World Health Assembly-the inside guide

Couldn’t make it to Geneva? Not a problem! Lifebox is here all week, following the global surgery conversation at #WHA68. Come borrow our delegate badge and hang out with us…


DAY FIVE

Breathe easy! This chapter has a happy ending.

Back to the Palais for one last morning – the journal looking much thinner (and a here a moment of administrative solidarity with whoever is getting that mountain ready each morning) – but at first coffee it looks like a resolution is still a ways away.

Because the committee sessions can’t begin until their draft reports are presented in the main assembly room – and if there’s one thing we learned from watching three  voting rounds in the external audit elections yesterday, it’s that you can’t hurry protocol…

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…but it can hurry you! The general assembly whisks through the agenda faster than we can tweet a viewing gallery picture (“move to approve/any objections/I see no objections/approved/applause!” x2), and then we’re off again – back to Committee B and the nine member states who are queued and waiting to speak in support of global surgery.

There are certain gongs each delegate keeps sounding – surgery, anaesthesia, education, equipment, infrastructure, measurement, ketamine, training – and other notes they give their two minute statements which make clear how, in every case, this issue has risen personally and pressingly to the level of nationwide concern.

And then the beauty of non-state actors in official relations with WHO, who also get the floor.

J.P. Abenstein, president of long-time Lifebox supporter ASA takes the mic for our own WFSA.

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And then the house finally takes it back, and Marie-Paul Kieny, Assistant Director General for the Health Systems and Innovation Cluster (AKA where global surgery lives at WHO) speaks.

She commends the many – many! – co-sponsors of the resolution, including those who asked specifically to be added today, and declares that WHO is ready to lead a coordinated response.

There are no objections.

And so it is that EB136.R7 – strengthening emergency and essential surgical and anaesthesia care as a component of universal health coverage –

Was resolved.

And immediately the committee moved on.

(To item 17.2. – WHO Global Code of Practice on the International Recruitment of Health Personnel, a vital and a related issue, but someone else’s blog).

THE END.

Of course it’s not the end! It’s not even the end of the day, let alone the end of the story. Although, as the Zambian Minister of Health said eloquently from the panel at the afternoon’s official side event in support of the resolution – planned in advance, with as much hope as confidence that it would pass –

“This is the end of the beginning.”

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He should know – Zambia was the lead sponsor of the resolution (farewell, ‘proposed resolution’!) and its advocates have been pushing towards this day for a long time.

Longevity grows perspective. The minister set celebration against caution, with the lessons learned from the Alma Ata Declaration – and its radical call for universal primary health care in 1978.

“Those of us who recall Alma Ata know the diversion of implementation strategies around the world, particularly the speed. Lessons must be learned. Let there be an action plan at the centre – but above all, let each country have its action plan as soon as possible.”

2015_May_WHA_Margaret Chan_global surgery side eventNon state actors in official relations with WHO are also given a voice at side events, and Lifebox prepared a statement on behalf of WFSA.

Even WHO Director-General Dr Margaret Chan stopped by!

Before we left, we had the luck to chat with Emmanual Makasa, the Zambian orthopaedic surgeon who has been one of the driving forces for global surgery.

In day or two he’ll be out of his suite and in a small airplane, as part of a rural surgery outreach programme to the most remote areas of Zambia. Sometimes there may not even be an anaesthesia provider, let alone a pulse oximeter to sedate and monitor the patients on the table, in desperate need of their operation.

Happily we had a pulse oximeter with us, and it was a privilege to hand it over.

2015_May_WHA_Sarah and Emmanuel Makasa_oximeter handover

We’re moved and enthused and challenged by this resolution.

We’re ready for a coordinated action plan for safe surgery and anaesthesia.

We’re also getting on with the work at hand.

TO BE CONTINUED.


 

DAY FOUR

What’s the longest you’ve waited for something? And what does it mean when you get it?

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In the – prolonged lunch break – between now and a historic moment in global surgery, it feels appropriate to go back to 1980 and that speech by WHO Director-General Dr Halfdan Mahler.

“The vast majority of the world’s population has no access whatsoever to skilled surgical care and little is being done to find a solution…[but] the era of only the best for the few and nothing for the many is drawing to a close…”

A long time. A lot of suffering in the waiting.

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And then it feels appropriate to go back to this morning, and a mad dash past the Broken Chair Sculpture and the avenue of flags, through security, into Building A, up to the second floor, left along the corridor, sharp left turn along the Glass Walkway of Health Concerns And Their Public Awareness Posters, over into Building E, down two escalators and swing about into the NGO and Press door into Salle XVII.

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Whew.

The committee rooms are straight out of the political scene in any global disaster movie – windowless and cavernous, with concentric circles of chairs radiating out from a dais, microphones and rows of laminated country name cards in alphabetical order.

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Barbados, Bahrain, Bahamas…Libya, Lithuania…and by every seat half a little grey plastic egg, attached to a curly ’80s telephone cable. It cups niftily onto your ear and mini-megaphones the discussion for you. Turn the dial clockwise and you shift from English, to French, to all the official WHO languages (which Lifebox reflects in our education materials), simultaneously translated from the booths above.

