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An ode to Sisyphean challenges of a Global Surgeon

By guest contributor Dhananjaya Sharma

I am/ was (the task is still on the anvil) writing a commentary/ opinion piece on many challenges faced by a Global Surgeon working in a the global south – based on my lived-in experience for the last three and half decades.

The woes began with the realization that nobody is coming to bail me out and I have to perform clinically meaningful research – in my resource constrained atmosphere – to find local affordable solutions to local challenges. As and when a local solution was found I was expected to write a proper scientific paper about it so it can be peer reviewed and read/ accepted by peers. The next hurdle was finding that there is no template/ guideline to write about low-cost/ frugal innovations. So I made a checklist on how to write about Frugal Innovations, including all relevant scientific points, so it is easier to write, review and read. But the matter did not end here; my prospectively conducted observational studies were unfavorably compared to RCTs, so I had to defend the choice of my studies and the strength of their evidence. Next the bogey of ‘every surgical innovation must conform to all 5 stages of the IDEAL framework’ was raised; and again I had to defend and show that very few Frugal Innovations can do so. So I continued to find solutions to my challenges with the help of the two tenets of Global Surgery the ‘Occam’s razor’ and “Modify-Simplify-Apply” and publish them. However, in the evening of my career I was taken aback to find the huge know-do gap of dissemination and adoption of even successfully published Affordable Surgical Innovations in LMICs. This prompted me to develop a roadmap ‘DISSEMINATE’ for their effective dissemination to overcome this gap. Hence the narrative that a life spent in Global Surgery is a sequence of Sisyphean challenges. But it is a team game and we will overcome all barriers and hurdles so no one is left behind in the quest for surgical equity.

After writing this I felt that it needed to be made more interesting for the potential readers and the epiphany of writing an ode dedicated to the Sisyphean challenges faced by Global Surgeons dawned on me – and here we are!

An ode to Sisyphean challenges of a Global Surgeon

In a realm of constraints, where resources were scant,

I grappled with challenges, hoping for a helping hand.

Yet, I discerned the truth, a revelation profound,

The onus on me, solutions by myself to be found.

Embarking on a journey, the realm of research I tread,

Seeking clinically meaningful paths where solutions bred.

Simple, affordable answers, to my challenges they spoke,

A newfound wisdom, a flame that never broke.

Each discovery a beacon, shining bright,

Guiding through the darkness, dispelling the night.

In the corridors of knowledge, where wisdom enthralls,

I find ways to find solutions, meaningful, affordable for all. [1]

Just as I thought my work had met its end,

The call to publish, a message to transcend.

Peer review, they said, completes the scholarly tale,

So I embraced the craft of writing, to prevail.

Ode to the writer, to the researcher’s pen,

Crafting narratives in scholarly den.

In the crucible of critique, where knowledge thrives,

I embraced the journey, where academia thrives.

Once more I thought, my journey had found its close,

Yet they whispered, “Scientific report, the path impose.”

In the laboratory of thought, I labored with care,

Crafting a roadmap, a meticulous affair.

A checklist, a guide, meticulously designed,

To illuminate frugal innovations, their brilliance defined.

For frugal innovations, a scientific song,

Each checklist item, a note, in harmony strong. [2]

Critics again arose, questioning the studies observed,

RCTs they demanded, evidence deserved.

But behold, a plea, a paradigm to rearrange,

For the weight of evidence, a broader range.

When RCTs falter, impossible to be spun,

Give credence to the observational study that must be done.

For in the crucible of progress, change must persist,

A symphony of wisdom, where biases desist. [3]

Criticism echoed, a challenge lay bare,

IDEAL framework’s demand, heavy to bear.

For every innovation to traverse each stage,

A rarity in reality, a truth to engage.

Yet wisdom emerged, a truth to uphold,

Continuous refinement, a story untold.

IDEAL’s stages, a guideline, not a rigid gate,

In the ebb and flow of time, let innovations navigate. [4]

As journey persisted, solutions unfurled,

Challenges met, their simple solutions swirled. [5]

Feel-good hormones, a cascade profound,

Flooding the brain, where victories abound.

