๐๐ข๐ฆ๐ง ๐๐๐ฅ๐ฅ๐๐๐ฅ๐ฆ ๐ง๐ข ๐ฆ๐จ๐ฅ๐๐๐๐๐ ๐๐๐ฅ๐ – ๐๐ก๐ฆ๐ฃ๐๐ฅ๐๐ง๐๐ข๐ก ๐๐ฅ๐ข๐ ๐ง๐ฅ๐จ๐-๐๐๐๐ ๐ฆ๐ง๐ข๐ฅ๐๐๐ฆ
๐ ๐ฆ๐๐ผ๐ฟ๐ ๐ง๐ต๐ฎ๐ ๐ ๐ถ๐ฟ๐ฟ๐ผ๐ฟ๐ ๐ ๐ถ๐น๐น๐ถ๐ผ๐ป๐
Mrs A. is a woman living somewhere in rural Africa. She is a widow with only primary-level education, surviving day by day on what little she can earn or receive. On a fateful day, she was rushed to the hospital in a critical state. She presented with diabetic ketoacidosis following years of poorly controlled type 2 diabetes. Her condition was complicated by severe ascites, bilateral pitting oedema up to the mid-thigh, decompensated heart failure with severe hypertension, and features of advanced diabetic complications, including grade 4 diabetic foot and diabetic nephropathy.
Mrs A. had lived with these illnesses for years, not because they were not manageable, but because they were unaffordable. On presentation, she had no mobile phone, no written contacts, and no family member immediately reachable. Hospital bills for admission, daily meals, bed space, and consultations accumulated. She could not even pay for investigations, medications, or prolonged hospital care.
Healthcare workers, medical students, and kind individuals made contributions so she could receive a few essential medications. However, many of the expensive and most effective medications were beyond her reach. As the days passed, she was finally discharged, but she could not pay her bills to leave, yet she could not pay to be fully treated. She had to stay longer after discharge; each additional night on the ward increased her debt (bed space).
She was discharged after achieving a relatively stable and resuscitated state, but far from optimal care. Not because she was well, but because the system, her caregivers, and she herself had reached a point of collective frustration and helplessness.
This is majorly a medical case (surgical as well though), yes. But Mrs A. is not an isolated story.
She exists in every corner of the global health system, most profoundly in low- and middle-income countries (LMICs).
Yes, I would agree with you that something must be done.
๐๐ฒ๐๐ผ๐ป๐ฑ ๐ข๐ป๐ฒ ๐ฃ๐ฎ๐๐ถ๐ฒ๐ป๐: ๐ ๐๐น๐ผ๐ฏ๐ฎ๐น ๐ฆ๐๐ฟ๐ด๐ถ๐ฐ๐ฎ๐น ๐ฅ๐ฒ๐ฎ๐น๐ถ๐๐
Mrs A.โs story reflects a wider structural failure in access to healthcare, particularly surgical and perioperative care. Across the world, an estimated 160 million people each year are unable to receive essential surgical care, largely due to financial barriers, weak health systems, and poor policy prioritisation (Nepogodiev et al., 2025).
For many patients, the cost of care is not limited to surgery itself. It includes transportation, investigations, medications, prolonged hospital stays, and lost income. These cumulative costs push individuals and families into catastrophic health expenditure, deepening cycles of poverty and illness. Some would rather die than truncate their childrenโs future by spending their entire fortune on illness.
๐๐๐๐๐๐๐ข, ๐๐๐๐๐ ๐๐๐๐๐๐๐๐๐ ๐๐ ๐๐ก๐๐๐๐๐๐๐ ๐๐๐ ๐๐๐๐๐๐๐๐๐ฃ๐๐, ๐๐ ๐๐๐๐๐๐๐๐๐๐ข ๐๐ก๐๐๐๐๐๐ ๐๐๐๐ ๐๐๐๐๐๐๐๐๐ ๐๐๐๐๐๐ ๐๐๐๐๐๐๐๐ ๐๐๐๐๐๐ ๐๐๐๐ ๐๐ ๐ป๐ผ๐ธ๐ฒ๐. Yet without affordable surgical care, conditions that are preventable or treatable become disabling, fatal, or a death sentence .