The morning started slowly with ‘audit and oversight matters’ and then – without fanfare, but with lots of murmuring from the global surgery crowd in the corner (Lifebox, WFSA, IFMSA, IFCS, G4 Alliance, ASA, various surgery, anaesthesia and nursing lions and grand lions) –

Item 17.1.  Resolution EB136.R7.

Strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage.

Now things start to speed up.

Country after country, representatives are speaking up, giving their support to the resolution.

Each statement highlights a different aspect of the global crisis of lack of access to safe surgery and anaesthesia, building up a (minuted for the ages) picture of a fundamental inequality in healthcare.

Sitting in the gallery, hearing the support ring out, it’s increasingly emotional.  Yes, the work is already ongoing – but the resolution is legitimacy on a global scale. It’s supposed to be the bureaucratic traffic light gone green.

Everyone gets two minutes, cut off by the actual traffic light system, though it’s hard to stay to time when there’s so much to say.  Maybe that’s why, with more than eight countries and non-state actors still to speak…

…#historicmomentbreaksforlunch.

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A decent hashtag, but it’s like being made to stop midway through blowing up a balloon – everyone’s cheeks are flushed and they don’t really know how to hold back their breath.

And tonight no one is breathing easy. Because although the afternoon session began again promptly at 2:30pm, the agenda flipped back to finance: Canada, Pakistan, Philippines and Sierra Leone pitching for the job of external auditor. (A little global gameshow they might like to call ‘WHO’s auditing WHO?”)

No country took a majority, so we moved slowly though three rounds of voting as the clock ticked round.

At 5pm, it was clear that 17.1 wasn’t coming back tonight.

Just have to wait till tomorrow.

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DAY THREE

We’re calling it WHA calisthenics – wake up, leg it to the Palais des Nations, past security (and peacocks!) to check the journal.

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Monday’s opening agenda item 1.4 (allocation of agenda items) moved item 17 (health systems, AKA the one with surgery and anaesthesia as an essential component of universal healthcare, AKA the reason we’re here) from Committee A to Committee B, and from rumoured Wednesday to Thursday ‘if time permits.’

Global surgery advocates have been waiting 25+ years – permit time to come swiftly…

But no change this morning, so we’ll get coffee instead, and make a new plan for the day. This is a dynamic place to kick your heels, and while the committees roll on, there’s a lot to pick up in the meantime.

2015_May_WHA_End.Polio_273 x 365Like in the side event on ‘polio eradication: status, lessons learned, and the way forward’.

Polio eradication is a masterful case study in collaborative action, and as the iconic posters show, they are ‘this‘ close.

How do you bridge language, geography, economy to stamp out a killer that doesn’t respect – that actively disrespects – all these boundaries?

Well, according to the panel…

Through political commitment, with a ‘whole government’ approach (recognising, surely, that buy in from the ministry of finance is as important as from the ministry of health).

With innovation, not only from above, but with local solutions.

Through accountability – and with overlap. Cross-border collaboration isn’t just beneficial, it’s essential: it’s where some of the most vulnerable populations live.

These lessons weren’t learned softly, or without loss along the way, and global surgery advocates should pay attention.

Global surgery is never going to have an ‘end game’ like polio – it’s sci-fi to think we’ll eradicate the need for surgical treatment any time soon, but we can certainly eradicate lack of access to safe care.

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And with or without the resolution, that work is ongoing, and it will continue. With education (SAFE courses, Essential Pain Management, etc), with capacity building (like AAGBI’s anaesthesia fellowships in Uganda), standards (e.g. WFSA’s guidelines), advocacy (like the G4 Alliance) and practical projects like our oximeters and training (in action on the ground in Tanzania and Niger this week!). Colleagues around the world are already working together, changing lives for millions of surgical patients.

There’s a lot to do, but work is already underway.

2015_May_WHA_Global.surgery.side.event_400 x 300This is the message Lifebox will be delivering on Friday, at the official side event, hosted in support of the resolution: ‘strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage’.

Our co-founder, WFSA, is in official relations with WHO, and as such they have the right to give statements at official events. (Two minutes, till the red card goes up and they turn off your mic. Traffic light style, but better than a vaudeville cane pulling you off stage.)

Lifebox is representing them, and we want to make sure that our statement – a small building brick, but a piece of the wall nonetheless – is clear and aligned and strong.

We’re stretched, we’re caffeinated, we’re ready!


 

DAY TWO

A greyer morning in Geneva – but that only makes our oximeter pop amongst the daisies! Leaving whimsy in the park though, because look at the journal: this is a day of serious subjects, ruthlessly scheduled – and wherever possible, translated.

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2015_May_WHA_WHO.Instagram_WHA01_229 x 425There were 261 delegates 62 countries at the inaugural assembly in 1948. Today there are more than 3000, traveling from 194 member states.  Every country has its own profile and complexity, but their delegations are here together representing the healthcare of billions. And the issues that make it to the table are the ones that affect us all.

