EDITORIAL
Global Surgery, Global Economy: Value Based on the Wide World After All ‘‘No generation has ever had the opportunity that all of us now have to build a global economy that leaves no one behind. It is a wonderful opportunity. It is also a profound responsibility.’’ —B. Clinton ‘‘I think everyone is forgetting what plastic surgery is for — if you have a face-eating tumor, lose a breast or are involved in a car accident, then it’s a good idea.’’ —S. Phillips ‘‘I wish I had a twin, so I could know what I’d look like without plastic surgery.’’ —J. Rivers ‘‘Science may someday discover what faith has always known.’’ —Anonymous
I
t was late spring of last year, we were all engulfed with the newly renewed interest in global health care and the impact we do on other global systems to help patients for a better outcome. It was felt that our obligation to our readers necessitates the production of this special issue. The help we as surgeons provide globally comes in many forms and many different name tags, but the goal is the same; it is to provide access to those who are deprived from the proper care because of their global position. The proper care is to provide the needy a better outcome than what they have and an achievable quality of life so that they enjoy their journey as the rest of those on planet Earth. Those patients may have 1 of the 3 categories of clinical issues in plastic surgery: congenital deformities, trauma victims, or patients with oncologic issues. The system of providing access to care can be done in the form of visiting professorship with education on the graduate and undergraduate systems, volunteerism, arranged global medical missions, or itinerant surgery. What it is about is access and care following the Hippocratic Oath of doing no harm. This does not involve the medical and surgical tourism, which has evolved to its reversed new fashion in the past few years for that system is purely evolved around and based on economics. The world is moving into a harmonious global economy; tagged on the world wide economy is the health care system that will emerge also and may be taking a prominent front within the new world order. This may, however, still take some time because all the obstacles were overcome by the astute men and women recognizing the need for such a move. This is, however, still not an easy task, and it is primarily now led by the world powers to be placed in a prominent block as it is coming from us. This will also not be an easy task or will not be achieved without some struggle with those who are having advantages, leaving the majority behind to struggle to get what they want. A professor at a leading institution said recently that the world order is coming together through an evolutionary struggle and the drums of war are sounding all the time; if What Is This Box? A QR Code is a matrix barcode readable by QR scanners, mobile phones with cameras, and smartphones. The QR Code links to the online version of the article.
The Journal of Craniofacial Surgery
you do not hear them you are certainly deaf. The health care in our county is a dinosaur that is slowly moving to extinction, taking with it the business of the practice of medicine as we know it. The world we live in today and thrive in is the success of the global economy that, tagged to the big picture, is the global health. Whether we like it or not, the global health advantages are far more than that of the disadvantages. Having said all that, we see the Journal of Craniofacial Surgery has this dedicated special issue with many contributions from leaders in the global health as it relates to plastic surgery. We see that without effort of the few, we would not have been able to accomplish this task. The leaders who spearheaded this task was led by my colleague and friend from our beloved Florida, Dr Thaller who gathered the group of participants to give the readers and the students an idea about how some are working hard to improve the global health care of people in other countries working on all aspects of health care. It is in a way an itinerant surgery of the global arena with the added caveat of graduate education to make it more effective. A major reservation for the majority of the patients are well-thought missions, are well organized, and are there in a double mission; first one is in the front and is foremost, that is, the graduate educational especially for those who are doing the aftercare and the maintenance programs, and the second will be the main goal of helping the patient to improve the quality of life, if they have major deformity from a birth defect, trauma, or because of oncologic problems. Now with the focus of the education of the local doctors for any mission that is of prime importance is to make the system safer and more user friendly for the patient and for the involved families. Learning and teaching about immediate complications that can be attended by the mission team of surgeons or delayed complications that can be treated via telemedicine or prior awareness by an instructional programs that the group have made. We also gathered contribution in the rest of the issues from all around the world to show how the process that started many years back by some of the visionary humanitarian surgeons who wanted to give is paying off today by having the local surgeons achieve their patients care with the telemedicine support. It is good to that we see the fruits of their work in the form of excellent outcome that is noted and proudly so by their patients. Although there is no statistical evaluation since the numbers are small but outstanding, outcome as an improved quality of life should be noted at all the time. Some of the great works are presented in the form of patient presentations or multiple patients within the group as a series. This
