarely has there been such unanimity in the field of global surgery and there is urgent action needed. The lack of surgical care will be on the agenda during the World Health Assembly in May 2015. We solicit international health policy makers to support the initiative towards a WHA resolution on ‘Strengthening Emergency and Essential Surgical Care and Anaesthesia as a component of Universal Health Coverage.’ We need to make the world realize that we completely forgot something: Surgery should be part of the United Nations’ post-2015 sustainable development goals as an essential and named component of universal health coverage.

Transcript of The Amsterdam Declaration on Essential Surgical Care · Surgical infections Incision and drainage...

Page 1: The Amsterdam Declaration on Essential Surgical Care · Surgical infections Incision and drainage of abscess, ... hemostasis, suturing, escharotomy, skin grafting Severe head injury

TheAmsterdamDeclarationonEssentialSurgicalCareWorldJournalofSurgery(articleinpress)Matthijs Botman, Rinse J. Meester, Roeland Voorhoeve, Henning Mothes, Jaymie Ang Henry, Robert H. S. Lane, Michael H. Cotton, Hugo A. Heij, Edna Adan Ismail IntroductionOnbehalfofthesupportingorganisationsandallparticipantsoftheinternationalsymposium‘SurgeryinLowResourceSettings’,November2014,inAmsterdam,wepresentthe‘AmsterdamDeclarationonEssentialSurgicalCare’.ThesituationwithregardtoalackofsurgicalcapacityinLMICsisuntenableandurgentactionisrequiredtoalleviatethesituation.Manythousandsofpatientsaredyingunnecessarilyeverydaybecausethereisnoonetrainedtooperateonthem.Asaconsequence,thedeathtollofsurgicalconditionsinlowresourcesettingscurrentlyoutnumbersthedeathtollofHIV,malariaandTBcombined.Rarelyhastherebeensuchunanimityinthefieldofglobalsurgeryandthereisurgentactionneeded.ThelackofsurgicalcarewillbeontheagendaduringtheWorldHealthAssemblyinMay2015.WesolicitinternationalhealthpolicymakerstosupporttheinitiativetowardsaWHAresolutionon‘StrengtheningEmergencyandEssentialSurgicalCareandAnaesthesiaasacomponentofUniversalHealthCoverage.’Weneedtomaketheworldrealizethatwecompletelyforgotsomething:SurgeryshouldbepartoftheUnitedNations’post-2015sustainabledevelopmentgoalsasanessentialandnamedcomponentofuniversalhealthcoverage.

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TheAmsterdamDeclarationonEssentialSurgicalCareBeingconcernedaboutthefactthat:

• Twobillionpeoplehavenoaccesstoessentialsurgicalcare1especiallyinlow-andmiddle-incomecountries

• Fivemillionpeoplediefrominjurieseveryyear;morethan90%ofwhomarefoundinlowresource

settings

• Athirdofamillionwomendieeveryyearfromchildbirth;15-20%ofwhomcanbesavedthroughsafeessentialsurgicalcare

• Twomillionwomenlivewithuntreatedobstetricfistula;allentirelyinlowresourcesettings

• Twentymillionpeoplesufferfromtreatableblindnesscausedbycataract

• Millionsofpeoplesufferfromcorrectablecongenitaldeformitiessuchascleftlipandclubfoot

• SurgicalconditionsnowkillmorepeoplethanHIV,TB,andMalariacombined

• Surgicalandobstetricconditionsapproximatelyaccountfor11%oftheworld’sdisability-adjustedlife

years(DALYs)losteachyear

• Thereisacriticalshortageinsurgicallyandanaestheticallytrainedhealthcareworkersinlow-andmiddle-incomecountries(forexample0.5surgeonper100.000peopleinSubSaharanAfrica)

• Themedicalinfrastructure,suppliesandobservedproceduresinlow-andmiddle-incomecountriesareinsufficienttoprovidetheneededessentialsurgicalcare

1Definition:Wedefineessentialsurgicalcareas:‘Basicsurgicalproceduresthatsavelivesandpreventpermanentdisabilityorlife-threateningcomplications.Suchsurgeryshouldbeofappropriatequalityandsafety,accessibleatalltimesandaffordabletothecommunity’

Proposedlistof15essentialsurgicalconditionsConditions Interventions

Obstructed labour Caesarean section. Symphysiotomy, assisted or manipulative delivery Severe uterine bleeding Evacuation of Retained Products of the Placenta, B-Lynch suture, repair of uterine perforation Surgical infections Incision and drainage of abscess, fasciotomy, dental extraction, tympanotomy, bone drilling, arthrotomy Severe wounds (including burns) Debridement, hemostasis, suturing, escharotomy, skin grafting Severe head injury Management of head injury, cranial burr holes, elevation of depressed skull fracture Airway obstruction Management of compromised airway, tracheostomy, cricothyroidotomy, removal of foreign body Chest injury and infections

