Rural Surgery Presentation at GAPIO Conference: A Summary


The Global Association of Physicians of Indian Origin [GAPIO] is an organization that intends to connect the 1.2 million physicians of Indian origin working all over the World. English speaking western world has about 125,000 physicians of Indian origin. The objectives include contributions towards medical education, training and research in addition to networking and social work. GAPIO has been conducting free plastic surgery camps and charitable clinics at Bangalore and Hyderabad. It also has a web portal called Swaasth India portal to network with the members in helping charitable organizations [1].


The Lancet commission on Global health was initiated about 2 years ago to address the current inequalities in delivery of global surgery and anesthesia care. The commission has over 100 publications so far from collaborators from 110 countries. The key findings so far are the following:

  • Every year there are more than 5 billion in the world who cannot access safe surgery when needed
  • To meet the surgical needs about 143 million surgical procedures are necessary every year but unfortunately the poorest third of the population receive only 6.3% of the surgical procedures performed all over the world
  • It is estimated that 33 million individuals face catastrophic expenses paying for surgery and anesthesia every year and an additional 48 million have catastrophic non – medical expenses seeking surgical care
  • It is estimated that 28 to 32 % of global burden of disease is from surgical conditions.

Spending more than 40% of the average non–food expenses is considered catastrophic. In most of the low and low–middle income countries any major surgical procedure means 56 percent chance of being impoverished. If the non–medical costs are included in many countries there is more than 94% chance of being impoverished after a caesarian section.


The Karad consensus statement was planned to kick start the Lancet commission effort to evaluate and make recommendations for surgical care in rural areas in India. A team from Lancet commission on Global surgery, Association of Rural Surgeons of India [ARSI] and International Federation of Rural Surgeons [IFRS} worked together for months before the meeting at Karad on the consensus statement prepared during the preconference meeting of the ARSI/IFRS conference at Karad in November 2015.

There were three primary groups and the discussions about the following problems that are faced by the rural surgeons.

The Lancet ARSI Consensus

  • Severe shortage of workforce
  • Inadequate rural training programs
  • Accreditation bodies are not coordinated
  • Equipment is not affordable
  • Accreditation standards are irrelevant
  • Uptake of innovation is poor
  • Banked blood is in severe shortage
  • Safe alternatives (UDBT) are not legal


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