A Surgeon’s Journey in Global Health

When you ask orthopaedic surgeon David Spiegel, MD, about his global health career, he will tell you that he came to global health by happenstance. What he thought of as a one-off opportunity blossomed into a two-decades-long partnership.

Dr. Spiegel took a sabbatical in Nepal after completing his residency training at Duke Medical Center. He had heard of a U.S.-trained, Nepali orthopaedic surgeon, Ashok Banskota, MD, who was transforming surgical care there, and he went to learn more. During his time in Nepal, Dr. Spiegel spent his time learning and building friendships with his colleagues. Those friendships have led to clinical and research collaborations that have transformed the lives of thousands of children over more than two decades.

He has traveled to Nepal more than 20 times to teach new surgical techniques and to support the research infrastructure of the nonprofit hospital, Hospital and Rehabilitation Centre for Disabled Children (HRDC), founded by Dr. Banskota. Dr. Spiegel notes that with each visit, he comes away with new insights and understanding of pediatric orthopaedics and global surgery work that inform his work here at Children’s Hospital of Philadelphia (CHOP) and in various other global settings.

Friendship and personal relationships

Dr. Spiegel’s affable manner and humility shine through in any conversation you have with him. It’s easy to see how friendship and personal relationships have served as a foundation for his global health work.

“Global health for me is about being invited into someone else’s home, being somebody’s guest and listening to what they are interested in. … The only way to really be useful is to put yourself in another person’s shoes for every aspect of their life.”

He credits his colleagues for identifying the needs in their communities, developing strategies to address those needs, and then leveraging his expertise to maximize the impact of those strategies. In Nepal, he helped HRDC to introduce the Ponseti technique to treat clubfoot. Over the last 15 years, more than 5,000 feet have been treated, and the hospital has decentralized service delivery. With the addition of four satellite sites, more than 700 feet are now treated per year.

Beyond the significant impact of his interactions with the HRDC team, Dr. Spiegel also sees the culmination of his global health work in the joy of getting to know his colleagues in Nepal well — some as close as family.

Context of global surgery

Global surgery, like healthcare anywhere, exists within sociocultural and geospatial contexts that influence the availability of surgical resources as well as the diagnosis and presentation of a health concern. In addition to his work in Nepal, Dr. Spiegel has been active in promoting essential surgical care globally through the World Health Organization’s (WHO’s) Emergency and Essential Surgical Care (EESC) program. He has served as a consultant for WHO in Mongolia and Somalia, as an Honorary Professor at the University of Basra in Iraq, and recently has been involved in the development of an educational course for orthopaedic surgeons in Pakistan.

The healthcare infrastructure in many of these countries has suffered because of extreme poverty and/or armed conflict — namely, the Nepalese civil war (1996-2006), the Iraq war (2003-2011), instability in Pakistan from the conflict in neighboring Afghanistan, and more than two decades of internal conflict in Somalia.

For Dr. Spiegel, the context — no matter how challenging — presents an opportunity to develop innovative solutions to give patients a chance at a productive life that allows them to participate in everyday activities.

Improving health systems

Through his work, Dr. Spiegel has come to realize that many of the surgical concerns that patients in many global settings present with are a result of broken health systems that are poorly equipped to meet patients’ needs. Additionally, when global health programs are designed, surgery is often overlooked. The good news is that this is slowly beginning to change through the advocacy work of surgeons around the world, including Dr. Spiegel. He along with many of his surgery and anesthesia colleagues advocate for global surgery to become an “essential” health service that is part of the comprehensive package of services that health systems worldwide provide to their communities.

“Available epidemiological information and experiential evidence lend support to the conclusion that basic surgical and anesthetic services should be integrated into primary health-care packages.” – Spiegel, DA, and Gosselin, RA, Lancet 2007