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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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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.
Australasian Junior Doctor JournalAustralasian Junior Doctor Journal
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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%20/7/28/2019 Junior Doctor Journal - Issue 2 - Global Health
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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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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 info@worktheworld.co.uk
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 | info@mips.com.au| 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:info@worktheworld.co.ukhttp://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:info@worktheworld.co.ukhttp://www.facebook.com/juniordoctorjournal7/28/2019 Junior Doctor Journal - Issue 2 - Global Health
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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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