In the world of global surgery, progress is a word we love to repeat. Since 2015, we have celebrated the drafting of National Surgical, Obstetric, and Anaesthesia Plans (NSOAPs), applauded World Health Assembly resolutions, and cited countless academic papers. But walk into a district hospital in a low- or middle-income country, and the patient waiting for a life-saving operation will not feel that progress. For them, the promises of global surgery remain distant echoes in conference halls and journal pages.

This week, during the Global Surgery Advocacy Certificate Program, Desmond Tanko Jumbam delivered a lecture that cut through the noise. He reminded us why the reality on the ground still does not reflect the paper progress we so often celebrate. It is not due to a lack of evidence. The data are overwhelming. It is not because the moral case is weak. Denying surgical care is a failure of human rights. It is not even because surgery is unaffordable. The economic returns are clear and compelling.

The reason is simple and uncomfortable: Surgery does not yet have political priority.

And political priority is not spontaneous. It is built deliberately, brick by brick, voice by voice, pressure by pressure.

Consider South Africa in the 1990s. Millions were dying of HIV/AIDS while the government hesitated to provide access to antiretroviral treatments. It was not peer-reviewed articles that shifted the tide. It was advocacy. Patients, families, health workers, and activists reframed treatment as a right. They went to court, marched in the streets, and refused to be ignored. The Treatment Action Campaign saved millions of lives not through science alone, but through relentless political pressure.

Global surgery has not had its Treatment Action Campaign moment. Until it does, progress will remain trapped in academic circles and policy briefs. Desmond emphasized that advocacy is not about speaking louder. It is about speaking smarter. It is about knowing your audience.

Finance ministers care about gross domestic product, not Glasgow Coma Scale scores. Parliamentarians care about votes, not ventilator settings. Communities care about lived experiences, not p-values. If we want political traction, we must translate surgical needs into the language each audience understands. Here is the uncomfortable truth: we are still singing to the same choir. Surgeons speak to surgeons. Anesthetists speak to anesthetists. We need teachers, journalists, religious leaders, economists, and patients in the room. These are the voices that can sway power in ways citations never will.

Surgery does not just need better tools in the operating room. It needs louder voices outside it.

Advocacy is the scalpel that cuts through indifference. Without it, we will continue to mistake paper progress for real impact. The Lancet Commission diagnosed the problem. NSOAPs outlined the pathway. But only advocacy can keep governments and funders honest. Until the mother in a rural district can access a timely cesarean section, or the child with appendicitis does not have to wait until it bursts, we cannot call this progress.

Global surgery does not need more evidence. It needs more advocates.

That is where I see my own journey. As a medical student, researcher, and co-founder of the Association of Future African Plastic and Reconstructive Surgery (AfroPRS), I have come to understand that progress is not only about mastering the science of surgery. It is about shaping the politics around it. My generation cannot afford to wait for change to trickle down. We must be the ones to demand it, build coalitions, and hold leaders accountable. Because at the end of the day, the future of global surgery will not be written in policy briefs or Lancet papers alone. It will be written in the lives of patients, mothers, children, and families who finally receive the care they need, when they need it. That future will only be realized if we choose to advocate as fiercely as we operate.

Shirley Sarah Dadson is a medical student in Ghana.