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President's address at the Opening of 2nd International conference of IFRS at Ifakara, Tanzania (27-29 Sept.2007)

President, IFRS


Our ancient sages said some 5000 years ago that the whole world is one family. I would not know how and why they said that. But a British geneticist, Walter Bodner also said some thing like that, "we are all descended from Africa". That obviously is a scientific conclusion. And now last month I read that another geneticist Spencer Wells, working on a project for the National Geography and IBM also stated that people in Europe, Central Asia, India, Far East, Australia etc migrated from Africa some 50,000 to 60,000 years ago. That means we from India have come to our place of origin. That idea makes me very happy indeed.

Our wise old sages from India used to pray

Sarve Bhavantu Sukhinaha Sarve Santu
Sarve Bhadrani Pashyantu Ma Kashchid

"May all be happy, may all be healthy, may all see good things, may no one ever have to suffer". Unfortunately this prayer has never been fulfilled for all these centuries.

United Nations High Commissioner for Human Rights declared in 1968 that "highest attainable standard of health is a fundamental birth right of every human being". That has not made a lot of difference to the poor either.

Then came the Declaration of W.H.O."Health for all by 2000 AD" in 1977, and of Alma Ata conference declaration in 1978. None of these have been effective as far as the health care of the poor is concerned. On the other hand, the medical fraternity, whose duty it is to look after the health also has been indifferent in this area. Dr. Banoo Koya from Maharashtra, India very correctly said that"we are happy with excellent health care of the 5%, mediocre care of the 15% but we are not at all concerned with the health care of the remaining 80%!" As a result of all this in India, in 1995, not more than 30% of the population had any access to the basic surgery. (Dr. Takavale1995). The situation in other developing countries may not be very different.

The developments and advancements of health sciences have no respect for the cost factors. To add to this is the present context of globalization and everything that comes with it. As a result, the noble profession that medicine was has now become an ignoble commerce. In stead of simplifying it the practice of medicine and surgery is becoming more and more complicated, day by day, even to the practicing surgeons, leave alone the patients. Perhaps that is why Austrian philosopher Ivan Illich exclaimed that"…medical doctors have expropriated health from public". A number of newer gadgets and protocols are being introduced all the time. These may be affordable by the developing countries and the top 5 to 10% of Indian population but they are certainly not within the reach of nearly 70-80% of the rest. How relevant or irrelevant these protocols are is difficult to say. In such a state of affairs, I believe, making health care affordable is far more important than trying to follow the academics or the latest standards.

Perhaps that is also the reason why in Declaration of Alma Ata they opted for "acceptable level of health" and not the"highest attainable standard of health". The Alma Ata conference in 1978 said that Primary Health Care is the key to achieve the goal of "Health for All by 200 AD." I believe, Rural Surgery or what you call Primary Care
Surgery is the key to the surgical care of the people.

Some surgeons from rural India got together nearly 20 years ago and focussed attention of all on to surgery as they practised it. They called it Rural Surgery. To paraphrase what is said of the Primary Health Care in the Alma Ata declaration, rural surgery is "based on
practical, scientifically sound and socially acceptable methods and technology, made universally accessible to individuals and communities at a cost that community and country can afford…." In other words it is the appropriate multi-disciplinary surgical care. 80% of the surgeons in India are concentrated in urban areas and the remaining 20% surgeons practice rural surgery to serve the nearly 70% of rural population and urban slum dwellers. Dr. Halfdan Mahler the past Director General of W.H.O. had said something to the effect that only that technology is important which is useful to the majority. Obviously, our new concept of rural surgery was and is certainly one such useful technology.

But this truth was unacceptable to the academicians. Arthur Schopenhauer had said: "All truth passes through three stages. First it is ridiculed, second it is opposed violently and third, it is accepted as being self evident".

Association of Rural Surgeons of India has literally experienced all these three stages. Now the very concept has been accepted as being obviously important for our nation. A separate section of Association of Surgeons of India on rural surgery has been started. The Indian Government has started a Rural Health Mission. Thanks to Dr. Shyamprasad,National Board of Examinations has started Diplomate of Rural Surgery, a post graduate course too. We hope that very soon this postgraduate qualification in rural surgery will give it the rightful status of a speciality.

When a technology has to be made affordable, people innovate to cut costs and to overcome the constraints. You have the wonderful example of Prof. Awojobi inventing a bicycle driven centrifuge. We in India too have some great innovations that have made health care more affordable.

  1. Jaipur foot. It is a low-cost lower limb prosthesis, with which an amputee can work in wet fields and even climb trees.
  2. Low cost Ventilator introduced by Dr. Ghaisas does not need the costly oxygen as operating force.
  3. Mosquito net introduced by Dr. Brahma Reddy for hernia repairs is a very cheap alternative.
  4. Our past president of India, Dr. Kalam gave light alloy of space technology to reduce the weight of prosthesis for poor children.

With all these and many more, rural surgery in India is gradually becoming popular, more
patient friendly and also effective.

International Federation of Rural Surgery was an idea put forth by Dr. Thomas Moch, our present Secretary and Dr.J.K. Banerjee, present president of ARSI. The main purpose of I.F.R.S. is to pass on the message, that rural surgery is best suited to the developing countries. I feel that each of your countries needs to modify surgery to suit its people and its health problems. It is by no means a quick fix solution. What Dr. Halfdan Mahler said for Primary Health Care is true for Rural Surgery too. He said "What we need most of all is singleness of purpose, absolute determination to overcome obstacles, trial and error and retrial, and refusal to retreat in frustration if progress is slower than we would like". At the end of it all you will be proud of the rural surgery you developed for your country.

It is said that men and nations act wisely when they have exhausted all alternatives. You do not have to wait till you exhaust all your alternatives. Develop your surgery keeping your alternatives. Innovations need only the God given wisdom. Such wisdom is seen in almost all communities and I am sure you too have wise people in your countries and you too may create many useful innovations. By all means use all the help from abroad, it will be unwise to start from the beginning; but develop your own surgery best suited to your people and your country. Aim for self-dependence. Self-dependence will make you proud of yourselves. We are proud of all our innovations and the mosquito net, which is symbolic of our attempts to reduce the cost of surgery, and a dignified and very effective alternative to the imported proline mesh.

It is my sincere hope and the hope of I.F.R.S. and A.R.S.I. that this meeting will stimulate the desire in the hearts of all surgeons and nations of Africa to work for the health care of the poorer section of each country. By the time we meet in two years for the next conference, we hope that we will have many more associations or societies of rural surgeons in from different parts of Africa. May God bless you all.

(Proceedings of IFRS general body meet will be published in the next issue)

A section of the Indian delegates with dignitaries

This issue has been sponsored by Dr. Laila E Chandy, California, USA

     Moments of 2nd IFRS conference