Junior Doctor Journal - Issue 2 - Global Health

7/28/2019 Junior Doctor Journal - Issue 2 - Global Health

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Australasian Junior Doctor JournalAustralasian Junior Doctor Journal

July 2012 http://www.facebook.com/juniordoctorjournal4

talk or think about international development

development and the recognition that everyone

has something to teach and everyone has

something to learn.

We need action as well as analysis. Continuing

that other countries as they become richer will

adopt the old models we need to discard and

this will help those in the poorest countries or the

poorest people in our own.

It is important to spell out an alternative visionand to develop and live it through our work. For

help make visible what is already happening,

promote and protect the innovators and the

groups who are making change. We can all

learn and all teach

health workers so that they are equipped with

the mindset and skills needed in this new

and in their actions

build a movement, create partnerships across

countries, experience exchanges, join up and

Lord Ni gel Cri sp is an independent member of the House of

Lords. He was Chief Executive of the English NHS the largest

health org anisation in t he world and Per manent Secretar y of

the Department of Health from 2000 to 2006. He led major

reforms and i mprovements in t he NHS. He now works mainly

in Africa an d India on healt h issues and has written Turni ng

the World Upside Down the search for global health in the

21st century which de scribes what r ich countri es can learn

from poorer ones and 24 Hours to Save the NHS the Chief

Executives account of reform 2000 to 2006. More information

is atnigelcris p.com.

how services are delivered and health systems

designed. I believe there is a new tradition

in particular, women

creative linkages between healthcare,

education, employment and other local

services

activities by local entrepreneurs

health and population health

workers are undertaking roles which we

out caesarean sections to giving anaesthetics.

diseases and our health systems are having to

the hospital and physician based systems which

have served us so well over the last centur y are

skills and attributes I have listed in the bullet

Co-development

My travels also made me understand better

and our health systems are interconnected

and interdependent. New diseases, perhaps

originating in a low income country with poor

health surveillance, can spread round the

and we are all dependent on the same limited

unhealthy habits and behaviours. Freer trade

here as well.

access to health, to health services and to

health resources is not equitable between or

poor access to medicines and the likely

people everywhere have the worst health and

the worst health services and live in the least

healthy environments.

Nevertheless, we are all in this together. What

we share many problems and, as I have argued

above, richer countries have much they can

We are all in this together. What happens in poorer c ountries

affects richer ones, we share many problems and, as I have

argued above, richer countries have much they can learn

from poorer ones.
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7Register now at www.juniordoctorjournal.com July 2012July 2012 Register now at www.juniordoctorjournal.com6


patients (many with ailments that are not directly

acuteleaving patients with unhealed wounds

may train local personnel to provide a minimal

with little recourse.

model? Western doctoreducated, upper class,

usually Whitetravels to remote Eastern village

many visiting physicians use it as a pr incipal

Lastly, a question about intentions. Economists

argue that people are rationalthey make

decisions about how they allocate their resources,

like time and money, in order to maximise their

that these physicians are rewarded with otheramenities upon their returns ho me. Labels like

in our societiesthey earn doctors prestige and

admiration. Whats more, these labels can propel

them, especially those in academic settings,

really is no other recourse to healthcare and where

where the economic and sustainability issues are

less pressing than the immediate consequences

willing to venture given the very reasons that they

that embarking on these missions may provide,

intervention is not appropriatewhere care is

already available and the challenges discussedabove are imminent. In so doing, they outcompete

native physicians with substandard, unsustainable

intervened at all.

avenues where committed physicians really

building through training and consulting with

native doctors, working with aid and development

income settings, or working to better understand

these settings via guided research.

Ultimately, righting the health inequity borne

Global South by the Global North is a serious

QUESTIONINGTHE GLOBALHEALTH DOCTORMODEL Dr Abdul El Sayed

As he presented his experience treating the

indigent in a Sub-Saharan African country,

a PowerPoint slideshow documented, in

pictures, his time. Photo after photo featured

the young doctorone picture centered on a

hug shared with an elderly woman, another

with a gaggle of smiling children, and a third

with a pregnant woman conveniently garbed

in her native birthing dress.

talk, eager students swarmed to ask his advice

experience.

