LAUSR

Dear Editor, Five billion people lack access to safe, timely, and affordable surgical care when needed [1]. As a result, nearly 18 million people die from surgically treatable conditions every year – over five times the mortality of malaria, tuberculosis, and HIV/AIDS combined – whereas one-third of the global burden of disease is amenable to surgery [1]. Global surgery, conceptually, can be defined as ‘an area for study, research, practice, and advocacy that places priority on improving health outcomes and achieving health equity for all people worldwide who are affected by surgical conditions or have a need for surgical care’ [2]. In 2015, the World Health Organization formally acknowledged global surgery’s integral role in attaining universal health coverage by unanimously adopting the World Health Assembly Resolution WHA68.15, ‘Strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage’ [3]. Confronting its colonial past, Belgium has expanded its global health efforts in the past few decades; however, the country’s involvement in global surgery has been lacking to date. There are good reasons to consider Belgium as a growing player in the global surgery arena. First, InciSioN – International Student Surgical Network, the world’s largest global surgery trainee network uniting over 5000 students and young doctors from over 80 countries, has its official seat in Belgium since its inception in 2016 [4]. In 2018, the inaugural InciSioN Global Surgery Symposium took place in Leuven, Belgium, convening individuals from 49 countries to discuss global surgery matters. Second, Brussels, the capital of Belgium and the heart of the European Union, is a melting pot of like-minded institutions. For example, M edecins Sans Fronti eres (Doctors Without Borders) has been supporting access to emergency and essential surgical care in war-torn and crisis settings across the globe. In turn, Enabel, formerly called the Belgian Technical Cooperation, has supported surgical system strengthening interventions across lowand middle-income countries (LMICs), which can be further scaled to meet the demands of local populations. Lastly, non-governmental organizations such as Chain of Hope have developed sustainable, bilateral relationships with LMIC settings to provide complex surgical care, such as pediatric cardiac surgery, whilst contributing to local capacity-building. Moving forward, several opportunities arise. The recent development of the standardized Flanders-wide Master of Science in Global Health follows the Institute of Tropical Medicine’s Master of Science in Public Health to become the first comprehensive global health-oriented Master program at Belgian universities. While not yet including global surgery in its current curriculum, the focus on health systems and governance can serve as a stepping stone to introduce conceptual models such as National Surgical, Obstetric, and Anesthesia Plans (NSOAPs) to leverage holistic health systems strengthening in LMICs [5]. On the ground, these processes can be supported by Enabel to accelerate the NSOAP movement around the world. Furthermore, the growing understanding and interests of students and residents in the sustainable health systems approaches of global health and global surgery should serve as an impetus to build on existing momentum to train future generations of global surgeons, obstetricians, and anesthesiologists in Belgium. Indirectly, this may lead to a better understanding of residents and clinicians of the social layers of and inequities within patient care in the Belgian health care system, and promote trickle-up or reverse innovation, introducing low-cost innovations developed in LMICs to high-income country settings. Lastly, the Institute of Tropical Medicine in Antwerp, one of the world’s leading tropical medicine institutions, has the potential to leverage its existing network and global health expertise to break down vertical disease silos and expand health systems strengthening interventions. Building on a strong domestic academic and medical legacy, supported by institutional global health expertise and developmental capacity, Belgium can play an increasingly important role in the expansion of surgical, obstetric, and anesthesia care to the five billion people worldwide without. It is now up to the country’s policymakers, professional societies, and academic institutions to leverage the global momentum and position itself on the global surgery map.