Barrow Global Bulletin Spring/Summer 2024: Action & Advocacy

By Gail Rosseau, MD, Adjunct Professor of Global Neurosurgery at Barrow; Clinical Professor of Neurosurgery at George Washington University; Chair of the Board of Directors of the G4 Alliance

We are all deeply committed to our primary professional responsibility: to take the best possible care of each of our patients. In our increasingly global world, there is a growing realization that we have a second professional responsibility: to support efforts to provide access to high-quality neurosurgical care for everyone, everywhere. This responsibility is a founding principle of Global Surgery and forms the mission of Global. It is at the core of our activities in education, research, and advocacy. While we already incorporate the sharing of knowledge and ongoing research into our daily practice, it is not always as obvious that our actions must include advocacy.

The importance of advocacy stems from the public health issues running in the background of our daily care of patients. We all see public health concerns in many aspects of the health problems of individual patients, which create challenges in effectively caring for them. The advocacy of surgeons was stimulated by the publication in 2015 of the Lancet Commission Report on Global Surgery (LCoGS). This landmark study included several key findings, including the fact that 5 billion people do not have access to emergency and essential surgical care. These findings translated into more than 5 million urgent neurosurgical procedures that are needed around the world each year that cannot be done, because of an estimated deficit of 23,000 neurosurgeons. The LCoGS led the World Health Assembly (WHA), the legislative arm of the World Health Organization, to pass Resolution WHA 68.15, strengthening emergency and essential surgery. A vast number of civil society organizations responded, with the creation of numerous ongoing initiatives of professional societies, academic organizations and nongovernmental organizations (NGOs).

For global neurosurgery, its very nature often leads to the need for advocacy with these international organizations. The World Federation of Neurological Societies (WFNS), Barrow Global, and many others are member organizations of the leading advocacy organization of global surgery, the G4 Alliance. The G4 Alliance is a global federation of 70-plus member organizations that advocate for surgical patients. G4 Alliance member organizations include large specialty associations, such as the World Federation of Societies of Anesthesiology, the Royal College of Surgeons of England and Ireland, Mercy Ships, and Operation Smile, as well as organizations well-known to neurosurgeons, such as the Congress of Neurological Surgeons, the Harvard Program in Global Surgery and Social Change, and Northwestern University’s Pediatric and Adult Global Health programs. The disciplines of surgery, obstetrics, traumatology and anesthesia, collectively known as SOTA, require similar infrastructure to deliver care. The G4 Alliance is the “home” for global surgery and is the primary mechanism by which global neurosurgery interacts with large multilateral organizations, such as the World Health Organization, the World Bank/International Monetary Fund, and the United Nations General Assembly.  

Some examples of the global surgery advocacy activities of the G4 Alliance include:

• Advocacy with the U. S. government: successfully lobbying Congress to include language in the United States federal budget from  2022 onward that requires investment in global surgery including trauma and directing the United States Agency for International Development (USAID) to report to Congress on how funds will be used for these purposes;

• Advocacy at WHA: creating and successfully convincing all member nations of WHO to vote for WHA Resolution 76.12 on micronutrient fortification including folic acid to prevent spina bifida; and  

• Advocacy to make neurotrauma a reportable condition to systematically approach the pressing problems of brain and spine injuries.

“Advocacy for global neurosurgery is a challenge that we are willing to accept, we are unwilling to postpone, and one we intend to win.”

Gail Rosseau, MD

Neurosurgeons are already making a measurable difference. Neurosurgical organizations work with other G4 Alliance member societies as well as large international multilateral organizations to advocate for progress in global neurosurgery.  We work with the College of Surgeons of Eastern, Central, and Southern Africa (COSECSA) to help prepare our partner site at Kilimanjaro Christian Medical Center (KCMC) to become an official training site for the board-certified residency in neurosurgery.  We work with members from large global specialty surgical societies to create the Operative Encounter Registry, which WHO champions as the unified global registry of surgical cases and outcomes. We advocate for policies and procedures that will assure global availability of such essential surgical tools as oxygen and pain medications.

Working toward a world where everyone has access to high-quality neurosurgical care is a daunting challenge. It has been called “neurosurgery’s moonshot.” But these efforts will serve to organize and measure the best of our energies and skills. Advocacy for global neurosurgery is a challenge that we are willing to accept, we are unwilling to postpone, and one we intend to win.