Volume 26, Number 4, June 2015
1001
Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
Editorial
The Journal of Craniofacial Surgery
later system will be of value with 2 edges: one it will be an encouragement to those around the world to present their patients so that we can give the constructive criticism, and the other is to show that we treat them as equal with mutual respect to what they have done, and are doing with a ‘‘bravo’’ tagged at the end of their work. The era of arrogance of ignorance that we have noted previously in the journal is slowly going by the wayside and we are coming to the new health care world order that is global, and we are having a great time with working together globally based on admiration, mutual respect, and common interest of the patients regardless of their color ethnicity or place of origin. Those last goals are well noted in the pages of the journal since its inception, for both the doctors in their community and their patients. So, the world global evolution is on the way and there are more that our efforts in the Journal of Craniofacial Surgery to note that in almost every issue. There will be more conferences and congresses hosted by the United Nations and international outreach meetings to achieve the final outcome based on value and cost for improving patients’ outcome. Of course there will be some major drawbacks, but that will all be able to be overcome through education and the willingness of those involved to do so. Safety in any system we see is going to be paramount. I have few examples to elucidate those issues, especially the difficulty facing the surgeon when our convenient base is violated working in an environment away from home. It was not too far in the arena of the national meeting when the discussions were focusing on the global arena. The journal was already full for the special issue on the subject, but who knows how to do it till we got an idea that we will do as an internal supplement. It was a rough sailing and the seas were not ready for such a project. But, with a good captain we were able to do the sailing and reach the shore unharmed. So we raise our hats to the captain who carved his azimuth in the tacking and jibbing between the waves. Dr Thaller completed the project that almost few times we were going to go back to ground zero. The focus was on missions to help others through educations of those in the medical field interested on the global arena to avoid medical tourism, which has started in the homeland and now moving abroad in a reverse fashion. With mission surgery and volunteerism that we applaud those who are doing it on a constant level, it is hard, risky at times, and involve many people and support teams, especially in the complex system we work with and under. Doing surgery abroad, that incidence I experienced stayed with me as long as I live; it left me with impression that what we have in our work place make us as lucky as it can be. I was invited as visiting professor in faraway land, worked with the students, who are very bright they spend all their time reading what is in the medical literature with the limited electronic resources they have, they ask pertinent questions being inquisitive not to show off in front of a visitor who does not speak the language of the land. The chief of the service asked me whether I can see a patient that they were unable to operate on, for it was too complicated. I saw the patient, concurred it was indeed complicated, they asked whether I have seen something similar, and whether I have operated. I said yes, and that we have a special method we do to make it safe, so they begged me to do so. I was obliged after I had a discussion with the family, went in for surgery the next day, picked everything we needed as far as equipment, talked to all involved, but in life you take things for granted and we do not invasion that the worst can happen. The next day came, we went in, everything went smoothly and almost toward the end of the procedure I noticed the blood was getting darker and started screaming, waking up everyone behind the curtain, it was the oxygen tank was empty. Asked about the oximeter that was gone, or we use only during induction and they took to the next room. Few
1002
Volume 26, Number 4, June 2015
minutes later, the patient heartbeat slowed down then it is a systole as it stopped. We got a new oxygen tank and practicing my pediatric advanced life support as it was a while, seemed like years the patient came back and was able to close all the wounds. The issue was then that I insisted to tell the family, which my host agreed and I waited 2 days to make sure all is well with the patient no residual damage at all. The family were so grateful and they got me a present probably some of the valuables in their house hold, I was so embarrassed to accept as I was telling the family it is my ultimate goal to do what need to be done and make them happy that we achieved the outcome. I gave later the present to my host. I always like to use any experience as a teaching instructional course. For it is more valuable that we learn that not everyone is the same globally yet may be few more years different, for sure we do not think the same. As we depend on technology and on advancement we will need to have