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Rapid Responses: Rapid Responses published:
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This Is a Master piece!
- Wayengera Misaki (7 October 2004)
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Academic Medicine Needs a Global Health Agenda: Global Health Equity and Graduate Medical Education
- Jennifer J. Furin, Paul E. Farmer, Joel T.Katz (7 October 2004)
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Standard of surgery in Professor Sir Ian McAdam's time.
- Richard G Fiddian-Green (7 October 2004)
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Wayengera Misaki, Doctor,Mulago Ntional Refferal Hospital,Uganda/Chief Editor, Makerere Medical Journal Uganda 256
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As former student of the Faculty of Medicine & Editor in Chief,MMJ - i have never had any doubt about Prof Nelson Sewankambo's vision for the Medical school here. When i read this article- i began picturing how much "we have seen arise " on the seen of Academic medicine here under his wise leadership. The Academic Alliance for Aids Care & Research is an example. Various Research colloborations with Western Universities like John Hopkins, Case Western Reserve University, University Of Medicine & dentistry of New Jersey, are but a few. So as he pins down the need for colloboration between western Academic Medics & those of the south, i have no doubt that there are benefits to his view. The African scientists-for instance, have a lot of knowledge base about their endemic diseases, but in many cases, it is as they collaborate with their Western counter-parts that their dreams come true- talk of Research funding. In one of his editorial, former Editor of the BMJ-Richard Smith said modern Medical schools are wired to produce just doctors, not scientists...., such that most doctors aint scientists.I concur. He defines a scientist - if am to rephrase as "one who studies an event & the variables surrounding it's occurance, generates falsifiable hypotheses, and gathers data through well designed experiments to proof his ideas". You will find that only an Academic medic fits in this picture. Such a person will have the gifted eyes to see a rare case on the ward- & know it has never been described in textbooks-say like Nelson S et al desribed Slim Disease-AIDS or how recently i described a case of congenital Absence of sternum while all other "so called senior doctors" just kept looking on blindly I think that - as the dean states, the world of medicine needs an appropriate balance between academicians & Just doctors...(I have seen times when Academic Medics become soo busy to the immediate needs of the patients, despite having them as central to their business. Unfortunately, the patient doesn't see this) & all Medical schools should be striving to achieve that with the help of their governments & foreign aid. Competing interests: None declared |
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Jennifer J. Furin, Associate Clinician, Associate Director, Howard Hiatt Residency in Global Health Equity Brigham and Women's Hospital, Boston, MA 02115, Paul E. Farmer, Joel T.Katz
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Dear Editors: It was with great interest that we read your issue on the need for a global health agenda in academic medicine. As a team of physicians, nurses, epidemiologists, and social scientists who have been working on global health equity issues for the past 15 years, we have witnessed first -hand the growing health outcomes gap between resource-poor and resource- rich environments. We have also experienced the difficulties of trying to bring state-of-the-art medical care—often founded and based at academic medical centers—to those populations in the world most desperately in need. Few programs in the world’s wealthy countries target global health needs. And, unfortunately, many trained physicians and nurses from poor areas of the world leave their countries of origin to seek work in the world’s more wealthy regions. This “brain drain” has left a dearth of qualified professionals able to deal with the needs of the sick-poor around the world. One of the most fruitful ways we have found to bring a global health agenda to academic medicine is through the training of a cadre of new physicians within and outside the United States who will be future leaders in the field. To this end, the Brigham and Women’s Hospital in Boston, Massachusetts has recently launched a new internal medicine residency program whose goal is to provide opportunities for physicians to receive rigorous training in internal medicine with a focus on health equity. The Howard Hiatt Residency in Global Health Equity and Internal Medicine is a four-year training program endorsed by the American Board of Internal Medicine that allows resident trainees to gain competencies required to broadly address issues of health as a global human right. In addition to clinical skills needed in caring for patients in resource-poor settings, participants learn about global health policy, advocacy, ethics, pharmaceutical procurement and finance. They also pursue advanced degrees in public health or public policy. They participate in a monthly longitudinal seminar series (also open to the wider medical community) that focuses on issues of global health from the perspective of graduate medical training. Current field sites are in Haiti, Peru, Russia, Mexico and Roxbury, Massachusetts. To our knowledge, this is a unique internal medicine training program with an explicit global health focus. In July, our first two trainees began in the residency and we anticipate enrolling at least two new resident physicians each year. We are planning wide cooperation with the entire medical community in the Boston area and in resource-poor settings around the world. In order to address issues of global health equity in academic medicine, we need broadly-trained physicians and public health practitioners. The Howard Hiatt Residency in Global Health Equity and Internal Medicine at the Brigham and Women’s Hospital is an example of what we hope will be a successful model to integrate the health equity agenda into graduate medical education throughout the world. Competing interests: None declared |
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Richard G Fiddian-Green, FRCS, FACS c/o Hrhold, Maitland and Co, 44 Dover Stret, London W1.
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How does the standard of surgical care at Makerere today compare with that in Professor Sir Ian McAdam's time (1)? His contemporary at Groote Schuur Professor Jannie Louw, which saw patients of similar socio-economic circumstances, had done a large number of Billroth I gastrectomies with very low mortality at the time (2). As gastric ulceration is also common in Uganda the Billroth I gastrectomy could be used as a marker of the standard of major elective surgery performed in Makerere in past decades. I would have expected standards to have declined precipitously in Amin's time, if records were still kept, and to have returned to the standrds in Sir Ian's time by now. Has it? Do you have any data? 1. Ekwueme O, McAdam IW, Kyalwazi SK Postgraduate surgical training in Makerere. The crystallization of ideas. Ann R Coll Surg Engl. 1975 Oct;57(4):198-203. 2. Louw JH The treatment of chronic peptic ulceration. S Afr Med J. 1971 Oct;45(41):1131-4. Competing interests: None declared |
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