Full project outline

• What is the problem being solved?

  80% of the world’s population lack access to safe, affordable surgery. Thankfully, there is now a diverse, rapidly growing international movement, termed “global surgery” to help address this concern, spanning from the United Nations and the World Health Organisation all the way down to the grass root levels in many low and middle income countries.

  Understandably, the provision of affordable surgery to the neglected billions of people across the planet is a complex and challenging issue. Amongst other complexities, there are a number of long established institutional, financial and cultural barriers that are hindering progression. One critical barrier in particular is the ability to create scientific research from within a low and middle income country, and disseminate high quality, peer reviewed knowledge freely and openly between communities and populations across the world facing similar surgical pathology.

  And comparable to how cryptocurrency has torn down financial dogma, there exists a major stranglehold within the research and scientific industry that needs questioning.

  Imagine you are a clinician in a low or middle income country and you are treating challenging cases on a daily basis with extremely limited resources. If you performed research on any condition or disease you are investigating, and attempt to publish your work in a reputable journal (almost all established in high income countries), you would likely have to pay $2500 to the journal to get this published and retain ownership of your work. If you did not pay this open access fee, you would need to sign over your copyright to the journal, who then subsequently charge end users an average of $40 to access your work.

  Consider the average income of someone in Malawi (for example) is $100-200/ year, you can quickly imagine the absolute shackles of developing and promoting clinical research in low and middle income countries for any local researcher – once more being held hostage to a foreign industry not built for purpose. And even if the funds were available to you, transferring fiat currency from a low income country to a higher income country, to pay for the privilege of publishing or accessing science, comes with its own financial barriers (owning a credit card or PayPal account, transaction fees, banking fees, currency exchange etc).

  However, we believe a shackle-breaking solution is not only urgently required but imminently possible. One.Surgery proposes to build a high quality journal with bare minimum overhead running costs, therefore ensuring that the price of publishing or accessing research in low and middle income countries is dramatically reduced. This would allow our journal model to be replicated by other newer journals wishing to provide a similar service.

  Furthermore, we hope to develop an ability for our low cost journal model to receive Bitcoin Cash payments and build a sustainable scientific ecosystem. Imagine now if we reduced the running cost of a journal so much that the price to publish or purchase articles were 1-2% of the current industry rates – and imagine that these payments could be integrated with BCH – eliminating financial transaction costs also.

  Consider now, if we succeed, that a researcher in Malawi can submit research to a high quality, local journal, paying vastly reduced publishing costs to make it open access. Furthermore, even if the article was not open access, a researcher in Zimbabwe could pay a much more affordable amount for this article with BCH, rather than the extortionate fees currently being charged by the current industry.

  It is our vision that we can liberate the restraints of a multi-billion dollar scientific industry – and if we can, we need a borderless, instant, minimal cost payment system that works for us… do you know of any?

  *Recent study carried out by One.Surgery; awaiting publication; but further reading on the costs of the industry here

• What is One.Surgery?

  One.Surgery is an online platform designed to support the global surgery movement by empowering the most important stakeholders in global surgery – the patients and those that dutifully care for them, day in, day out in challenging settings.

  ONE.SURGERY aims to unite this dynamic and diverse worldwide community, whilst simultaneously breaking down the traditional institutional barriers (and their associated financial restrictions) that often limit the spread of surgical knowledge and skills between communities.

  By creating novel, free to access web based tools that empower local clinicians, we hope to liberate surgical education and scientific research in a peer to peer philosophy, whilst fostering a joyous connection between people across the globe.

• Who runs One.Surgery?

  The ONE.SURGERY project was originally created in March 2018 by Dr. Saqib Noor, a British orthopaedic surgeon. After various experiences in low resource settings over the past ten years and publishing his personal diaries describing the lack of surgical healthcare worldwide, Saqib began this project to create a unifying platform to support the global surgery movement.

  ONE.SURGERY is now run by a growing international team passionate about global surgery from all around the world. Meet our team here!

• Who is Saqib Noor?

  Saqib has a verifiable history demonstrating a lifetime’s dedication to global surgery as well as evidence of innovation using tech solutions to solve global healthcare related issues.

  His book, Surgery on the Shoulders of Giants, details 10 years of travel as a surgeon in low and middle income countries, including being present in the aftermath of the Haiti earthquake and Pakistan floods in 2010.

  Furthermore, he has written extensively in the field of surgery and global health, with over 30 peer review scientific articles published.

  Lastly, he has already developed innovative web projects to solve problems within healthcare, creating a low cost patient management system in Cambodia and creating a novel teaching platform for orthopaedic cases in Canada. These projects have been hugely successful and were created just prior to launching One.Surgery.

• What are the project goals?

  Phase One (this Flipstarter): One.Surgery aims to create a truly open access, digital, scientific journal focussed on surgical healthcare in low and middle income countries. This journal would have no associated or hidden costs for authors to publish, and no cost for readers to access the science. This journal will be peer reviewed and supported by a worldclass advisory board to maintain journal integrity and reputation within our own community (One.Surgery has been fostering links and developing relationships with trusted clinicians and like minded healthcare organisations since 2018).

  Furthermore, it will be beautifully designed and automated as much as possible, therefore created to keep running costs and overheads to an absolute minimum. With your Bitcoin Cash startup funds, we believe this will be the first scientific journal purely funded by crytpcurrency and the first step to decolonizing a very centralised, powerful industry. We believe just phase one of this collaboration with the BCH community, in it’s own right, will greatly add value to the Bitcoin Cash movement with significant marketing and branding value of BCH within the scientific community.