He is but one entrepreneur in a burgeoning

patients and returning home with pride in their

It is an industry that has capitalised on the

questionable premise that no matter what, no

matter where, providing healthcare is always good.

assumptions that must be articulated clearly and

best doctors to higher income countries where

crisp white coats, visiting doctors are better able

importantly, their services cost nothing.

ones. In this way, despite their intentions to

provide the native population with healthcare,

and exacerbating the imbalanced incentives that

Consider, also, the limited capacity to provide

week mission. What attracts medical visitors to

though, treating more severe illness takes more

time and oversight. Shouldnt it be less amenable

patients with substandard care.

Dr Abdul El Say edis a MD/PhD student at Columbia

University, where he is pursuing a PhD in Epidemiology

alongside a medical degree. His research interests incl ude

Arab-American health; paediatri c and peri-natal epidemiology;

obesity; complex systems approaches in epidemiology; and

the social determinants of health. As a Rhodes Scholar he

completed a DPhil in Public Health at the University of Oxford.

He is also a Fellow at Demos, a progressive policy think tank

and regularly contributes to the Guardi an, Al Jazeera and the

debate regarding Public Health; the US health system; racial,

ethnic and socioeconomic inequalities; and Islam in the West.

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, similar advocacy by students

across the country has increased the number

3

global health curriculum4

training in this way will provide young doctors

modern medical practice.

Youth are engaging political processes that shape

our world and planning interventions which make

campaigns such as Root Out, Reach Out at the

Health5

and international levels. Locally, young people

moral contract to society and a way to build public

trust and gain a better understanding vulnerable

6

exchanges, enabling students to learn about the

and that students everywhere are implementing

despite their inadequacies are taking action, and

are taking it now.

Every young person can train themselves

movement strong enough to not only challenge

1. Novak S. Taking a More Holistic Approach to Global

Health Education. The New York Times [I nternet]. 2012 Feb

19 [cited 2012 Mar 22]; Available from:http://www.nytimes.

com/2012/02/20/world/europe/20iht-educlede20.html

2. Yudkin JS, Bayley O, Elnour S, Willott C, Miranda JJ.

Introducing medical students to global health issues: a Bachelorof Science degree in international health. The Lancet. 2003

Sep;362(9386):8224.

3. Tomorrows Doctors online (2009) [Internet]. [cited 2012

Mar 22]. Available from:http://www.gmc-uk.org/education/

undergraduate/tomorrows_doctors_2009.asp

4. Johnson O, Bailey SL, Willot t C, Crocker-Buque T, Jessop

V, Birch M, et al. Global health learning outcomes for medical

students in t he UK. The Lancet [Internet]. 2011 Oct [cited 2012

Mar 22]; Available from:http://www.thelancet.com/journals/

lancet/article/PIIS0140-6736(11)61582-1/fulltext

5. Guinto RLL, Yore D, Habibullah NK, de Leon AM, Tillman T,

Elliott-Green A, et al. Students perspective on rooting out causes

of health injustice. The Lancet. 2011 Dec;378(9808):e20e21.

6. Earnest MD, et. al. Physi cian Advocacy: What is It and How Do

We Do It? Academic Medicine. 2010 Jan; 85(1): 63-67.

Felicity Jones is the joint national coordinator of Medsin-UK

In our increasingly globalised world,

the local and national health challenges

which medical professionals tackle on a

daily basis cannot be disengaged from

their global context. Todays medical

professionals face: health threats which

transcend national borders; patients who

can, and do, travel the world overnight;

and diverse, multicultural societies - trends

which are only increasing.

community, then they must study and impact upon

not only local and national health issues, but also

the generation who, through television, buy into

with technology that connects us with those on

passion, and our credibility as the generation

current policy all place us in a unique position to

implement change in global health.

and idealistic! they tell me, What can I do? Not

only can we do a lot, but we already are.