more understanding that some in others country may not have the means to do so and many not even have the support they need to achieve their goals to come on the same level of sophistication. They may be good technician and great craftsmen but the technological advances have produced a leap forward in the safety of our patients that is not yet practiced globally for many reasons. So, the outcomes are now better and patient satisfaction is more noted. In faraway countries such missions, volunteerism, or visiting professorship gives their patients and their families’ hope as well as access to care they did not envision of having for what they need so, especially their children will have a better quality of life and the adults will have a more productive years. So, by us spreading work and knowledge to those who need it beyond our borders is a noble endeavor and even at times may look like itinerant surgery abut with the educations we provide to those who do the follow-up and the maintenance programs that are needed to assure a upgraded outcome. Yes, there will always be risk and part of our training we learned how to take the risk, how to have a good judgments, and how to avoid complications with a better planning and education. On a final point the global system in health care is changing and through the work that is done with education and personal volunteerism, we see in a few more years the same care a person receives in one part of the world will be similar to whereever they are through access to quality care, This may not sound easy but it is doable in the long haul. Today, there is already a limited global health insurance as third-party coverage, and tomorrow there will be a global health system. This may have been a dream many years back but today value based on global economy it is a reality. With that we will see more innovations, advances, and progress coming from all over the globe and we are seeing that in the Journal of Craniofacial Surgery beside the contributions coming from all over we see the special theme issues we have also reflecting that particular point in our March issue from China and an earlier issue from India. They demonstrate catching up to par and now more in the form of innovations and progress in patients care. All that will lead to a better outcome with advanced access to care and a better quality of life for the patients in the global community.
Mutaz B. Habal, MD, FRCSC, FACS Editor in Chief/JCS Tampa, Florida, USA [email protected]
#
2015 Mutaz B. Habal, MD
Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
Global Surgery, Global Economy: Value Based on the Wide World After All ‘‘No generation has ever had the opportunity that all of us now have to build a global economy that leaves no one behind. It is a wonderful opportunity. It is also a profound responsibility.’’ —B. Clinton ‘‘I think everyone is forgetting what plastic surgery is for — if you have a face-eating tumor, lose a breast or are involved in a car accident, then it’s a good idea.’’ —S. Phillips ‘‘I wish I had a twin, so I could know what I’d look like without plastic surgery.’’ —J. Rivers ‘‘Science may someday discover what faith has always known.’’ —Anonymous
I
t was late spring of last year, we were all engulfed with the newly renewed interest in global health care and the impact we do on other global systems to help patients for a better outcome. It was felt that our obligation to our readers necessitates the production of this special issue. The help we as surgeons provide globally comes in many forms and many different name tags, but the goal is the same; it is to provide access to those who are deprived from the proper care because of their global position. The proper care is to provide the needy a better outcome than what they have and an achievable quality of life so that they enjoy their journey as the rest of those on planet Earth. Those patients may have 1 of the 3 categories of clinical issues in plastic surgery: congenital deformities, trauma victims, or patients with oncologic issues. The system of providing access to care can be done in the form of visiting professorship with education on the graduate and undergraduate systems, volunteerism, arranged global medical missions, or itinerant surgery. What it is about is access and care following the Hippocratic Oath of doing no harm. This does not involve the medical and surgical tourism, which has evolved to its reversed new fashion in the past few years for that system is purely evolved around and based on economics. The world is moving into a harmonious global economy; tagged on the world wide economy is the health care system that will emerge also and may be taking a prominent front within the new world order. This may, however, still take some time because all the obstacles were overcome by the astute men and women recognizing the need for such a move. This is, however, still not an easy task, and it is primarily now led by the world powers to be placed in a prominent block as it is coming from us. This will also not be an easy task or will not be achieved without some struggle with those who are having advantages, leaving the majority behind to struggle to get what they want. A professor at a leading institution said recently that the world order is coming together through an evolutionary struggle and the drums of war are sounding all the time; if What Is This Box? A QR Code is a matrix barcode readable by QR scanners, mobile phones with cameras, and smartphones. The QR Code links to the online version of the article.
