“We need to decolonise and demystify surgery by acknowledging that it is only one component in achieving health and well-being. A rethink of global surgery could give billions of people, mostly in low- and middle-income countries, equitable access to life-saving surgical care."
This is the view of Prof Kathryn Chu, Director of the Centre of Global Surgery in the Faculty of Medicine and Health Sciences at Stellenbosch University. She delivered her augural lecture on Thursday (21 October 2021) on the topic Decolonising global surgery: A call to action.
In her address, Chu said modern surgery is very Euro- and Western-centric with its emphasis on the need for state-of-art in-patient-based technology without an appreciation for how patients, especially those in low- and middle-income countries, understand health and well-being.
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“Understanding patients' perceptions of health and well-being as well as indigenous health systems and beliefs is critical to appreciate their acceptance or fears about surgical care. So often in global surgery, which seeks to understand barriers to access to surgical care, the patient is left out of the conversation.
“In global surgery, there is a distinct hierarchy: first the surgeon knows best, and maybe the anaesthesiologist and sometimes the nurses. But the persons with the surgical conditions and their communities are rarely included in research to improve care."
“If we want to decolonise global surgery, we need to rethink this critical exclusion," Chu added. She said the neo-colonial approach to surgery fails to appreciate that health is multidimensional.
“Doctors often believe that surgical conditions require a biomedical magic bullet cure. The patients don't always accept this approach. In many parts of the world, local beliefs around the causes of illnesses are not purely biomedical. Some believe they may have angered past ancestors or there's an imbalance in a particular relationship that needs to be fixed."
Chu offered a few recommendations to decolonise surgery.
She called for a shift in the power dynamics locally and globally by combatting epistemic injustice.
“We can do this locally by including communities and persons with surgical conditions in global advocacy and research. Globally, this can be done by supporting the premise that global surgeons and clinicians in low- and middle-income countries know about barriers to access to care in their own settings and can lead South-North collaborations.
“We should also replace short-term service delivery efforts by international teams with co-creation of sustainable surgical health systems by local surgical teams and communities. We need to build a pipeline of young global surgery leaders in low- and middle-income countries, diversify the surgical workforce and create enthusiasm among students about what surgeons can do."
Chu added that another step in the decolonisation of surgery is increasing its physical accessibility to more communities, especially to people living in rural areas.
She also emphasised the importance of addressing structural violence (e.g. disparate access to resources, political power, education and health care) which is a major barrier to surgical care.
“Various components of structural violence are interrelated and addressing them will be a major step in the decolonisation of health care, including surgical care."
Chu said more needs to be done to make surgical care a reality at our district hospitals.
- Photo: Prof Kathryn Chu: Photographer: Damien Schumann