Young people across the world are educating

and its member organisations run events such as

.

medical curricula to incorporate teaching about the

YOUTH ARE A

FUNDAMENTAL

FORCE FORCHANGE INGLOBAL HEALTH Felicity Jones
http://www.juniordoctorjournal.com%20/http://www.juniordoctorjournal.com/http://www.juniordoctorjournal.com/http://www.juniordoctorjournal.com%20/http://localhost/var/www/apps/conversion/tmp/scratch_2/Health5.Andhttp://localhost/var/www/apps/conversion/tmp/scratch_2/Health5.Andhttp://localhost/var/www/apps/conversion/tmp/scratch_2/Health5.Andhttp://www.nytimes.com/2012/02/20/world/europe/20iht-educlede20.htmlhttp://www.nytimes.com/2012/02/20/world/europe/20iht-educlede20.htmlhttp://www.gmc-uk.org/education/undergraduate/tomorrows_doctors_2009.asphttp://www.gmc-uk.org/education/undergraduate/tomorrows_doctors_2009.asphttp://www.thelancet.com/journals/lancet/article/PIIS0140http://www.thelancet.com/journals/lancet/article/PIIS0140http://www.thelancet.com/journals/lancet/article/PIIS0140http://www.thelancet.com/journals/lancet/article/PIIS0140http://www.gmc-uk.org/education/undergraduate/tomorrows_doctors_2009.asphttp://www.gmc-uk.org/education/undergraduate/tomorrows_doctors_2009.asphttp://www.nytimes.com/2012/02/20/world/europe/20iht-educlede20.htmlhttp://www.nytimes.com/2012/02/20/world/europe/20iht-educlede20.htmlhttp://localhost/var/www/apps/conversion/tmp/scratch_2/Health5.Andhttp://www.juniordoctorjournal.com/http://www.juniordoctorjournal.com%20/


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As awareness of global health increases,

medical students and professionals are

encouraged to work in a resource-poor

country to complement their clinical

studies at home. Firsthand experience in a

contrasting environment offers unparalleled

and professional development.

Many hospitals in developing countries are

treatment plans with minimal access to the

laboratory or medical equipment that are available

judgement and medical knowledge also sharpens

clinical skills and acumen. For many it provokes

questions about the reliance on technology and

with a Pinard stethoscope, something I have

There is also opportunity to see

cases that are rarely, if ever, found

in Australasia. Significant tropical

diseases such as malaria, leprosy

or dengue fever are common and

exposure to their managementallows students and practitioners to

broaden their clinical repertoire and

awareness of major global health

issues.

not common I had only ever encountered them in

Students and practitioners can use the

Charlotte3 had completed a rotation in oncology

provide a good opportunity to compare cancer

treatments between regions. Her time with

advanced disease at initial presentation, but only

5% have access to care.

and procedures. Until now I had only ever read

3

countries results in a situation whereby delayed

presentation extends beyond cancer patients.

Commonly, individuals present with conditions

medical equipment.

THE CHALLENGES ANDLEARNING OPPORTUNITIES OFA GLOBAL HEALTH PLACEMENT Ruth Chapman


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Australasian Junior Doctor Journal

14 July 2012 http://www.facebook.com/juniordoctorjournal

with the limited resources available. It sounds

small but I was shown how to use g auze as

it to minimise wastage and how to use it to

dressings such as Jelonet. While I have access

4

Whilst there are positive observations, there are

in part because key practices such as hand

washing appear easy to implement. Education is

which is why sharing knowledge and skills has

5

water in Nepal is highly polluted by domestic

and industrial waste so I used alcohol hand gel.

this strange solution that I kept applying to my

noticed that they also had some alcohol gel on

6

contamination is achievable, there are situations

whereby solutions to seemingly basic issues

may appear elusive.

on this particular day, there was no power or

sterilising instruments, no oxygen concentrator

to administer oxygen to a newborn babe with

learn more about disease progression, advanced

pathologies, and tropical disease, as well as

unparalleled learning opportunity, which can

ultimately, help you on your journey to being abetter clinician.

