On a screen in the cavernous hall at the Harvard Club of Boston were images of two patients, one with a hernia and the second with breast cancer, conditions routinely treated with surgery in the United States.Only these patients were not in this country. They were in the developing world, where access to surgery is a rarity. Instead of neat scars from conditions treated early, the images showed a hernia so distended that it was as large as a football, and a cancer left untreated until it consumed a breast.For decades, the focus of medical professionals fighting to improve health in the developing world has been on defeating infectious disease. In more recent times, the focus has shifted toward chronic illnesses, such as heart disease and diabetes, which until recently were thought of as problems limited to industrialized nations.Public health professionals and surgeons gathered on Friday (Nov. 5) to begin addressing another major area of unmet need in global health: surgery.Though people in the developing world have regular surgical needs — not just from hernias and cancer but also from car accidents, cooking fires, industrial accidents, even childbirth — surgical care is often not considered part of the global health picture.“Surgery is the neglected stepchild of global health,” said Paul Farmer, Maude and Lillian Presley Professor of Global Health and Social Medicine at Harvard Medical School (HMS) and co-founder of Partners In Health, a nonprofit that specializes in providing care to the world’s poor in countries such as Haiti, Rwanda, and Lesotho.Farmer was just one speaker at the all-day session, “The Role of Surgery in Global Health.” The event was introduced by Kelly McQueen, a research fellow at the Harvard Humanitarian Initiative (HHI), and by HHI director Michael VanRooyen, associate professor of global health and population at the Harvard School of Public Health (HSPH). McQueen said the problem of treating surgical disease internationally is largely unknown and hard to estimate. Often, she said, the underlying unmet needs don’t become apparent until a disaster, such as Haiti’s earthquake last January, brings in surgeons to treat the trauma.VanRooyen asked surgeons in the room to help make the case that surgery needs to be considered part of the right to basic health care.“Our task together is to make this argument,” VanRooyen said.Atul Gawande, associate professor of surgery at HMS and Brigham and Women’s Hospital and associate professor of health policy and management at HSPH, said not only are too few surgeries performed, but the ones that are performed are too often unsafe, resulting in infection and sometimes death.Gawande said the number of operating rooms per capita varies widely in the world, from 10 per 100,000 people in the developing world to fewer than two per 100,000. Gawande said he believes that having fewer than five operating rooms per 100,000 is inadequate — which is the situation for 3 billion people. Two billion people live in areas without even one operating room per 100,000 people, which Gawande said translates to a lack of access to even minimal surgical services.Gawande told the story of a man he met while working at a hospital in India. The man, who had trouble breathing, had been to a number of hospitals and clinics. X-rays showed fluid in his lung, but he had received little treatment. When Gawande found the man, he could barely breathe, and Gawande and the local doctor with whom he was working understood that they needed to drain fluid from his chest. The hospital, however, didn’t have a chest tube, so they wrote a prescription for one. The man’s brother raced to nearby medical suppliers to get it. When he returned, they had to wait again, this time for an operating room. When they got to the operating room, there were no knives. So the man waited again while the brother was sent to buy a knife.By the time the brother returned for the second time, the man was dead, of a tubercular abscess in his lung.“It’s about people and skill. It’s about systems and capacity,” Gawande said.While a lack of resources is a constant problem, Gawande said there are ways to reduce the cost of vital resources. He described a new collaborative effort aimed at getting critical blood oxygen monitoring equipment, called pulse oximeters, to resource-poor hospitals. Because of a lack of demand in the developing world, hospitals had been paying $2,000 to $3,000 for each unit, while American hospitals pay just $900 to $1,000, in part because of their economy of scale. By banding together and approaching manufacturers directly, the poor hospitals got a price of $189 for manufacturing and a delivered cost of $240 per unit.Gawande said global health is in the charter school phase of learning how to adequately deliver surgical services in resource-poor settings. Like charter schools, many groups are struggling, though a few, such as Partners In Health, offer shining examples of ways to succeed.“We are in the charter school phase in our efforts to do global surgery in a good way,” Gawande said. “We’re looking for the city on the hill.”The session was sponsored by half a dozen organizations, including HHI, the Massachusetts General Hospital’s Center for Global Health and the MGH International Trauma and Disaster Institute, the HMS Department of Global Health and Social Medicine, Brigham and Women’s Hospital, and the Harvard Institute for Global Health.Harvard Humanitarian Initiative director Michael VanRooyen asked surgeons in the room to help make the case that surgery needs to be considered part of the right to basic health care. “Our task together is to make this argument,” VanRooyen said.
