Where You’re Born Still Decides Whether You Can Access Surgical Care

Where a person is born should not determine whether they survive, whether they live with dignity, or whether they are forced to endure years of preventable suffering while waiting for surgical care that may never come.

Yet, across large parts of Africa, this remains the reality.

At this year’s 79th World Health Assembly (WHA79) in Geneva, world leaders gathered to discuss the future of global health, healthcare equity and international responsibility. Despite the scale of these conversations, one essential component of healthcare continues to receive far too little global attention: access to safe surgery in general, and plastic and reconstructive surgical care in particular.

For millions of patients, plastic and reconstructive surgery is not cosmetic. It is not optional. It is essential healthcare that restores function, mobility, independence and dignity.

It allows burn survivors to use their hands again. It enables children born with craniofacial malformations to attend school without stigma. It gives patients living with traumatic injuries, cancers or congenital defects the possibility of participating fully in life once more. These surgeries are lifesaving.

However, in many regions, access to plastic and reconstructive surgery is effectively denied.

Non-existent access to surgeons

For more than a decade, I was one of only two plastic and reconstructive surgeons serving Rwanda’s 14 million people. In some parts of the world, highly specialized surgeons are everywhere. In others, they are almost non-existent. When there is less than one trained surgeon for hundreds of thousands – or even millions – of people, the consequences are devastating.

In Rwanda, I regularly travel to hospitals where hundreds of patients arrive seeking care in a single day. Many have already waited years for surgery. Some live with severe burns that have left their limbs contracted and immobile. 

Others endure untreated injuries or tumors that continue to shape every aspect of their life. Some patients travel extraordinary distances only for us to tell them they must continue waiting because the system is already stretched beyond its limits.

What is most painful is knowing that many of these patients continue suffering or their conditions worsen to the point of becoming untreatable while waiting for care – not because treatment does not exist, but because access to trained specialists remains critically limited, there is too little infrastructure and too few resources available to meet the overwhelming demand.

Sustained investment

Behind every surgical waiting list, there is a human life suspended in uncertainty. This is not merely a surgical issue; it is a global health issue. Healthcare systems cannot adequately

respond to trauma, burns, maternal health complications, cancer reconstruction or congenital conditions without sustained investment in surgical capacity.

And still, surgery continues to be treated in many international conversations as secondary rather than foundational to healthcare equity.

A documentary has been made about my team, which follows us as we work in remote hospitals in Rwanda and confront the daily realities of providing care within a system under immense strain. 

Our local work includes efforts to train the next generation of African surgeons, fighting to increase regional access to surgical care for the future.

Dr Victoire Mukamitari is a young surgical trainee navigating the immense pressures of training within a male-dominated field while carrying the hopes of becoming part of a new generation of plastic and reconstructive surgeons.

Unbearable pressure

There are days when the pressure feels unbearable. Days when electricity becomes unreliable in the operating room. Days when resources force impossible decisions. Days when a surgeon carries the knowledge that help arrived too late.

There is exhaustion, responsibility, grief and the emotional burden of carrying more patients than one healthcare system was ever designed to support.

But there is also extraordinary hope and immense pride to serve and contribute to something bigger than us.

Several years ago, I realized that no individual surgeon – no matter how committed – could ever meet this level of need alone. My response was to help build a training program capable of preparing the next generation of plastic and reconstructive surgeons across the region. 

My goal is to help train 30 new surgeons by 2030 so that no surgeon in Rwanda or neighboring regions will ever again have to carry this burden alone.

This mission is not about one doctor, one hospital or one documentary. It is about building sustainable healthcare systems capable of serving future generations with dignity and consistency, creating a multiplier effect.

And this work cannot happen through temporary interventions alone. It requires a holistic approach with long-term investment in surgical education, healthcare infrastructure, equipment, researchpartnerships and healthcare systems designed not only to respond to crisis, but to endure.

Most importantly, it requires the international community to finally recognize that access to surgical care is not optional within global health. It is essential, a fundamental human right.

The patients waiting for care deserve healthcare systems capable of treating them safely, compassionately and without years of preventable suffering.

The next generation of surgeons is ready to lead if the world is willing to invest in them. This should be a collective responsibility.

Dr Faustin Ntirenganya is a consultant, General and Onco-Plastic and Breast surgeon, at University Teaching Hospital of Kigali and Head of Department of Surgery at the School of Medicine and Pharmacy. The documentary, Making of a Surgeon: Fighting Africa’s Hidden Crisis, explores these realities and the growing effort to expand plastic and reconstructive surgical care across Africa.