Ms Gründl, “global surgery” is a bit of a new topic. Why are you actively supporting it?
When it comes to global healthcare, most people tend to think of infectious diseases. However, about five billion people have no access to safe surgical care. Each year, some 16.9 million people die of diseases that could have been treated by surgery, meaning more than the deaths caused by HIV, malaria and tuberculosis together. This fact led among other things to the WHO adding “global surgery” to its agenda three years ago. And the measure was so successful that today, for example, health ministers in African countries appeal to the WHO because they want to include surgery in their national healthcare plans. The focus now must be on gathering the data.
You are helping research the data that needs to be collected – what form does your work take?
I am studying medicine in Freiburg, but from August 2016 I also had the opportunity to be part of a team of 20 students and surgeons in Harvard who collected the “global surgery” data worldwide and also trained local staff to collect data. The research position at the Harvard Medical School leads the way in this field. In Rwanda, on behalf of the health ministry we examined the desired national surgery plan as regards various aspects: How many surgeons and operating theatres are there? What equipment do they have? How often do the operating theatres have electricity? Is there running water? And on this basis what are the actual requirements?
What practical impact does your work have?
In Rwanda I also researched surgical wound infections. The country’s healthcare system provides a healthcare anchor for every village, who is chosen by the community and trained for two weeks, for example in order to be able to treat malaria. We have now also trained this healthcare worker in how to identify whether someone has an infected wound. Now, ten days after a patient has undergone surgery they visit him or her with a tablet PC and go through a checklist of specific questions on pain, wound secretions, and inflammation. We created an algorithm to go with the questions and if after running it the healthcare worker identifies an infected wound they then send the patient back to hospital.
The German Global Surgery Association you helped found does a lot of information-based work. What form does this take?
The association sees itself as a think tank. Global surgery is a new topic. In the USA and Canada there are already about ten corresponding research institutes, but in Europe there are only two: in London and at the university in Lund, Sweden. We are trying to plug this gap and are actively networking. With a pilot project we have already managed to get four surgical questions included in health data surveys in Zambia. We lobby politicians and other decision-makers and deliver reports at UN events, such as Universal Health Coverage Day or the World Health Assembly in Geneva.
What motivates you to be so active?
I had something of an eye-opening experience in Tanzania, where after graduating from high school I worked as a volunteer in a hospital in a remote mountain village. Back then I knew I wanted to study medicine and become a paediatric surgeon, and I was interested in health policies. I wanted to find out if working in a hospital all day was really for me. On my very first day, an infant died of a ruptured appendix simply because it could not be operated on in time and looked after. Now that doesn’t really happen any more in industrialised nations and it strengthened my belief that we needed to change something emphatically in this regard.