  Phase Two (future Flipstarter): Once One.Surgery can prove the concept of a low cost journal (in its own surgical field), we hope to then distribute this model, allowing other medical fields and scentific communities (particularly in low and middle income countries), to develop their own low cost journals. Before distribution, we would aim to work closely with Bitcoin Cash developers to integrate a BCH payment system within our journal template, so that future journals can also accept BCH payments from either authors or readers (or both). This will allow journals to develop their funding stream through the use of instant, borderless, micropayments powered by BCH. After phase 1, we would hope to have developed a trusted relationship with the BCH community, as phase 2 of this project will need close collaboration with BCH developers to create payment systems for our journals.

  Bottom line: Ultimately, we envision research being created in one country, published in a beautiful low cost journal, and being accessed from another country using BCH payments to power the journal.

• What is the project timeline and project risks?

  If phase 1 of this project is funded, we would aim to launch our first journal, “The Journal of One.Surgery” by mid-2021, with a full editorial board in place and infractructure to start accepting submissions from authors, in particular targetting authors in LMICs. Naturally, any new journal within this industry requires time to establish itself and its reputation, and gain trust from the community. Similar to the abuse of cryptocurrency, the publishing industry is rife with predatory journals and scams. We will need to carefully maintain our reputation and inspire authors from low and middle income countries to submit their work with us. We believe with our hard work of the last (almost) 3 years and demonstrating incredible results on a tiny budget, we have earned this trust and have the confidence to try a novel approach to a major industry problem.

  If we can demonstrate a low cost journal that is attracting interest from the global health community, phase 2 of this project will be to develop the technology and infrastructure to replicate the model worldwide, with additional integrated BCH payment infrastructure. We would aim to do this towards the end of 2021 and create a second flipstarter for this project at this time. The risks here would be ensuring we attract others in the global health industry to follow our model, and ensure we have fully functioning tech (and user friendly integration with BCH) to expand our model across the global health landscape.

• How can we trust One.Surgery with BCH?

  ONE.SURGERY is a non-profit organisation and a registered community interest company in the UK (Company number: 12488453). It is built by a team of healthcare professionals who passionately believe in holding ourselves accountable to the highest ethical standard, both in patient care as well as our project management. We are 100% transparent and have a dedicated page on our website to bitcoin cash. Here we publish details of our bitcoin cash wallet, and if this flipstarter is successful, every transaction that traces to this wallet will be published on our website with full curation as to what every transaction represents. Failure to maintain this ledger will be a damning blow to the reputation we have built in the global surgery community over the past few years and the trusted partnership we hope to foster with the BCH community.

• How will you use the BCH for this Flipstarter - phase 1? (43 BCH)

  BCH	Est. $ value	Service
  24	$7200	Development of the One.Surgery Journal – User friendly, admin backend management, well designed frontend user systems – manuscript submission service, online peer review facility with author mentorship, feedback and manuscript revisions, plus automated PDF creations of approved articles
  11	$3300	1 year maintenance of the One Surgery Research Index – an archiving and distribution service of all open access research related to global surgery (because publishing research is pointless unless it is delivered to those that need to read it the most!)
  4	$1200	Commence consultation and work with BCH developer to plan for BCH integration and costing for phase 2
  4	$1200	1 year registration and API integration with international recognised referencing agency, for example CrossRef – critical to disseminate our journal’s publications into existing scientific databases

  *Based on 1BCH=$300

• What even is global surgery?

  Those of us living in well resourced countries have either had an operation or know someone dear to us that has undergone a major surgical procedure.

  However, up to 80% of the world’s population do not have this privilege, with 4.5 billion people in the world lacking access to the safe, affordable surgery that we all too often take for granted.

  Surgical healthcare has been neglected in vast parts of the world, resulting in a lack of dedicated infrastructure, insufficient human resources, vulnerable supply chains and limited funding to provide sustainable services for desperate populations.

  Global surgery is a diverse international movement that recognises this heartbreaking disparity and is striving to equalise access to surgical care across the world. Providing safe surgery is a complex challenge needing a multifaceted approach, requiring a collaborative approach with many stakeholders all over the world in the realms of clinical care, surgical education, scientific advancement and patient advocacy.

• Is the situation really that bad?

  Unfortunately, it really is. Without access to timely surgery, many people lose their lives each year. In 2010, an estimated 16·9 million lives (32·9% of all deaths worldwide) were lost from conditions needing surgical care. This figure well surpasses the combined number of deaths from HIV/AIDS (1·46 million), tuberculosis (1·20 million), and malaria (1·17 million).

  There are countless studies, reports and of course upsetting graphic images detailing the consequences of neglected surgical disease in austere settings, from severe deformities to enormous tumours. For example, a study in 2013 highlights the extremely poor outcome of patients with bone tumours in Cambodia, in comparison to modern medical standards. There are hundreds of similar articles describing a vast array of neglected pathology that exist in the world today.

  Asides from the paucity of surgical infrastructure and equipment, healthcare professionals and organisations in low resource settings also face a number of institutional barriers that prevent workforce development such as acquiring necessary surgical skills, and the prohibitive costs of publishing medical research.