Heart and intellect, in tandem, aligned,

Stimulated by accolades, a journey defined.

In the dance of honors, intellect refined,

A symphony of recognition, a journey enshrined.

In the orchestra of global surgery’s call,

A philosophy echoes, reaching one and all.

Occam’s razor embraced, a principle profound,

Simplicity in solutions, where brilliance is found. [6]

Modify, a tweak, a surgeon’s art,

Simplify, distill, to the core impart.

Apply, in practice, the wisdom refined,

In the tapestry of surgery, where innovations bind.

Ode to the philosophy, “modify-simplify-apply,”

Where Occam’s razor and surgeons’ dreams lie.

In the crucible of innovation, simplicity prevails,

A symphony of solutions, where ingenuity sails.

In the twilight of my life, contentment embraced,

Published solutions, in simplicity traced.

Yet, their dissemination and adoption challenges unforeseen,

Prompting a roadmap ‘DISSEMINATE,’ a response so keen. [7]

Diligently crafted, a guide to navigate,

Through know-do gaps, where solutions await.

In the realm of Affordable Surgical Innovations,

A point by point roadmap, a transformative foundation.

O, tale of Global Surgery, a saga profound,

A Sisyphean odyssey, challenges unbound.

Yet, in this team game, united we stand,

Overcoming each new obstacle, hand in hand.

No soul abandoned in equity’s quest,

Every heart, every hand, on this journey abreast.

A symphony of resolve, determination’s embrace,

Facing the tempest, with unwavering grace.

Onward, with purpose, our lanterns aglow,

In the pursuit of equity, shadows shall go.

This ode to Global Surgery, a testament true,

To the triumph of teamwork, in skies so blue.

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About the author:

Dr. Sharma writes:  I am a lifelong activist and campaigner for “simple affordable solutions for health-care in developing world” and ~ half of my 335 publications are on Global Surgery/ low-cost surgical solutions to achieve health equity for underserved populations. My code of honour is “Noblesse oblige” and I live by the motto: “our challenges – our solutions”. I feel truly blessed to be able to “make a difference” and do God’s work, even though I don’t wear a Priest’s collar.



  1. Sharma D, Agrawal V, Agarwal P. Editorial: Roadmap for clinical research in resource-constrained settings. Trop Doct 2021;51(1):4–5. DOI: 10.1177/0049475520974844a.
  2. Sharma D, Harris M, Agrawal V, Agarwal P. A plea for standardised reporting of Frugal Innovations. BMJ Innov 2021; 7 (4): 642-646. DOI: 10.1136/bmjinnov-2021-000710.
  3. Sharma D, Kumar S, Agarwal P, Yadav SK. Editorial: Time to stop the witch-hunt against Observational Studies. Ind J Surg 2023; 85: 225–227. DOI: 10.1007/s12262-023-03714-2.
  4. Sharma D, Agarwal P, Agrawal V, Yadav SK. Evaluation of Low-Cost Surgical Innovations. In Dopson S, Harris M, Bhatti Y, Farchi T Eds The Oxford Handbook of Healthcare Innovation. Oxford University Press. In Press.
  5. Sharma D, Agarwal P, Agrawal V. Surgical Innovation in LMICs – the perspective from India. The Surgeon 2022; 20 (1): 16-40. DOI: 10.1016/j.surge.2021.11.002.
  6. Sharma D. Occam’s razor and Surgeons. Ind J Surg 2023; 85: 700-701. DOI: 10.1007/s12262-022-03483-4.
  7. Sharma D, Agrawal V, Sam-Agudu NA, Agarwal P, Yadav SK, Bajaj J. ‘DISSEMINATE’: a conceptual framework for facilitating adoption of affordable surgical innovations in low-and middle-income countries. BMJ Innov 2023; 9: 207-214. DOI: 10.1136/bmjinnov-2022-001077.

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