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Chapter 49: Global Surgery

Patients in rural and developing locales often have difficulty accessing health care and undergoing surgical interventions. Interest in global surgery has grown significantly in recent years due in part to all of the following EXCEPT

A. Trained surgeons migrating to areas of need.

B. Improved control of acute infectious diseases previously the cause of significant morbidity.

C. Technology allowing improved access to health care information and training.

D. Recognition of the cost-effectiveness of surgery as a public health intervention.

Answer: A

Although much of the world remains with limited access to surgery, this is changing. Patients who have been denied surgical care previously due to concerns about cost and access are no longer being ignored. Over time, it has become apparent that the patients in need of surgical care are those who have the greatest socioeconomic impact on society (ie, young, otherwise healthy and productive members of society). Offering a potential cure via surgery allows the patient to return to normal function and contribute to society in a meaningful way; improving the infrastructure of the country. Many trained physicians, especially surgeons, who planned to return to areas of need find that the lack of resources and infrastructure hamper their opportunity for development. Therefore, fully trained surgeons tend to remain in larger, more developed areas. While this is seen across the globe, migration of practitioners to economically and culturally favorable locales impacts Low and Middle Income Countries (LMICs) more, as they have a higher burden of diseased patients with fewer health care workers and a steeper gradient from developed to developing areas of their country. (See Schwartz 10th ed., pp. 1960–1962 and 1970–1976.)

A 24-year-old man in Tanzania is traveling without helmet on the back of a motorbike sideswipes a large truck. He is brought in to the hospital and found to have rib fractures, a femur fracture, and a traumatic brain injury. If one wanted to calculate the impact of this injury on his life, one could calculate a Disability Adjusted Life Year (DALY) score. What components make up this score?

A. Years of life lived.

B. Severity of illness and years of life lived with that disability.

C. Patient quality of life and years of life lived with impaired quality of life.

D. Years of life lost, compared to country average, and a weighted calculation of life years lived with disability.

Answer: D

The Disability Adjusted Life Year (DALY) score is a measure ...

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