Publications

Introduction Global surgery conferences are critical for sharing best practices, networking, developing policies and strengthening surgical systems, yet they often under-represent low- and middle-income countries (LMICs), perpetuating academic inequities. This study describes systemic barriers to frontline provider participation, and suggests actionable recommendations to facilitate the inclusion of LMIC voices at these conferences. Methods The development of the consensus statement involved the Association for Academic Global Surgery’s Advocacy Committee in collaboration with several experts and volunteers from LMICs. A literature review and deductive thematic analysis were conducted to identify the key barriers to LMIC representation at global surgery conferences. Recommendations were proposed in a three-tiered format. A modified Delphi process was employed to gather consensus on the recommendations through a series of virtual meetings. Results Our literature review identifies three fundamental barriers – financial, geopolitical, and limited access – ranging from unaffordable costs of attendance, to visa procurement and racism, to gender and language related disparities. Consequently, fewer abstracts, speakers, attendees, and publications from the global south are represented, perpetuating an imbalance in global discourse and knowledge sharing. During the consensus exercise, 30 recommendations were proposed. Of these, 26 achieved 100% agreement, and four met and exceeded the consensus threshold (80%) by the end of the second Delphi round. Conclusion Recognizing that these changes take time, continued effort, and resource investment, we advocate for a tiered approach to our recommendations, enabling conference organizers to progressively achieve more inclusive and equitable practices. Key consensus recommendations include introducing fee waivers and travel grants to counter financial barriers for LMIC attendees, promoting hybrid conferences, advocating in political forums, and relocating events to visa-friendly countries to address geopolitical challenges. Additionally, live translation services, mentorship opportunities, and targeted advertising in LMIC forums can enhance access. Thoughtful advocacy across all levels of stakeholder engagement is imperative to democratizing global surgery dialogues and ensuring that international forums feature diverse and equitable representation.

Globally, 60% of the surgical procedures are carried out for 15% of the world population in developed countries. The Lancet commission on Global surgery estimates that a population of 100000 would ideally require 5000 surgical procedures every year. Although the national average is about 800 in most of the rural areas in India, in the North-eastern states it varies from 30 to 300. We look at the various models and options available for empowering the surgeons in the rural areas. Short Term Medical Missions have been used for a long time including those with structured programs. Pioneering long term medical missions are few and difficult to sustain. Empowering surgeons working in rural areas with modern surgical techniques is a sustainable solution with high impact. Empowering the rural surgeons with training in Gas Insufflation Less Laparoscopic Surgeries and Endoscopic Urology surgeries helped the surgical coverage in the target population of the 8 rural hospitals studied go up from 1287 per 100000 per year to 2880 the next year and 3739 the following year. It is a financially sustainable model that could be scaled up by funding travel of the trainers and equipment for the trainees.