Development of the SOSAS survey, a population based assessment of surgical need. #globalsurgery #globalhealth

Without the relatively simple operation the father of three and main breadwinner would certainly have died. He presented to the hospital like so many other patients in low and middle income countries (LMICs) with nearly dead intestines stuck in a defect in his abdominal wall – a condition known as a strangulated hernia. In high income countries such conditions are uncommon and rarely fatal; usually hernias are repaired early to prevent strangulation. In LMICs millions of hernias remain unrepaired with strangulation and death all too common.

That patient survived; however, the following day another young man presented with signs of a ruptured appendix. In the operating room, more than a gallon of pus was drained. The rupture had occurred five days previously; luckily he had been strong enough to survive the long journey to the hospital. He too would survive.

While traditional public health teaching does not routinely include surgical care, untreated hernias and appendicitis are but two examples of surgically treatable conditions that have received little attention from the global health community. After caring for a multitude of patients with these conditions, questions emerged. Could these conditions have been prevented? If these were the strong patients who survived, how many patients died before reaching the hospital? What was the surgical need of the population? What was the magnitude of the problem?

To begin to truly address the presumed massive surgical need throughout the world, a public health approach was needed. In LMICs only limited data on surgical care were available and these were mainly extrapolations from hospital registries. A population—base household survey of surgical need was required to determine a denominator – the number of people in the population who suffer or who died from a surgically treatable condition.

This led to the development of a collaborative effort by academic institutions, Ministries of Health, and civil society organizations to create a tool, a survey, to estimate the prevalence of surgical care needs to begin addressing the problem.

To read more about the development of the Surgeons OverSeas Assessment of Surgical need (SOSAS) survey, see Chapter 1 in Operation Health: Surgical care in the developing world.