CONTACT

Work the World on 1-800-601-365 or

email [email protected]

for more information.

References

1. Shannon Saro, Work the World studenthttp://www.

worktheworld.co.uk/case-studies/shannon-saro/

2. Hannah Townsend, Work the World studenthttp://www.

worktheworld.co.uk/case-studies/hannah-townsend/

3. Charlotte Brown, interview Jun 28, 2010http://www.

worktheworld.co.uk/case-studies/charlotte-brown

4. George Glass http://www.worktheworld.co.uk/blog/the-

5. A Guide to Working Abroad for Australian Medical Stud ents

and Junior Doctors, The Medical Journal of Australia e

supplement. 2011;194: eS11.

6. Craig Hickson, Work the World studenthttp://www.

worktheworld.co.uk/blog/infection-control-the-reality-of-

developing-country-hospitals_2938

7. Carlee Mark, Work the World studenthttp://www.worktheworld.

co.uk/case-studies/carlee-mark/

Ruth Chapman is a consultant at Work the World.

These placements may provide an

unparalleled learning opportunity,

which can aid personal and

professional development and,

ultimately, help you on your journey

to being a better clinician.

Medical Indemnity Protection Society Ltd

po box 25 carlton south vic 3053 | [email protected]| www.mips.com.au

member services| p. 1800 061 113 | f. 1800 061 116 | abn 64 007 067 281

Put yourself in safe hands. MIPS benefits include MIPS MembersMedical Indemnity Insurance Policy, MIPS Protections for non medicalindemnity matters, medico-legal advice, Group Personal Accidentcover, risk management education sessions, special member benefitoffers, e-publications and more! Apply online at www.mips.com.au

Medical Indemnity Protection Society Ltd (MIPS) is an Australian Financial Services Licensee (AFS Lic. 301912). MIPS Insurance Pty Ltd (MIPS Insurance) is awholly owned subsidiary of MIPS and holds an authority issued by APRA to conduct general insurance business and is an Australian Financial Services Licensee(AFS Lic. 247301). Any financial product advice is of a general nature and not personal or specific.
http://www.facebook.com/juniordoctorjournalmailto:[email protected]://www.worktheworld.co.uk/case-studies/shannonhttp://www.worktheworld.co.uk/case-studies/shannonhttp://www.worktheworld.co.uk/case-studies/hannahhttp://www.worktheworld.co.uk/case-studies/hannahhttp://www.worktheworld.co.uk/case-studies/charlottehttp://www.worktheworld.co.uk/case-studies/charlottehttp://www.worktheworld.co.uk/blog/thehttp://www.worktheworld.co.uk/blog/infectionhttp://www.worktheworld.co.uk/blog/infectionhttp://www.worktheworld.co.uk/case-studies/carleehttp://www.worktheworld.co.uk/case-studies/carleehttp://www.mips.com.au/http://www.mips.com.au/http://www.mips.com.au/http://www.mips.com.au/http://www.mips.com.au/http://www.mips.com.au/http://www.mips.com.au/http://www.mips.com.au/http://www.mips.com.au/http://www.mips.com.au/http://www.mips.com.au/http://www.mips.com.au/http://www.mips.com.au/http://www.mips.com.au/http://www.mips.com.au/http://www.mips.com.au/http://www.mips.com.au/http://www.mips.com.au/http://www.mips.com.au/http://www.mips.com.au/http://www.mips.com.au/http://www.mips.com.au/http://www.mips.com.au/http://www.mips.com.au/http://www.mips.com.au/http://www.mips.com.au/http://www.mips.com.au/http://www.worktheworld.co.uk/case-studies/carleehttp://www.worktheworld.co.uk/case-studies/carleehttp://www.worktheworld.co.uk/blog/infectionhttp://www.worktheworld.co.uk/blog/infectionhttp://www.worktheworld.co.uk/blog/thehttp://www.worktheworld.co.uk/case-studies/charlottehttp://www.worktheworld.co.uk/case-studies/charlottehttp://www.worktheworld.co.uk/case-studies/hannahhttp://www.worktheworld.co.uk/case-studies/hannahhttp://www.worktheworld.co.uk/case-studies/shannonhttp://www.worktheworld.co.uk/case-studies/shannonmailto:[email protected]://www.facebook.com/juniordoctorjournal


