As you're wheeled down to surgery, nervously waving goodbye to loved ones, it's unlikely that one of your fears is whether your surgeon will have to double up as your anesthesiologist.
But at a hospital in Nigeria, Dr. David Barash remembers watching an obstetrician perform a cesarean section while at the same time instructing a nurse on how to deliver anesthesia.
Then at another hospital in Nigeria, Barash saw women left unattended, lying on beds in the hallway, to recover on their own after C-sections.
For billions of people around the world, situations like these are the norm, not the exception. Going under the knife is extremely risky.
In 2010, a third of all global deaths were from common conditions, such as obstructed labor, appendicitis and fractures, because people didn't have access to safe surgery, Barash and an international team of doctors report Monday in The Lancet journal.
Most of the deaths occurred in low- and middle-income countries, where 9 out of 10 people struggle to find basic surgical treatment, the study finds.
Barash is the chief medical officer for the GE Foundation, which gives communities medical equipment and helps train health workers. He spent several years inspecting surgery rooms in developing countries.
The sparkling surgery rooms of Western hospitals are a far cry from the dingy operating tables he saw. "They don't have sterilizers or clean water. And they definitely don't have power on a consistent basis," Barash says.
"Having practiced as a physician in a developed country, and then to go to a developing country and see that there is a whole other world out there that is not as lucky as I am or my patients are, it was eye-opening," he explains.
Up to 90 percent of maternal deaths can be avoidable if surgical provisions are improved, Barash and his colleagues report. "We are talking about hundreds of thousands of mothers and infants per year. A lot of lives are at risk," he says.
Two other procedures are singled out as problem areas: the treatment of fractures in which the bone breaks through the skin and laparotomies, when doctors open up the abdominal cavity to remove tumors or repair injuries. "If we can put enough of the surgical ecosystem together to do these procedures safely, it will have an extraordinary impact on saving lives," Barash says.
But training doctors and setting them up with the right equipment is expensive. It would take about $420 billion over the next 15 years to bring surgical resources up to scratch in the weakest countries, the report estimates.
On the other hand, that cost is "far outweighed" by economic losses to communities resulting from the global shortfall in access to surgery, the researchers write.