This article is based on the Hugh Greenwood Lecture delivered at the 2016 Congress of the British Association of Paediatric Surgeons. It presents the view of the global surgery movement from the bottom of the surgical food chain and proposes what HICs (high-income countries) can do for global surgery in a coordinated fashion. From the LMIC (low- and middle-income countries) surgeon perspective, global surgery is transitioning from the charity-based surgery model to codevelopment with multiple stakeholders. The caveats and current opportunities are described using two case studies. Surgeons may not play a pivotal role in the solutions. The future of the surgical workforce, innovation, workarounds, unmet burden of disease, and health metrics are discussed and multidisciplinary solutions proposed for the entire chain of surgical healthcare delivery in LMIC. A new breed of “essential surgeons”, technology solutions for intellectual and physical isolation, competency-based credentialing, industry-driven innovation, task sharing over task shifting, prioritizing delivery based on surgical burden, and a rota-based overseas model of help are proposed as solutions for the issues facing global surgery. Evidence level Level V.
- Global surgery
- Health metrics
- Low- and middle-income countries
- Surgical workforce