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EDITORIALS: David Mabey Improving health for the world's poor BMJ 2007; 334: 1126 [Full text]

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Helping UK doctors work in the 3rd World

Andrew L Perkins   (2 June 2007)

We can’ t give up hope

tanveer afzal   (3 June 2007)

Response from the editors of 'Improving health for the world's poor: what can health professionals do?'

Martin Carroll, Mike Rowson, David McCoy   (13 June 2007)

Helping UK doctors work in the 3rd World 2 June 2007
Andrew L Perkins, none 27, Greenfield Rd, Westoning, Beds, MK45 5JD Send response to journal: Re: Helping UK doctors work in the 3rd World	I read Professor Mabey's editorial in the BMJ of 2/6/071 with great interest. You are right to point out that the BMA & the Government’s fine words about encouraging UK doctors & health professionals to work overseas needs to be backed by concrete actions. He highlighted some of the problems, namely uncertainty about how revalidation etc will work for those overseas & also a rigid MMC programme which doesn’t allow time out. For the some, the burden of debt from student loans may also be a problem. Surely it is not beyond the wit of our profession to devise a scheme that will make it easier for UK health professionals to work overseas either as missionaries, volunteers with NGOs or in other “bona fide” set ups. Some of the issues you raise also affect UK doctors wanting to take career breaks in the UK. I have some suggestions; 1. Devise a way that UK doctors working overseas can be part of some form of revalidation. 2. We have an over supply of doctors at the moment trying to get into the MMC/MTAS process. Allowing some to opt out in order to work overseas should be encouraged by recognising the experience they will have gained & facilitating their re entry into the system. 3. At the moment UK doctors working overseas cost the UK Government nothing as their costs are met through the voluntary sector. The UK government could do more to recognise this by helping to pay off debts from student loans & help with GMC registration fees etc. This money could come out of the overseas aid budget & would have the added advantage of being money well spent & not subject to the usual percolation of much of overseas aid. It is worth noting in passing that some organisations such as the BMA & Medical Protection Society (MPS) recognise overseas service by offering either free or heavily discounted membership to medical missionaries & NGO volunteers. Dr Andrew Perkins, Former medical missionary in Mali. Beds. MK45 5JD alperkins@doctors.org.uk 1. Mabey, D, Improving health for the world’s poor. BMJ 2007;334:1126 (2nd June 2007) Competing interests: I have been a medical missionary in Mali. West Africa
We can’ t give up hope 3 June 2007
tanveer afzal, doctor bb4 5pl Send response to journal: Re: We can’ t give up hope	David Mabey’s article made pessimistic reading to any young enthusiastic doctor wishing to offer their services in the world’s poorest countries. He’s right to portray this picture because for any of us reading the article it offers little guidance to the practical problems health professionals are facing. Having worked in a developing country I am aware of the problems health professional can face. Here’s to name a few, lack of resources, lack of government interest in the health profession, lack of basic facilities and more importantly funding to improve the medical standards. As a consequence, the poor people are deprived of a basic right- good adequate medical care whilst the rich can afford private care. So, there’s no incentives to improve, nobody listen to the poor and the rich are happy paying. What is the solution? UK governments need to offer more incentives to allow our young blood go and improve the situation in these countries. Yes, the so called third world countries are improving but they still need our help, and we must not forget this. To do so will be not to fulfil our duty as doctors in helping all we can. However, health professionals can not alone act as saviours what needs to be done is to adopt a more multi facetted approach, improve the assistance to health professionals but also improve the overall structure in place in these countries only then can we make lasting change. Competing interests: None declared
Response from the editors of 'Improving health for the world's poor: what can health professionals do?' 13 June 2007
Martin Carroll, International Department British Medical Association, Mike Rowson, David McCoy Send response to journal: Re: Response from the editors of 'Improving health for the world's poor: what can health professionals do?'	The BMA publication, 'Improving health in the developing world: what can health professionals do?" was designed to encourage debate about the contribution that health professionals can make to improve global health. Professor Mabey's response, however, misunderstands the purpose of the publication. Our intention was not to suggest methods by which the NHS can contribute to the health care needs of poor countries. This has already been done by Lord Crisp’s report on global health partnerships. Instead, we aimed to complement the Crisp report by proposing advocacy actions that doctors and the other health professions can take as part of global civil society. Our publication set out to encourage health professionals to think outside of the box and take action on issues that lie beyond the health care sector, such as trade, climate change and global governance. We also sought to inform health professionals about issues where our surveying showed there to be a lack of awareness. Contrary to Prof. Mabey’s assertion, the publication does nonetheless acknowledge the vital role played by individual health professionals working in developing countries. We welcome David Mabey’s observation that the publication does not cover an exhaustive list of issues - the eight that were chosen stand as an initial response to the question, 'what can health professionals do?'. Important issues such as population control, poverty and conflict are not covered. And of course we welcome any correction of factual errors. It is now up to the BMA membership to consider the recommendations at the end of each chapter and open a debate about the potentially powerful role that health professionals can play in tackling many of the broader determinants health inequalities and poor global health. We look forward to more comments from the BMJ readership. Mr Mike Rowson, Centre for International Health and Development, University College London Dr David McCoy, Department of Epidemiology and Public Health, University College London Mr Martin Carroll, International Department, British Medical Association Competing interests: We edited the publication. We were also among the contributing authors.