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expand on current opportunities, New Zealand

has demonstrated relatively little active association

or engagement with global health education,

research, innovation or delivery.

adopted a conservative approach to our role in

targeted media coverage, have done a stellar

job in creating and later perpetuating the image

that global health is synonymous with, and

malnutrition, and maternal and child health issues

in developing countries. When presented with this

who question the need to make global health a

look beyond mere assumption, we see that many

key global health issues display direct alignment

with our current challenges.

We all know that New Zealand boasts a diverse,

witness and manage a respectable range

exposure is still broad and challenging. Certainly,

communicable illness just as it is on the global

preventative approach is understood as something

more than just a romantic notion. We struggle to

understand and appropriately address the role

issues, including physician migration, remain a

We cannot escape global health when it is

already acutely relevant: our challenges are

the challenges.

We also cannot escape the simple truth that we

are a small country and, no matter where you

draw the line, these are big issues. Furthermore,

we recognise that our research and total

healthcare budgets cannot compare with those

considering an alternative view, we can instead

promote rather than hinder our capacity to be a

global health leader.

and the ability to rapidly implement practical

solutions. In addition, our small population means

that we are ideally placed to develop and test

approaches, treatments and programmes in the

healthcare space. Furthermore, when compared

bureaucratic and political barriers to change in

requires evidence to drive policy development

technology solutions are amongst the best in

the world and, as a consequence, New Zealand

has established systems to collect, analyse

accurate evaluation places New Zealand in

innovation, New Zealand is an excellent location

to pilot cutting edge advances in global health.

Whilst some would argue that our geographical

certain global health challenges, this is a globalised

world and our relatively mobile and well travelled

share solutions. New Zealand should be a hub

have the potential to progressively advance and

ideas and solutions.

Our passion, skill, originality, ability to execute,

and humour are almost unrivalled. Given that

realise our potential, and lead.

Dr Karina McHar dygraduated from the University of

Aucklands School of Medicine in 2005. In 2008, she movedto the UK to undertake an MSc in Global Health at the

University of Oxford. Karina is currently a Clarendon, Wolfson

and Department of Public Health Scholar and is completing a

doctorate through Oxfords Department of Public Health. She is

also an honourary clinical lecturer at Aucklands Department of

Medicine and works as a Global Health and Health Promotion

Tutor at Oxford.

Dr Lloyd McCann is currently the Medical Director for Harris

Healthcare Solutions for EMEA, a global communications,

information and technology company. He is also a consultant

for NHS Interim Management and Support. Lloyd has worked

clinically and managerially in the New Zealand and UK healthcare

systems. He holds an MSc in Health Services Management from

the University of Warwick.

THE

LITTLE

COUNTRY

THAT COULD

We are two Kiwis whose career and life

paths have unexpectedly taken us awayfrom New Zealands shores for a few years.

Our time away has afforded us a different

perspective on the organisation and

management of healthcare in New Zealand,

together with the opportunity to work in,

contribute to, and compare both established

and developing healthcare systems.

Furthermore, our recent choice to pursue

on these systems and the diverse and complex

passionate about and engaged with health and

healthcare in our home nation, despite our current

experiences overseas, a clear message is that

New Zealand is ideally placed to be a leader

observations and experiences in various settings

and abroad in distinct roles.

However, up until this point, it seems that

New Zealand has used its position as a small,

somewhat remote, and developed nation to

. Indeed, despite communicated

Dr Karina McHardyand Dr Lloyd McCann

1 This statement is intended to apply at the national level: we

recognise that many individual ex-pat Kiwis are already well


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Junior Doctor Journal - Issue 2 - Global Health

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