The Journal of Craniofacial Surgery
you do not hear them you are certainly deaf. The health care in our county is a dinosaur that is slowly moving to extinction, taking with it the business of the practice of medicine as we know it. The world we live in today and thrive in is the success of the global economy that, tagged to the big picture, is the global health. Whether we like it or not, the global health advantages are far more than that of the disadvantages. Having said all that, we see the Journal of Craniofacial Surgery has this dedicated special issue with many contributions from leaders in the global health as it relates to plastic surgery. We see that without effort of the few, we would not have been able to accomplish this task. The leaders who spearheaded this task was led by my colleague and friend from our beloved Florida, Dr Thaller who gathered the group of participants to give the readers and the students an idea about how some are working hard to improve the global health care of people in other countries working on all aspects of health care. It is in a way an itinerant surgery of the global arena with the added caveat of graduate education to make it more effective. A major reservation for the majority of the patients are well-thought missions, are well organized, and are there in a double mission; first one is in the front and is foremost, that is, the graduate educational especially for those who are doing the aftercare and the maintenance programs, and the second will be the main goal of helping the patient to improve the quality of life, if they have major deformity from a birth defect, trauma, or because of oncologic problems. Now with the focus of the education of the local doctors for any mission that is of prime importance is to make the system safer and more user friendly for the patient and for the involved families. Learning and teaching about immediate complications that can be attended by the mission team of surgeons or delayed complications that can be treated via telemedicine or prior awareness by an instructional programs that the group have made. We also gathered contribution in the rest of the issues from all around the world to show how the process that started many years back by some of the visionary humanitarian surgeons who wanted to give is paying off today by having the local surgeons achieve their patients care with the telemedicine support. It is good to that we see the fruits of their work in the form of excellent outcome that is noted and proudly so by their patients. Although there is no statistical evaluation since the numbers are small but outstanding, outcome as an improved quality of life should be noted at all the time. Some of the great works are presented in the form of patient presentations or multiple patients within the group as a series. This
Volume 26, Number 4, June 2015
1001
Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
Editorial
The Journal of Craniofacial Surgery
later system will be of value with 2 edges: one it will be an encouragement to those around the world to present their patients so that we can give the constructive criticism, and the other is to show that we treat them as equal with mutual respect to what they have done, and are doing with a ‘‘bravo’’ tagged at the end of their work. The era of arrogance of ignorance that we have noted previously in the journal is slowly going by the wayside and we are coming to the new health care world order that is global, and we are having a great time with working together globally based on admiration, mutual respect, and common interest of the patients regardless of their color ethnicity or place of origin. Those last goals are well noted in the pages of the journal since its inception, for both the doctors in their community and their patients. So, the world global evolution is on the way and there are more that our efforts in the Journal of Craniofacial Surgery to note that in almost every issue. There will be more conferences and congresses hosted by the United Nations and international outreach meetings to achieve the final outcome based on value and cost for improving patients’ outcome. Of course there will be some major drawbacks, but that will all be able to be overcome through education and the willingness of those involved to do so. Safety in any system we see is going to be paramount. I have few examples to elucidate those issues, especially the difficulty facing the surgeon when our convenient base is violated working in an environment away from home. It was not too far in the arena of the national meeting when the discussions were focusing on the global arena. The journal was already full for the special issue on the subject, but who knows how to do it till we got an idea that we will do as an internal supplement. It was a rough sailing and the seas were not ready for such a project. But, with a good captain we were able to do the sailing and reach the shore unharmed. So we raise our hats to the captain who carved his azimuth in the tacking and jibbing between the waves. Dr Thaller completed the project that almost few times we were going to go back to ground zero. The focus was on missions to help others through educations of those in the medical field interested on the global arena to avoid medical tourism, which has started in the homeland and now