๐ฅ๐ฒ๐๐ต๐ถ๐ป๐ธ๐ถ๐ป๐ด ๐ฆ๐ผ๐น๐๐๐ถ๐ผ๐ป๐: ๐ฃ๐ผ๐น๐ถ๐ฐ๐, ๐ฆ๐๐๐๐ฒ๐บ๐, ๐ฎ๐ป๐ฑ ๐๐ป๐ป๐ผ๐๐ฎ๐๐ถ๐ผ๐ป
Addressing cost barriers to surgical care requires more than goodwill or ad hoc donations. It demands ๐ข๐ง๐ญ๐๐ง๐ฌ๐ข๐จ๐ง๐๐ฅ ๐ ๐จ๐ฏ๐๐ซ๐ง๐ฆ๐๐ง๐ญ ๐๐๐ญ๐ข๐จ๐ง ๐๐ง๐ ๐ฌ๐ญ๐ซ๐จ๐ง๐ ๐ก๐๐๐ฅ๐ญ๐ก๐๐๐ซ๐ ๐ฉ๐จ๐ฅ๐ข๐๐ฒ ๐๐ซ๐๐ฆ๐๐ฐ๐จ๐ซ๐ค๐ฌ. National surgical, obstetric, and anaesthesia plans (NSOAPs), integration of surgery into universal health coverage schemes, and sustainable financing mechanisms are critical steps toward ensuring that patients like Mrs A. are not denied care because of poverty.
Equally important is the generation and use of reliable data. Understanding who is left behind, why they are excluded, and where system bottlenecks exist is essential to reversing the statistic of 160 million people without access to essential surgery each year.
๐๐ป๐ป๐ผ๐๐ฎ๐๐ถ๐๐ฒ ๐๐ฎ๐ฟ๐ฒ ๐ ๐ผ๐ฑ๐ฒ๐น๐: ๐๐ฒ๐๐๐ผ๐ป๐ ๐ณ๐ฟ๐ผ๐บ ๐๐บ๐ฏ๐๐น๐ฎ๐๐ผ๐ฟ๐ ๐ฆ๐๐ฟ๐ด๐ถ๐ฐ๐ฎ๐น ๐๐ฒ๐ป๐๐ฟ๐ฒ๐
Encouragingly, innovative models are emerging. ๐๐ญ๐๐ง๐๐๐ฅ๐จ๐ง๐ ๐๐ฆ๐๐ฎ๐ฅ๐๐ญ๐จ๐ซ๐ฒ ๐ฌ๐ฎ๐ซ๐ ๐ข๐๐๐ฅ ๐๐๐ง๐ญ๐ซ๐๐ฌ have shown promise in reducing cost barriers by delivering essential surgical services efficiently and affordably. In countries such as Uganda, these centres demonstrate how tailored surgical delivery models can lower out-of-pocket expenditure, reduce hospital stay durations, and improve access for underserved populations (Tusiime et al., 2025).
By focusing on high-volume, essential procedures, streamlined staffing, and cost-conscious infrastructure, ambulatory centres provide a scalable approach to improving surgical equity, particularly in resource-limited settings.
๐๐ฐ๐๐ถ๐ผ๐ป ๐๐ฒ๐ฐ๐น๐ฎ๐ฟ๐ฎ๐๐ถ๐ผ๐ป๐
โข Essential surgical care is not a luxury; it is a fundamental component of universal health coverage.
โข No patient should be discharged prematurely or denied optimal care due to inability to pay.
โข Governments must prioritise surgical care financing within national health policies.
โข Innovative, context-appropriate delivery models must be supported, studied, and scaled.
โข Data-driven advocacy is critical to exposing inequities and driving reform.
๐๐ก๐ ๐๐ฉ๐๐ซ๐๐ญ๐ข๐ง๐ ๐๐จ๐จ๐ฆ ๐๐ฅ๐จ๐๐๐ฅ (๐๐๐๐) stands for advocacy, innovation, and equity in surgical care. We amplify real stories like that of Mrs A. to remind the world that behind every statistic is a human life. ๐๐๐๐ is committed to promoting policies, partnerships, and practical solutions that ensure safe, affordable, and accessible surgical care for all, regardless of geography or income.
Mrs A. should not be the norm.
And together, we must ensure that she no longer is.
๐๐จ๐ข๐ง ๐๐ฎ๐ซ ๐๐ฅ๐จ๐๐๐ฅ ๐๐จ๐ฆ๐ฆ๐ฎ๐ง๐ข๐ญ๐ฒ!
The Operating Room Global (TORG)
๐โ๐ ๐ฟ๐๐๐๐๐ ๐ก ๐๐๐ก๐ค๐๐๐ ๐๐ ๐๐๐ ๐๐๐๐๐๐ก๐๐๐ ๐
๐๐๐ ๐๐๐๐๐๐ ๐ ๐๐๐๐๐๐ ๐๐ ๐๐๐ ๐๐๐๐๐!
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