Put Manny Ramirez and Dane Cook in a room together, and you’ll get more than just the greatest idea for a reality show ever assembled. No, it’s not just “Cookin’ with Manny” that you’d get, but instead two viewpoints that couldn’t be more opposite from each other and couldn’t be more perfect for each other. Major League Baseball’s playoffs, about to start World Series play, can best be characterized from a combination of two quotations, one from Cook and one from Ramirez. Cook, in those ridiculously cheesy and omnipresent TBS commercials, has quite emphatically informed fans, “There’s only one postseason. There’s only one October.” And though the rest of this column could easily be spent pointing out the flaws in everything else the comedian has ever said, that’s one sentiment that’s tough to disagree with. It’s not exactly the most motivational or inspirational or insightful statement ever spoken, but the message is correct. Baseball has reached the time where teams must win or go home, and it’s the most exciting time of the season. Still, though, the counterpoint to Cook’s statement is a valid one too, and it came from perhaps the most unlikely of sources, Manny Ramirez. “There’s always next year,” the Red Sox slugger told reporters before playing Game 5 of the ALCS with Boston facing elimination. “It’s not like it’s the end of the world.” Though the reaction to Ramirez’s comments was initially harsh, especially from Red Sox fans hoping to see a little more sense of urgency in their star, fans and media members alike have begun to understand the truth in his comment after the dust settled. Obviously, Ramirez wants to win. His performance in that game, 2-4 and the game-winning RBI, made that pretty clear. What the outfielder understood, however, and tried to convey, is that there will always be a next season, meaning a loss does not mean the end of the world. This postseason, probably unlike any other in recent memory, proves that it’s not always Cook’s viewpoint nor Ramirez’s, but rather one of the two, depending on the situation, that best describes the driving force behind playoff baseball. This postseason’s biggest story lines are a mix of events and actions that follow either Cook’s or Ramirez’s statements. Playing in his 17th season at the age of 40, Kenny Lofton made his mark on the playoffs. Ramirez’s quote doesn’t make too much sense in describing the old-timer though, because there isn’t always going to be another season for the center fielder. It is hard to imagine Lofton playing in another postseason when he’s 41 years old. In this situation, there is only one postseason for Lofton; there is only one (last) October. Finishing the regular season on an incredible win streak before rolling past their first two playoff opponents, the Colorado Rockies are the team to beat in the World Series. With a corps of players who are young, cheap and talented, there’s no reason to think next season won’t be another good one for the Rockies. There isn’t only one postseason or October in the future for this team. Though losing would probably hurt the squad considering the amazing streak it’s been on, for the Rockies it’s just like Ramirez said, there’s always next year, and judging by the team’s roster, there’s always the year after that and the year after that too. Following the Yankees first-round playoff elimination at the hands of the Indians, manager Joe Torre was offered a contract he called “insulting” and promptly rejected. After 12 seasons and four World Series wins with the New York Yankees, the team decided Torre wasn’t the same skipper he’d been in the past because he hadn’t been getting the job done in the postseason. In this situation, it’s a perfect combination of Cook and Ramirez that can describe what happened. Because the Yankees were so concerned with winning now, they offered a contract to Torre that would require immediate success in order to be lucrative. It really was the end of the world for New York after seven seasons in a row without a World Series ring. They acted on Cook’s way of thinking only because they’d gone by Ramirez’s