Working overseasBMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7061.2 (Published 05 October 1996) Cite this as: BMJ 1996;313:S2-7061
Just back from Rwanda, Charles Easmon discusses working for the aid agencies
Overseas aid in the context of this article is used to refer to medical work in either developing countries, former Eastern Europe, or newly independent states. Many doctors express an interest in it, but what constitutes a career in it? A succession of jobs in developing countries does not in itself constitute a career, taking the definition of the word as a path through life, or a profession or occupation chosen as your life's work.
If you choose overseas aid as your life's work it is not unreasonable to expect decent remuneration, long term job satisfaction, a clear line of responsibility, and at least some degree of security. By this definition no career exists. Working for a large supra/governmental, governmental, or non-governmental agency could achieve some of these goals. Obvious options include the Overseas Development Administration, the European Union, the United Nations, the World Bank, the International Red Cross, the World Health Organisation, and Save The Children.
Helping people in developing countries directly
Satisfaction of full or partial skill transfer
Learning from and assimilating new cultures
Understanding sociopolitical aspects of humanitarian aid
Developing new healthcare sytsems
Finding feasible solutions to healthcare problems
The satisfaction of close teamwork
Developing skills such as management, decision making, and appropriate emergency response
Poor remuneration at early stages
Social disruption of relationships and problems with childcare
Lack of job security
Stressful decision making
Problem with reacclimatisation on return (counselling services are offered by several agencies such as Merlin and MSF)
Most of these agencies have field project managers, consultants and technical advisers. These positions are well established in organisations such as the Overseas Development Administration and the World Bank. As part of their success is in making foreign governments less dependent on assistance the Overseas Development Administration notes that this will be reflected in a declining number of jobs for Westerners.
More speculatively, the EU through its European Community Humanitarian Office may in the future be looking for doctors as technical advisers. The United Nations High Commission for Refugees currently hosts only senior posts but may in future have some trainee posts available.
Technical advisers are expected to have a specialised area of knowledge such as public health, communicable disease surveillance, health economics, health policy or planning. Field officers would be expected to have an in country managerial role, liaising with local government and donors, ensuring that programmes develop as planned, are adaptable to necessary change and that appropriate responses are made to emergencies.
Consultants might specialise in one or several areas from emergency to development. The jobs mentioned above have two main entry levels. The first is entry as a senior adviser. Second is entry by gaining overseas experience and appropriate qualifications. Since there is often no direct career path a well chosen series of stepping stones may or may not help you to obtain a decent post. It is likely that more and more doctors will be chasing fewer and fewer posts, so a combination of overseas experience and qualifications are two stepping stones which cannot to be missed out.
Overseas experience in its simplest definition is the process of working overseas. Quantity is easy to measure but quality both of the work done and the individuals' contribution to that work is obviously difficult. Agencies that are prepared to consider candidates with little or no overseas medical experience are Medecins Sans Frontieres, Medical Emergency Relief International (Merlin) and Voluntary Services Overseas. Medecins Sans Frontieres seeks candidates with foreign travel experience and a suitable qualification such as the Diploma in Tropical Medicine and Hygiene (DTM&H)) or a Masters in Public Health (MScPH). Before starting a project there is a mandatory three week health preparation course in Holland, which is reportedly very good. Medecins Sans Frontieres will fund courses after a fixed period of work with them (often 18 months) and this may also commit you to a certain period of work after study.
Merlin will accept candidates with the above qualifications and are currently planning a pre-assignment training programrne. At present there is no funding available for courses.
Voluntary Services Overseas have six month posts available to those with no overseas experience but expect candidates to have at least six months training in the specialities of paediatrics or obstetrics.
Most other agencies prefer a higher level of experience. For example, the International Red Cross has posts for experienced surgeons and anaesthetists who are at least five years post qualification.
Applying for post
Register with as many agencies as possible and send updated curriculum vitae whenever possible. Expect a poor initial response but persevere. The reasons for poor initial response vary from administrative inadequacies to poorly trained reception staff. An initial period on a volunteer salary is unavoidable. The irony is that in financial and social terms it is easier to do your volunteer work early at the point of least experience, which understandably fewer and fewer governments and agencies find acceptable.
