Disparity Adds Insult to Injury – Springboard: Topics in Global Pediatric Surgery

WHO states that approximately 5.8 million people die each year as a result of injuries. That is 10% of the world’s deaths — almost a third more than the combined number of fatalities from three of the world’s leading infectious diseases (malaria, tuberculosis, and HIV/AIDS).

According to another WHO report, for kids between the ages of 5 and 29, road traffic injuries alone are in the top two leading causes of death. This is partially explained by children, teens, and young adults being at higher risk for injuries than other age groups.

The risk of injury is worsened by a lack of access to surgical care. A BMJ paper notes that most children around the world do not have access to safe, timely, or affordable surgical care. This is particularly the case in Low or Middle Income Countries (LMIC). Global inequities in distribution of healthcare services, such as post-operative follow-up care, can further complicate an already painful injury.

Makenge after his US surgery and custom prostheses.

Trying to remove these complications for individual children is where Childspring International steps in. In 2015, Childspring International served a young man named Makenge, who was attacked by a Hyena near his home in Tanzania and remarkably survived. The attack left him with tissue losses to the top and front of his head, with tissue absent down to his skull bones in some places. After the attack, Makenge no longer had hands. Additionally, portions of his arms were amputated to prevent infection from microbes in the Hyena’s saliva.

After wound care in Tanzania, he was brought to a hospital in Cincinnati where he received scalp reconstruction surgery. Makenge then came to Atlanta to be fitted for prosthetic hands. Through a partnership between Childspring International and a peer NGO, Makenge saw a dramatic improvement in his quality of life. Now he is able to shower, eat, wash dishes, and write on his own — activities he could only dream of being able to do after the attack.


This fall, Childspring International is bringing a 17-year-old girl named Akabir from Iraq to the United States for reconstructive surgery related to burn scarring. She had the burn accident 7 years ago and received only basic treatment available at a nearby hospital. When scar tissue developed on her torso and arm, she developed skin contractures that limited her range of motion. This arose partially as a result of improper burn care.

Now Akabir will be under the care of a plastic surgeon and burn specialist that can help her with the scar tissue, so she can once again perform daily activities she is prevented from doing currently. An important part of Akabir’s treatment in the US will be post-operative, follow-up appointments. Appointments like these would be nearly impossible for Akabir’s family in Iraq, since they live hours from the nearest hospital that could serve her needs. The transportation and lodging costs alone for such visits could be catastrophic expenditures for her family. Akabir’s family is not alone; According to the International Labor Organization’s Social Protection Platform, globally 41% or more of health care expenses are paid out-of-pocket, which can impose major financial burden to families and contribute to systemic stress on LMIC economies.

Childspring International serves children from diverse backgrounds, and equally diverse are their stories of seeking surgical care. One facet of that diversity is the special attention that must be paid to children who have experienced injuries. Access to surgical specialists is limited in many of the places our organization serves, and this is further complicated by the difficulties families have during the follow-up care period for an injury.

Childspring International aims to bring care to children in their home county if possible, but when we cannot, we commit to bringing children like Makenge and Akabir to the care, all without creating financial burden for their families.

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