long enough. Maybe it’s wrong to analyze the playoffs using quotations from two people who won’t be forever remembered as the scholars of our generation. For my money, though, putting what the two of them said together makes a pretty strong definition about playoff baseball. And yes, you can quote me on that. Mike is a sophomore majoring in being undecided. If you think that someone other than Cook or Ramirez had something insightful to say about the post-season you should keep it to yourself;, the column’s already been written. If you can”t resist the urge, however, he can still be reached at [email protected]
Marcos Alonso celebrating after scoring against TottenhamLondon, United Kingdom | AFP | Tottenham Hotspur made a losing start to life as Wembley’s full-time tenants after Marcos Alonso’s double earned Premier League champions Chelsea a 2-1 victory on Sunday.The Spaniard struck either side of a late Michy Batshuayi own goal to get Chelsea back to winning ways after their opening 3-2 loss at home to Burnley and end Spurs’ club-record run of 14 successive home wins.Spurs went unbeaten throughout their final league campaign at White Hart Lane, but struggled at Wembley in the Champions League and have now lost eight of the last 10 matches they have played there.Mauricio Pochettino’s men appeared to have avoided the worst when Batshuayi put through his own goal in the 82nd minute, only for Hugo Lloris’s feeble attempt at a save to gift Alonso the winner two minutes from time.For Spurs, who are playing at Wembley while White Hart Lane is rebuilt, it was a first home defeat in the league since a 2-1 loss to Southampton in May 2016.Having endured a deeply trying start to the season, Chelsea manager Antonio Conte will hope victory over the team his side pipped to the title last season will bring some much-needed positivity back to Stamford Bridge.The Italian celebrated Alonso’s winner with characteristic abandon on the touchline, thoughts of his side’s transfer window struggles and his long stand-off with want-away striker Diego Costa seemingly banished.Chelsea’s list of absentees — suspended pair Gary Cahill and Cesc Fabregas, injury victim Eden Hazard and the exiled Costa — moved Conte to adopt an unfamiliar 3-5-1-1 system, with David Luiz anchoring the midfield.He also gave a debut to £40 million ($51.5 million, 43.8 million euros) new signing Tiemoue Bakayoko, who produced a leggy 90-minute showing in his first appearance since arriving from French champions Monaco.– Kane hits post – Alvaro Morata should have crowned his full Chelsea debut with an early goal, only to head wide from seven yards when Cesar Azpilicueta’s cross picked him out unmarked, but in the 24th minute his side did go ahead.Chelsea were awarded a free-kick after Dele Alli clipped Luiz and from a position 25 yards from goal, slightly to the right of centre, Alonso arced a magnificent shot into the top-right corner.Harry Kane, Alli and Mousa Dembele had all threatened for Spurs prior to Chelsea’s opener and after falling behind, they dominated the rest of the first half.Kane bent a shot against the base of the right-hand post after cutting inside Andreas Christensen from Alli’s pass, while Ben Davies saw a swerving effort from range clubbed away by the diving Thibaut Courtois.The hosts could count themselves unfortunate to be behind, but they were also a little lucky to keep 11 men on the field after Eric Dier and Jan Vertonghen escaped with yellow cards for ugly fouls on Luiz and Victor Moses.With Chelsea’s back three becoming more of a back five, they successfully held Spurs at bay in the second half and came close to adding a second goal when Willian’s low drive came skidding back off the post.Spurs thought they had rescued a point with eight minutes remaining when Batshuayi, who had only been on the pitch for four minutes, inadvertently headed Christian Eriksen’s free-kick into his own net.But six minutes later, Alonso picked up a loose ball in midfield and swapped passes with substitute Pedro before drilling a low shot beneath Lloris to give Chelsea victory.Share on: WhatsApp