Global Cardiac Surgery at the 73rd UNGA

From September, 18th to October, 1st 2018, the 73rd edition of the United Nations General Assembly (UNGA) took place at and around the United Nations Headquarters in New York, United States. The UNGA is one of the six main organs of the United Nations, the only one in which all Member States have equal representation, during which Heads of State and international institutions discuss and vote upon resolutions regarding all issues affecting the world and covering all Sustainable Development Goals (SDGs).

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Health discussions, once again, took up a large part of the UNGA agenda, in particular during UNGA side events around New York. Although official Global Surgery meetings and contributed panels were limited (G4 Alliance’s “Eradicating Neglected Surgical Diseases: Advancing Universal Health Coverage Through Surgical Systems Strengthening” and the Access Challenge‘s Universal Health Coverage Conference), attention for the indispensable role of surgery to tackle non-communicable diseases (NCDs) gained increasing attention.

On September, 25th, Partners in Health, NCD Synergies, and the Program in Global NCDs and Social Change at Harvard Medical School held the breakfast event “What will it take to address NCDs and injuries (NCDI) for the poorest billion? Leading with equity on the NCDI and UHC agendas” at the Harvard Club of New York City. Here, attention was raised for the need to address NCDs and injuries in the poorest populations, given the disparities in accessing care. Different from many other events, however, a patient voice was included on the panel.

Erneste Simpunga, a young man from Rwanda, survived near-fatal rheumatic heart disease (RHD). He was diagnosed with RHD at the age of 16, and slowly progressed into heart failure. He needed valve replacement surgery, but there were no cardiac surgeons in Rwanda. His parents never finished high school and already sold many assets just to allow him to go to school. His family did not have tens of thousands of dollars to send him abroad for surgery. Even then, follow-up care would be an issue. “In Rwanda, we only have 6 cardiologists for 12 million people. Although our country has made great progress in health insurance, health workforce shortages remain an incredibly limiting barrier in accessing care.“, he said. After receiving philanthropic aid to fly to Boston and receiving life-saving surgical care, he is now in his fifth year of medical school at the University of Rwanda in Kigali, Rwanda, aspiring to become a cardiologist or cardiac surgeon and help his country in a way he could not be helped domestically. However, hundreds of thousands of babies are born with congenital heart disease, and hundreds of thousands children and adults suffer from rheumatic heart disease in Rwanda – many millions around the world, all waiting for life-saving surgery.

Screen Shot 2018-09-28 at 10.19.27Ernest Simpunga (second from right): “Surgery in India would cost 15,000 dollars, which we could not afford, and it would take three years for visiting teams to treat me. Seeing cardiologists and taking medicines costed hundreds of dollars per month, so I had to change to a cheaper high school.

On the evening of September, 25th, the American Heart Association, in collaboration with NCD Synergies, Partners in Health, Children’s HeartLink, and other partner organizations, hosted the “Time to Disrupt the Health Care System: Novel Solutions for Quality Care in the SDG Era” event, listening to patient advocates and global champions in advancing prevention and care for cardiovascular diseases (CVD). Here, surgical voices as Erneste, as well as Dr. Bhagwan Koirala (cardiac surgeon from Nepal) and Jackie Boucher (President of Children’s HeartLink) raised the notion of surgical care to treat CVD.

Screen Shot 2018-09-28 at 10.20.02Dr. Koiral (third from left): “Highly specialized, but widely needed care such as cardiac surgery can efficiently be provided in low- and middle-income countries with effective care models. In Nepal, we treat patients from neighbouring countries due to our low costs for cardiac surgery.

On September, 27th, the Third United Nations High-Level Meeting (HLM3) on Non-Communicable Diseases brought together Heads of State and leading non-governmental organizations to discuss the current state of NCDs and (re-)prioritize frameworks to address these around the world. Although Heads of State continued to repeat the message of traditional prevention focus in tackling NCDs, Dr. Sania Nishtar, Co-Chair of the WHO High-Level Commission on NCDs, underlined the importance of surgery to address the global rise in morbidity and mortality due to NCDs: “While designing universal health coverage, we must also cater to the poorest billion. We must recognize that access relates not just to medicines, but also to surgery given that 5 billion individuals lack access globally.

A long way is still to go to achieve equivocal attention for the link between surgery and NCDs, especially for cardiac surgery and cardiovascular diseases. The need for the global community to open up to wider discussions and understand the importance of intersectoral and interdisciplinary collaborations (read “Global Cardiac Surgery: a Wake-Up Call” for a longer note) is urgent and will determine the course of efforts towards UHC and the SDGs in 2030.

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