For £25 a year joining the International Health Exchange provides a job database, a bimonthly newsletter, and access to training courses.
The NHS and overseas work experience
If you wish to obtain experience overseas but keep a national training number as well, the best advice is to contact your postgraduate dean or college's regional adviser. It is not clear which posts overseas will gain accreditation, if any. The year abroad may be seen as a unfilled gap in an NHS career.
This attitude is changing. International Health Exchange has worked extensively with NHS hospitals to encourage overseas work sabbaticals. In June 1995, Ken Jarrold, the NHS Executive's director of human resources wrote to chief executives and general managers encouraging overseas experience as a means of professional development of NHS staff. Stockport Healthcare NHS trust launched a joint scheme with Voluntary Service Overseas in January 1995 and other health authorities are expected to follow. BMA seminars on working overseas have been running for the past three years: details should be available from your local office.
British public health and overseas work
A British public health trainee can, among other skills, acquire experience in communicable disease control, health policy, health promotion, economics, finance and planning. All of these may subsequently be relevant to work overseas. Some programmes allow trainees to obtain a masters in public health. Several public health authorities allow trainees to take secondments with aid agencies or to work part time in areas with an international perspective.
World Bank Graduate Scholarship Program or Young Professionals Program 1818 H Street, NW, Washington, DC 20433, USA Tel: (202) 477 1234
Associate Professional Officers Scheme (APOS) APOS Appointments Officer, Room AH304, ODA, Abercrombie House, Eaglesham Road, East Kilbride, G75 8EA Tel: 01355 843504
Overseas Development Administration (ODA) 94 Victoria Street, London SW1E 5JI Tel: 0171 917 0112
Medical Emergency Relief International (Merlin) 1A Rede Place, Westbourne Grove, London W2 4TU Tel: 0171 229 4560
Medicins Sans Frontieres-UK 3-4 St Andrew's Hill, London EC4V 5BY Tel: 0171 713 5600
International Health Exchange 8-10 Dryden Street, London WC2E 9NA Tel: 0171 836 5833
Voluntary Service Overseas 317 Putney Bridge Road, London SW15 2PN Tel: 0181 780 2266 International Red Cross 9 Grosvenor Crescent, London SW1X 7EJ Tel: 0171235 5454
Save The Children 17 Grove Lane, London SE5 8RD Tel: 0171 703 5400
The Liverpool School of Hygiene and Tropical Medicine Pembroke Place, Liverpool L3 5QA Tel: 0151 708 9393
The London School of Hygiene and Tropical Medicine Keppel Street, London WC1E 7HT Tel: 0171636 8636
As the skill base in developing countries increases it is important to consider what you actually have to offer. A knowledge of general medicine, paediatrics, obstetrics and other specialities beyond that of a first year SHO seems appropriate and a collegiate qualification ideal. For work in developing countries adequate knowledge of local diseases is mandatory.
The main UK diploma courses in tropical medicine and hygiene are based in Liverpool and London.
The Liverpool course runs twice a year from (February to May and September to December) and has a course fee £1490 for UK graduates.The London course runs once a year only (January with exam early April) and has; a course fee of £2500.
A master's course in any of the following would have useful applications abroad: public health, health education and health promotion, international community health, maternal and child health, and epidemiology, and summer field projects may be done overseas.
If an agency pays for the course this may tie you to a volunteer salary for up to 18 months.
The ODA Associate Professional Officers Scheme provides funds for several different master's courses and may link this with a post overseas.
The World Bank Young Professional Program is a scheme that provides funding to graduates under the age of 32 years. Graduates from developing countries are favoured.
Other entry requirements
Foreign languages especially French, Spanish and Swahili (the Esperanto of Africa) are useful to have. General management skills are also important.
As a volunteer expect anything from nothing (food and lodging provided) to £1500 a month depending on experience.
Larger agencies may pay UK taxable salaries of up to £30,000 depending on experience. Consultancy may be eligible for rates of £200-250 a day or more depending on experience and the agency. UN salaries may exceed $10000 a month.