Neocolonialism: should it concern surgeons?

Abstract

Global health that addresses the burden of surgical care, particularly in low- and middle-income countries (LMICs), is a simple definition of 'global surgery'. In recent years, researchers and global health practitioners, particularly those from LMICs, have drawn attention to the inequitable practices, reminiscent of colonial medicine and tropical medicine, that persist within global health. Herein, the concept of neocolonialism in global surgery is introduced and suggestions for how to approach global surgery in more equitable and inclusive ways are provided. Surgical care delivery through short-term surgical missions has faced challenges in providing high-quality surgical care with limited follow-up and sustainability. Similarly, skills gained in short-term training programmes may be misaligned with the disease burden of communities. In the context of surgical training, surgeons from colonized lands have historically travelled to high-income countries (HICs) to have their local experience validated through European or North American examinations. The master craftsman/trainer guild model remains in many parts of the world and is expensive and designed for the replacement of the workforce in HICs. It is also the rate-limiting factor for scaling up surgical education to address exponential population growth and the unmet need for surgery in LMICs. Global North domination of knowledge around national surgical plans (NSPs) and policy development has several negative consequences. The NSP development process needs to be bottom-up with wide stakeholder involvement for developing shorter-term, more focused plans to galvanize stakeholders.