moving abroad in a reverse fashion. With mission surgery and volunteerism that we applaud those who are doing it on a constant level, it is hard, risky at times, and involve many people and support teams, especially in the complex system we work with and under. Doing surgery abroad, that incidence I experienced stayed with me as long as I live; it left me with impression that what we have in our work place make us as lucky as it can be. I was invited as visiting professor in faraway land, worked with the students, who are very bright they spend all their time reading what is in the medical literature with the limited electronic resources they have, they ask pertinent questions being inquisitive not to show off in front of a visitor who does not speak the language of the land. The chief of the service asked me whether I can see a patient that they were unable to operate on, for it was too complicated. I saw the patient, concurred it was indeed complicated, they asked whether I have seen something similar, and whether I have operated. I said yes, and that we have a special method we do to make it safe, so they begged me to do so. I was obliged after I had a discussion with the family, went in for surgery the next day, picked everything we needed as far as equipment, talked to all involved, but in life you take things for granted and we do not invasion that the worst can happen. The next day came, we went in, everything went smoothly and almost toward the end of the procedure I noticed the blood was getting darker and started screaming, waking up everyone behind the curtain, it was the oxygen tank was empty. Asked about the oximeter that was gone, or we use only during induction and they took to the next room. Few
1002
Volume 26, Number 4, June 2015
minutes later, the patient heartbeat slowed down then it is a systole as it stopped. We got a new oxygen tank and practicing my pediatric advanced life support as it was a while, seemed like years the patient came back and was able to close all the wounds. The issue was then that I insisted to tell the family, which my host agreed and I waited 2 days to make sure all is well with the patient no residual damage at all. The family were so grateful and they got me a present probably some of the valuables in their house hold, I was so embarrassed to accept as I was telling the family it is my ultimate goal to do what need to be done and make them happy that we achieved the outcome. I gave later the present to my host. I always like to use any experience as a teaching instructional course. For it is more valuable that we learn that not everyone is the same globally yet may be few more years different, for sure we do not think the same. As we depend on technology and on advancement we will need to have more understanding that some in others country may not have the means to do so and many not even have the support they need to achieve their goals to come on the same level of sophistication. They may be good technician and great craftsmen but the technological advances have produced a leap forward in the safety of our patients that is not yet practiced globally for many reasons. So, the outcomes are now better and patient satisfaction is more noted. In faraway countries such missions, volunteerism, or visiting professorship gives their patients and their families’ hope as well as access to care they did not envision of having for what they need so, especially their children will have a better quality of life and the adults will have a more productive years. So, by us spreading work and knowledge to those who need it beyond our borders is a noble endeavor and even at times may look like itinerant surgery abut with the educations we provide to those who do the follow-up and the maintenance programs that are needed to assure a upgraded outcome. Yes, there will always be risk and part of our training we learned how to take the risk, how to have a good judgments, and how to avoid complications with a better planning and education. On a final point the global system in health care is changing and through the work that is done with education and personal volunteerism, we see in a few more years the same care a person receives in one part of the world will be similar to whereever they are through access to quality care, This may not sound easy but it is doable in the long haul. Today, there is already a limited global health insurance as third-party coverage, and tomorrow there will be a global health system. This may have been a dream many years back but today value based on global economy it is a reality. With that we will see more innovations, advances, and progress coming from all over the globe and we are seeing that in the Journal of Craniofacial Surgery beside the contributions coming from all over we see the special theme issues we have also reflecting that particular point in our March issue from China and an earlier issue from India. They demonstrate catching up to par and now more in the form of innovations and progress in patients care. All that will lead to a better outcome with advanced access to care and a better quality of life for the patients in the global community.
Mutaz B. Habal, MD, FRCSC, FACS Editor in Chief/JCS Tampa, Florida, USA [email protected]
#
2015 Mutaz B. Habal, MD
Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
