Global Hand: Time to Capacity Build

In 2015, the Lancet Commission defined and estimated the global burden of surgical disease; revealing 33% of the overall global burden of disease as surgical in origin and estimating that 95% of the population in low and middle income countries (LMICs) lack basic surgical care.1 As a means to rectify this, the commission agreed upon various targets, including improving access to timely surgery, workforce density and overall surgical volume.2 With this came growing interest in improving global provision of hand surgery. In 2013, the previous editor of the Journal of Hand Surgery (European Volume) called for further action globally, especially in improving research capacity in LMICs.3 But, where are we now? Today, various organizations exist that target hand conditions ranging from congenital malformations to injury. Notably, these include ReSurge International and the Touching Hands Program (THP), who aim to provide direct surgical care and local training of surgeons. At the time of writing this letter, the latter claim to have conducted 41 missions in 13 countries.4 However, these programmes remain limited by their ability to provide suitable patient-reported outcomes, surgical results and long-term efficacy of their training provision.