Big Results with Small Investments

As the destructive energy of hurricane Tomas was bearing down on Haiti this past Friday, a confluence of innovative intellectual energy and expertise was converging in Boston to discuss improving surgical care in the global context. I was at the "Role of Surgery in Global Health" program, where I learned more about programs and ideas to increase safe access to surgical services for the world's population. This was not an effort to bring high cost and complex procedures to areas that wouldn't benefit. Rather, it was the recognition that safe, basic, cost effective surgical services are a key component to public health. If you could have just one procedure that would reduce overall mortality in a population, what do you think it would be? Trauma laparotomy? Coronary artery bypass? Appendectomy? Actually, it is the availability of Cesarean section for nonprogressing labor. In addition to reducing maternal and fetal mortality, the incidence of debilitating fistula is reduced. Yet this requires anesthesia and clean operating theaters. We take anesthesia safety for granted in developed country, yet even when I was a child, anesthesia deaths and brain damage were more common due to unrecognized low oxygen saturations. The near universal use of pulse oxygen monitors has increased safety by orders of magnitude. Even though the cost is moderate by US standards ( about $1000), availability is limited in the areas of greatest need. What I learned was of a remarkable group that used business and political savvy to create an organization that would buy monitors in bulk from the manufacturers (who could then provide these at significant discount), and handle worldwide distribution and training. It reinforced my belief that the answer to many of our problems is not by throwing money at it, but by using human capacity for innovation and commitment to reach a goal.


I had more good news yesterday from Milot. The hurricane moved further west and damage was minimal. We are moving forward on our inventory project, the structure is erected, and here again, I've seen how we can bring in technology that will improve care at a moderate and justifiable cost. I'll fill you in on more as I plan another trip to Milot before the end of the year, this time to help with the integration, training, and roll out of the initiative. Thanks also to my classmates and instructors at the School of Public Health, who have provided invaluable insights and perspectives.



All this is in the background of some new directions that I'll be taking. I've appreciated the advice and support from many of you. It's certainly lightened my load and helped me focus on doing good things in the future.