Intercostal drainage, thoracostomy Acute Abdomen Emergency laparotomy including appendicectomy Fractures and Dislocations Reduction of fractures and dislocations, casting and splinting, external Fixation Severe limb ischemia, sepsis and injury Amputations Urinary outflow obstruction Suprapubic catheterization Hernia Hernia repair Cataract Cataract extraction and Intra-ocular lens insertion Clubfoot Casting and splinting, tenotomy Simple Cleft lip Cleft lip repair

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Takingintoaccountthat:

• Atpresentthereislimitedglobaleffortfromapublichealthperspectivetoreducethenumberofdeathsanddisabilitiesinlow-andmiddleincomecountriescausedbysurgicalconditions

• EssentialsurgicalcareinlowresourcesettingsiscosteffectiveinDALYsandcostcompetitivetootherpreventivehealthmeasures

• Makingessentialsurgicalcareavailableinlowresourcesettingsrequiresamultilevelapproach

Wemakethefollowingdeclaration2:

• Wesolicitthesupportofthegovernmentsofallnations,theUN,theWHO,theWorldBank,institutionaldonorsaswellasothermajordonors,non-governmentalorganisations,allinvolvedmedicalandsurgicalsocieties,colleges,andprofessionalbodies.

Toensurethat:

Essentialsurgerybemadeavailabletoallregardlessofage,gender,race,ethnicgroup,geographicallocation,financialstatus,andpoliticalandreligiousaffiliationthroughthefollowingactions:

1. IncorporateessentialsurgicalcareaspartofnationalhealthserviceswithinUniversal

HealthCoverage(UHC)

2. Realignandincreasetheallocationofresourcestoimproveessentialsurgicalcaredelivery

3. Maketrainingaccessibletohealthworkersprovidingessentialsurgicalcare

4. Ensuretheprovisionofsupplies,equipment,andinfrastructureforsafe,essentialsurgicalcare

5. Developprotocolsforethicalsurgicalpractice,assessment,audit,andfollow-up

6. Optimizecollaborationamongstallstakeholderssuchasprofessionalorganizations,institutions,charities,andfundingagenciestoavoidduplicationandmaximizeeffortstopromoteessentialsurgicalcare

7. SupporttheproposedWorldHealthAssemblyresolution‘Strengtheningemergencyandessentialsurgicalcareandanaesthesiaasacomponentofuniversalhealthcoverage’inMay2015

2ThisDeclarationwasinitiatedduringthefinalsessionofthesymposium‘SurgeryinLowResourceSettings’onNovemberthe15th2014inAmsterdamwiththefollowingorganisationsrepresented:AMREFflyingdoctors,theAssociationofSurgeonsofGreatBritainandIreland,theCollegeofSurgeonsofEast,CentralandSouthernAfrica(COSECSA),CAPACARE,DoctorsWithoutBorders(MSF-Holland),EdnaAdanUniversityHospital,Emergency,theGermanSocietyforTropicalSurgery(DTC),theG4Alliance,theInternationalCollaborationforEssentialSurgery(ICES),theInternationalCommitteeoftheRedCross(ICRC),theInternationalFederationforRuralSurgery(IFRS),theInternationalFederationofSurgicalColleges(IFSC),MercyShips,theNetherlandsSocietyforInternationalSurgery(NVIC),theNetherlandsSocietyforPlasticSurgery(NVPC),VolonteersOverSeas(VSO),andtheWorldOrthopedicConcern(WOC)

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Thisdeclarationissupportedby:

PraveenAggarwalAcademicCollegeofEmergencyExpertsinIndia

KellyMcQueenAllianceforSurgeryandAnesthesiaPresence

MichaelKleinAmericanPediatricSurgicalAssociation

JohnAbensteinAmericanSocietyofAnesthesiologists

MamtaSwaroopAssociationforAcademicSurgery

LindaGroahAssociationofperiOperativeRegisteredNurses

JohnMooreheadAssociationofSurgeonsofGBandIreland

RobertPierikAssociationofSurgeonsoftheNetherlands

RobertRivielloCenterforSurgeryandPublicHealth,BrighamandWomen'sHospital

PankajJaniCollegeofSurgeonsofEast,CentralandSouthernAfrica

KeithMartinConsortiumofUniversitiesforGlobalHealth

RobertNeighbourDiamedica

DeanJamisonDiseaseControlPriorities3thEdition

EdnaAdanIsmailEdnaAdanUniversityHospital

GinoStradaEmergency

VivekanandJhaGeorgeInstituteforGlobalHealth,India

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HenningMothesGermanSocietyforTropicalSurgery

JohnMearaGlobalSurgeryandSocialChange,HarvardMedicalSchool

EricaFrenkelGradianHealthSystems

MichaelCottonInternationalCollaborationforEssentialSurgery

PeterReemstInternationalFederationforRuralSurgery

RobertLaneInternationalFederationofSurgicalColleges

JelleStekelenburgInternationalSafeMotherhoodandReproductiveHealth

HarshadSanghviJhpiegoCorporation

FizanAbdullahJohnsHopkinsGlobalSurgeryInitiative

MedgeOwenKybele,Inc.