(That’s not just rhetoric, it’s biology.  And bacteria.)

“We all paddle in the same microbial sea,” quoted Norway’s Bent Høie, in this morning’s side event on antimicrobial resistance, “and none of us can consider ourselves a safe island.”

Even scientists need a metaphor sometimes! And this favourite phrase of the AMR community is repeated and recontextualised as often as the “neglected stepchild of public health” is by global surgery advocates.

It brings home universal vulnerabilities – of our bodies, and also our tendencies to let politics overtake logistics. Even when we can least afford to let state lines dictate policy.

As part of our safe surgery mission, Lifebox has been looking closely at the risk of surgical site infection worldwide.  In hospitals across the 90 countries where we work, antimicrobial resistance is a concern, and so we’re all eyes on the action plan proposed.
“It’s not perfect,” says WHO Director-General Dr. Margaret Chan, to the packed room, “but it’s almost perfect. Now we’re asking you for three ‘A’s: advocacy, action, adoption – and then the work begins.

Coffee break! The Palais is a maze – take one wrong turn and you’re lost to your own corridor echoes – but follow the signs and you’ll find everyone (at the Serpentine Bar) here:

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The sea of new faces makes friendly ones friendlier, and it was nice to catch up with THET by the window. Their partnership model is a leading example of collaboration across state lines (and disciplines – they’ve been instrumental in supporting our work with oximetry distribution and the AAGBI/WFSA SAFE course across Zambia), and prospective partners can learn a lot from their resource library.

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But at the mushrooming round tables at the bar, new faces become friendly quickly. Especially if you’re lucky enough to sit down with the delegation from Burundi.

We’ve worked extensively in Rwanda to support safer surgery, but have only sent a few oximeters to its neighbour. Hopefully that’s about to change – the Burundian director general of public health has a clinical background and knows very well how difficult it is for healthcare workers – particularly in rural settings – to support their patients. Oximeters and safer surgery training can make a profound contribution.

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Good thing we’re dressed business-smart, because there’s no time to change. With Board and business signed off, tonight is the formal launch of the G4 Alliance.  Cheers to global surgery! And taking a stand against the issues that affect us all.


 

DAY ONE

This week the World Health Assembly and Cannes Film Festival both turn 68. They may seem worlds apart – but swap the Palais des Nations for the Grand Théâtre Lumière, mountains for the sea and sensible shoes for high fashion, and there are some basic techniques will see you through both.

Wear your badge so people know you belong.

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Talk to everybody – you never know who you’re sitting next to, and how you can help each other.

Smile for the photo opportunities.2015_May_WHA_Ruben.Ayala_Operation.Smile_400 x 300

Tweet!

And believe in your mission – because everyone else is here with their project, and they’d much rather talk about their own work than yours.

And when the stakes are this high, you can’t afford for your voice to get lost.

The stakes for surgery at the WHA have never been as high as they are this week. For the first time in history, it’s not just a side event, it’s on the main agenda. EB136.R7, a formal resolution on “strengthening emergency and essential surgical care as a component of universal health coverage” is due for debate…

…some time this week. It’s a hefty schedule – and ’17. Systems Strengthening’ is sandwiched between ’16. Communicable Diseases’ and ’18. Progress Reports’, and it’s hard to say exactly when the pages turn. So the surgical tribe has its ear to the ground, ready to run to the the designated Committee Room at the first word.

An exciting atmosphere for Lifebox to land in! We settled into sunny Geneva Monday afternoon, joining our co-founder WFSA‘s delegation.

2015_May_WHA_Ambassador.Neil.Parsan_Trinidad.and.Tobago_400 x 300We were just in time to catch the end of the open sessions of the G4 Alliance board meeting. The G4 – Global Alliance for Surgical, Obstetric, Trauma and Anaesthesia Care, is an advocacy group wrapping a subtle grey and orange microphone around global surgery organisations – membership groups, charities, social enterprises – with an aim to turn up the volume on lobbying for access to surgery worldwide.

As the recent Lancet Commission on Global Surgery made clear, safety is an essential component of surgical access. So G4’s work, which has grown quickly and passionately in the last few months, is a vital complement to what we do.

It was a pleasure to settle in to a room full of friends – and family (with our co-founders HSPH, BWH and WFSA all involved – and a part of the writing on the wall!)

G4 is formally launching tomorrow, and we’re looking forward to another banner event in a brilliant month for global surgery.

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We also caught up with the International Federation of Medical Students Associations (IFMSA) on the way in, fresh from hearing Angela Merkel and a vital session on the Sustainable Development Goals. Representing a million students worldwide and with a WHA delegation second in size only to Russia’s, IFMSA are hard to miss, with a wicked sharp social media presence. Definitely one to follow if you’re looking to stay up to date with #WHA68.

As well as us, of course! Stay tuned for our first full day tomorrow…

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