Ecuadoran VP Promotes Global Surgery and Health Equity

5 min read

In 2021, as he was campaigning to be elected vice president of Ecuador, Alfredo Borrero traveled more than 50,000 kilometers around his nation, he said, to better understand the lives of the people he wanted to serve.

He visited places with no clean drinking water, no roads, little opportunity for work, and severely limited medical resources.

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Borrero's four decades of work as a doctor, medical educator, and hospital leader, and the experiences he had on the campaign trail, reinforced for him the need for a comprehensive approach to improving the health and well-being of the people of Ecuador.

That meant not only improving the country's health care system and providing better preventive care in the form of vaccinations and improved access to surgical care, but also facilitating improvements in infrastructure, nutrition, and education.

Borrero had been drafted to run for political office after a lifetime of practicing surgery, launching a medical school, and running a hospital. But coming from a career in neurosurgery, he saw a particular imperative to address unmet needs for surgical care in Ecuador.

"Surgery is a must-have," Borrero said. "When you need it, you need it right away."

Borrero was not alone in his thinking. In 2015, the Lancet Commission on Global Surgery helped launch a growing movement to improve access to crucial surgical care for all the world's people.

The commission issued a report that found that 5 billion people are unable to access safe, timely, affordable surgery and anesthesia, leading to 18.6 million preventable early deaths each year.

To meet these needs, the researchers calculated, an additional 143 million more surgical procedures were needed annually around the world.

The study found that surgery can both be affordable and an excellent return on investment, even though many global health advocates continue to see it as a luxury item, something nice to have once the more common, or more affordable, options are taken care of.

As part of Ecuador's efforts to address the issue, Borrero met with leaders, researchers, students, fellows, and clinicians on April 10 and 11. He was hosted by the Program in Global Surgery and Social Change (PGSSC), a part of the Department of Global Health and Social Medicine in the Blavatnik Institute at Harvard Medical School. Borrero also visited Brigham and Women's Hospital's Neurosurgery Department, Boston Children's Hospital's Innovation and Digital Health Accelerator, and Harvard Business School.

The visit was part of an ongoing collaboration between Ecuador and HMS, centered on Borrero's interest in global surgery and his desire to find new ways to support comprehensive, equity-focused efforts to improve the health and well-being of Ecuadorans.

Heart health. Nutrition. Brain health. And more.

Since 2021, PGSSC has worked with Borrero's office and the Ecuadoran Ministry of Health to develop a national surgical, obstetric, and anesthesia plan for Ecuador. The aim is to help Ecuador identify and close gaps in access to essential surgical care.

PGSSC has facilitated surgical planning processes in 10 countries to date, but Ecuador is the first nation in Latin America to commit to surgical planning. It's also the first plan to be initiated by a vice president. Previously, these planning processes were implemented by ministries of health.

PGSSC Director Robert Riviello noted that working directly with Borrero's office has fostered the kind of interministry collaboration within Ecuador that can address some of the root causes behind the need for surgery.

For example, Riviello noted that traffic injuries are the leading cause of death among people age five to 30 around the world.

"You want to have access to trauma surgery for people who get hurt, but you also want to work to make traffic safer, with better roads, safety regulations, and enforcement," Riviello said, noting that Borrero understands the importance of taking an integrated approach to improving health.

Borrero's support for the planning process has also raised awareness of the importance of global surgery with the United Nations, the World Health Organization, and regional health and development organizations across Latin America and the Caribbean, Riviello said.

"It's been an honor and an inspiration working with Vice President Borrero," Riviello said. "We’re looking forward to continuing the journey together."

To date, Ecuador has embarked on a comprehensive national review of existing surgical capacity and infrastructure and has engaged stakeholders from key constituencies to assess their needs and identify ways that different communities, organizations, and agencies can work together to help implement the needed changes.

While the assessment was national in scope, it also focused on important local details. For example, research revealed that several Ecuadoran hospitals were functioning without reliable access to clean water or electricity.

Identifying those kinds of specific problems is key to improving the entire system, said Karla Flores, Ecuador's undersecretary for national healthcare strengthening, who accompanied Borerro to Harvard along with Beatriz Almeida de Stein, honorary consul for Ecuador in Boston.

"If you can make these small changes, you can make a big difference in the quality of care that many people can access," Flores said.

"This is an important opportunity for us to move from research to action, to use the evidence we generate to engage in the policy dialogue at a national level, and to make concrete improvements in people's health," said PGSSC lead faculty for Latin America Tarsicio Uribe Leitz, who leads the Ecuador planning process in the PGSSC team.

Ecuador's collaboration with HMS began shortly after Borrero took office. In October 2021, Borerro's team contacted John Meara, then the director of PGSSC and now the program's chief strategist, to arrange a meeting between PGSSC and Borrero at the World Health Summit in Berlin later that month.

Kee Park, PGSSC's director of policy and advocacy, met with Borrero at the summit and began to lay the foundation for an HMS collaboration.

The idea was that PGSSC would supply research support to strengthen surgical care in Ecuador, and Borrero would pledge support to the growing global surgery movement by championing surgical care in the Latin America and Caribbean regions and globally.

With the assistance of David Golan, HMS dean for research operations and global programs, the partnership was made formal in February 2022, with the execution of a collaborative agreement for PGSSC to assist the Ecuadoran government with developing a national surgical, obstetric, and anesthesia plan.

"What we’re trying to do, working together, is prevent people from dying and becoming disabled because of a lack of access to simple surgical care," Park said. "It's an exciting partnership."