Equity in Academic Global Surgery

July 18, 2020: Posted by Ankit Raj

Globally 5 billion people lack access to safe, timely, and affordable surgical care. A significant proportion of these 5 billion belongs to lower and middle-income countries and limited-resource settings. But do we know how many surgeons, nurses, trainees, medical students, and supportive healthcare staff lack access to affordable and high-quality academic research opportunities, publications, projects, and skill development?

Equity, or lack thereof, is rarely talked about in the field of academic surgery, very specifically academic global surgery. Because any advocacy concerning that is suspiciously considered as a rant than anything else. Also, most trainees, researchers, and surgeons from LMICs consider this issue as too trivial in front of other more important issues such as surgical care to patients, financial catastrophe associated with availing surgical care, and healthcare quality and system strengthening. Nonetheless, someone else’s pain and struggles do not negate yours.

As LMIC surgical trainees, we have to work double the effort as anyone else with half the incentives. There is no added direct benefits for most trainees in LMICs for research projects, additional skills, and academic interests outside the core training. Neither there is an opportunity or freedom to comfortably avail a few months or years out of the surgical training to complete a research project or fellowship. Interestingly for most trainees, these issues become limiting factors for their participation in academic global surgery than anything else.

There are visible and subtle barriers to access published research and to publish new research for trainees and surgeons working in LMIC settings. The barrier also extends to opportunities available to these researchers in terms of skill development, funding access, and unfair expectations. Barriers extend from insufficient mentorship; clear lack of support from system, institution, peers, and seniors; limited funding support; minimal recognitions; and absence of initiatives. This creates skepticism, loss of confidence, and a feeling of resentment among many young trainees.

For HIC based institutions seeking collaboration with LMIC institutions and trainees, it is a crucial question that must be deliberated upon. There are scores of global surgery focused departments in HIC academic institutions but hardly any of them truly reflect the equity in their team dynamics. Even fewer reciprocate the advantages they gain out of participating with LMIC trainees and institutions and then publishing research and writing papers by offering equal opportunities to trainees in terms of training positions, funding support, and equal recognition.

We need to address these issues if we want to truly practice the equity we talk about in journals. Most importantly, this needs to be recognized by ones currently gaining the most out of it rather than an LMIC based trainee writing this blog in between his 36-hour shifts.

Ankit Raj About Ankit Raj – India | @RajAnkit14
Junior doctor from India with interests in global surgery, international relations and health policy. Occasionally writes. Rants on twitter.

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