PaulinePhilipLifeboxFoundation

WouterBakkerMedicalDoctorsinInternationalHealthandTropicalMedicineNetherlands(TROIE)

PeterLinzMercyShips

HenkKootNetherlandsOrthopedicAssociation

AnkievandenBroekNetherlandsSocietyforInternationalHealthandTropicalMedicine(NVTG)

RoelandVoorhoeveNetherlandsSocietyforInternationalSurgery

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HenriWintersNetherlandsSocietyforPlasticSurgery

ElisabethOgboli-NwasorNigerianSocietyofAnaesthetists

RubenAyalaOperationSmile

SusanKoshyPan-AfricanAcademyofChristianSurgeons

SaraAndersonReSurgeInternational

DeclanMageeRoyalCollegeofSurgeonsinIreland

RosemaruMukunziRwandaSocietyofAnaesthesiologists

EmileRwamasiraboRwandaSurgicalSociety

RogerEltringhamSafeAnaesthesiaWorldwide

ShivaniGargPatelSamahope

ErinStieberSmileTrain

JohanDiedericksSouthAfricanSocietyofAnaesthesiologists

MiliardDerbewSurgicalSocietyofEthiopia

HugoHeijSymposiumSurgeryinLowResourceSettings

JaymieHenryTheRighttoHeal

JohnMcGrathUrolink,BritishAssociationofUrologicalSurgeons

JorisEekhoutVoluntaryServiceOverseas

DavidWilkinsonWorldFederationofSocietiesofAnaesthesiologists

AntoonSchlosserandMichaelLaurenceWorldOrthopedicConcern

AriannedeJongDoctorsoftheWorld,Netherlands


Suturing Workshop

Suturing Workshop

laparoscopic suturing

laparoscopic suturing

Pos… · of the da Vinci@ Surgical System, with integrated training modules including Fundamentals of Robotic Suturing (FRS) and Robotic Suturing. Face, content, and construct validity

Pos… · of the da Vinci@ Surgical System, with integrated training modules including Fundamentals of Robotic Suturing (FRS) and Robotic Suturing. Face, content, and construct validity

Sequential surgical signatures in micro-suturing task · cal signatures in the context of micro-surgical suturing training task (see subsection2.1). For this, we used a pattern mining

Sequential surgical signatures in micro-suturing task · cal signatures in the context of micro-surgical suturing training task (see subsection2.1). For this, we used a pattern mining

Burns & Escharotomy

Burns & Escharotomy

Ot nursing & suturing

Ot nursing & suturing

Surgical Automation for Multilateral Multi-Throw Suturing · Surgical Automation for Multilateral Multi-Throw Suturing by Siddarth Sen Research Project Submitted to the Department

Surgical Automation for Multilateral Multi-Throw Suturing · Surgical Automation for Multilateral Multi-Throw Suturing by Siddarth Sen Research Project Submitted to the Department

GUIDE TO SUTURING

GUIDE TO SUTURING

The Surgical Assistant · Suturing Surgical technologists prepare sutures. Surgical assistants suture tissue. Assisting with hemostasis Performed by the surgical assistant. Clamping

The Surgical Assistant · Suturing Surgical technologists prepare sutures. Surgical assistants suture tissue. Assisting with hemostasis Performed by the surgical assistant. Clamping

Automated pick-up of suturing needles for robotic …Automated pick-up of suturing needles for robotic surgical assistance C. D’Ettorre, G. Dwyer, X. Du, F. Chadebecq, F. Vasconcelos

Automated pick-up of suturing needles for robotic …Automated pick-up of suturing needles for robotic surgical assistance C. D’Ettorre, G. Dwyer, X. Du, F. Chadebecq, F. Vasconcelos

A Novel Surgical Pre-suturing Technique for the Management ...

A Novel Surgical Pre-suturing Technique for the Management ...

A STICH IN TIME - Medical University of Lodzstudymed.umed.pl/media/A-stich-in-time.-Basics-of-surgical-suturing.… · NEEDLE AND SUTURE Modern surgical sutures are permanently combined

A STICH IN TIME - Medical University of Lodzstudymed.umed.pl/media/A-stich-in-time.-Basics-of-surgical-suturing.… · NEEDLE AND SUTURE Modern surgical sutures are permanently combined

Basics Suturing

Basics Suturing

Suturing Removal

Suturing Removal

Dental Suturing Materials and Techniques - Juniper … · Dental Suturing Materials and Techniques ... History of the Suture Materials and Classical Literature ... Surgical needles

Dental Suturing Materials and Techniques - Juniper … · Dental Suturing Materials and Techniques ... History of the Suture Materials and Classical Literature ... Surgical needles

Suturing and Assisting

Suturing and Assisting

Autonomous Multiple-Throw Multilateral Surgical Suturing ... · a representative set of frequently occurring procedures in surgery, used for surgical training and evaluation [36].

Autonomous Multiple-Throw Multilateral Surgical Suturing ... · a representative set of frequently occurring procedures in surgery, used for surgical training and evaluation [36].

Kuliah Suturing

Kuliah Suturing

Escharotomy Incisions

Escharotomy Incisions

Suturing technique

Suturing technique