Dr. Dennis Mazingi’s quest to improve access to safe surgery for children globally

By Mikyla Jade Rata, Global Surgery Fellow, Operation Smile

Operation Smile recently hosted Dr. Dennis Mazingi to speak to our staff on advancing global pediatric surgery.

While working as a general surgeon in Zimbabwe, Dr. Dennis Mazingi found that the most inspirational patients he encountered were the children in the pediatric surgical ward. He was inspired by their bravery and amazing capacity to recover from devastating surgical conditions.

However, Dr. Mazingi also observed many children with various surgical conditions who did not receive the care they needed due to limited health care staff, supplies and infrastructure. He realized that many children will continue to die if nothing was done to improve the systems of pediatric surgery delivery in his country and across Africa.

This realization led Dr. Mazingi to look beyond the operating room in search of a way to solve the problem of the unaddressed pediatric surgical burden in Zimbabwe and Africa.

In 2020, Dr. Mazingi joined the global surgery division at Oxford University to study the challenges that children face in accessing quality surgical care globally and identify innovative solutions to the problem. Since joining, he has led and co-authored numerous global surgery research papers. Dr. Mazingi is presently pursuing a Ph.D. at Oxford University focusing on the prevention of childhood injury in Zimbabwe.

On Tuesday, October 11, 2022, Operation Smile hosted Dr. Mazingi at the Policy and Advocacy Global Surgery Speakers Series. He gave a talk on advancing global pediatric surgery to our staff.

Surgery has long been an underserved area of global health and is often overlooked amid the global health discourse. Children represent a particularly vulnerable group. Presently, 1.7 billion children do not have access to safe, timely and affordable surgery and anesthesia care globally, and most of these children reside in low and middle-income countries (LMICs). Around 80% of children in LMICs will require a surgical operation before their 15th birthday, but due to the disparity in access to care, mortality can be as high as 100 to 200 times higher for children in some LMICs compared with children in high income countries (HICs).

Dr. Mazingi highlighted that the challenge is growing ever more daunting, as the pediatric surgical burden will continue to grow if nothing is done. Currently, about half the population of LMICs are children. This, in addition to the fact Africa’s population is set to double by 2050, means there will be a huge increase in young people vulnerable to and in need of surgical care. Therefore, pediatric surgery cannot be separated from global surgery, they are one and the same.

Operation Smile is helping to build pediatric surgical capacity in countries like Rwanda, where it partners with the University of Rwanda, the College of Surgeons of East, Central and Southern Africa, and the Rwandan Surgical Society to train the next generation of reconstructive plastic surgeons in the country. In 2022, the first cohort of residents graduated from the three-year program, more than doubling Rwanda’s reconstructive plastic surgeons from two to five. Pictured here are Rwanda’s first female plastic surgeon and program graduate, Françoise Mukagaju, with mentor Dr. Charles Furaha pf the University of Rwanda. Operation Smile photo by Jörgen Hildebrandt.

The need for robust local pediatric surgical systems was stressed during the COVID-19 pandemic. The first six months of the global pandemic saw a reduction in pediatric elective surgeries by 79%, emergency surgery by 23%, injury surgery by 31% and congenital surgeries by 35%, resulting in an exacerbation in the already large unmet need of pediatric surgery in African countries (Mazingi et al, 2023).

But Dr. Mazingi is not without hope. He believes that we can all work together in creating more resilient pediatric surgical systems in LMICs, and to do so, we must act with local priorities in mind and measure our success through the patient’s perspective rather than simple surgical indicators alone. Through this approach, we can create a roadmap to advance pediatric global surgery.

The road to ensuring that no child dies or is disadvantaged because of a treatable surgical condition may be long and winding, but it is essential because for countries “to have a prosperous and satisfying life, they have to be free of surgical disease and that will allow them to reach their potential as a nation,” Dr. Mazingi said.

As clinicians, we are often the last stop in a child’s health care journey, but much of the work that needs doing lies outside the operating room. While we may be good at repairing a cleft lip or fixing a broken bone, we must learn how to be researchers, advocates and effective communicators if we are to address the systemic and societal challenges that children face in accessing quality surgical care.

We must find our space at the decision-making table to ensure that children’s surgery is not forgotten when important policy decisions are made. We need to learn to lead and aim for systematic and sustainable impact to ensure that no child suffers from a condition that is treatable with safe surgical care.

References

Mazingi D, Shinondo P, Ihediwa G, Ford K, Ademuyiwa A, Lakhoo K. The impact of the COVID-19 pandemic on paediatric surgical volumes in Africa: A retrospective observational study. J. Pediatr. Surg. 2023. Forthcoming.