Personal Views Personal views

Conferences should be held where the problems are

BMJ 1999; 318 doi: (Published 27 February 1999) Cite this as: BMJ 1999;318:613
  1. Andrew R Potter, ophthalmologist
  1. Benin Republic, West Africa

    It is not often that I receive an invitation to attend an international conference. We who labour in the remote outposts of poor countries are hardly top of the list of likely candidates for such meetings. And, let me be honest, it is not a personalised invitation as such, but only a brochure sent out to a wide constituency of those who might have an interest in eliminating vitamin A deficiency. It is addressed to “Dear colleague” and says, “It is our pleasure to invite you, we look forward to your participation …and know that your attendance will add to its success.” I read on.

    The meeting is sponsored by the International Vitamin A Consultative Group (IVACG), which is dedicated to reducing the prevalence of vitamin A deficiency worldwide. IVACG hopes to promote research and awareness of the problem of vitamin A deficiency by means of such international meetings and to encourage innovative action. Aside from the formal lectures and scientific presentations, the meeting will afford opportunity to share information about successful strategies to correct micronutrient deficiency.

    Who is ready to sponsor an African district medical officer?

    Vitamin A deficiency is largely a problem of poor developing countries where adverse climatic conditions and a lack of dietary education compound the problem. In Asia and Africa hundreds of thousands of young children die each year and many others are left facing a lifetime of blindness caused by a lack of vitamin A, which can also aggravate measles and malnutrition. Scientific studies have shown that both mortality and morbidity are increased in a range of diseases if children are deficient in vitamin A.

    There are over 20countries in Africa that are affected wholly or in part by populations with clinical evidence of vitamin A deficiency. Benin Republic is one of these. Others, notably the landlocked semidesert lands of Mali, Burkina Faso, Niger, and Chad are much more severely affected because of years of political instability, drought, chronic malnutrition, very low levels of literacy especially among women, poorly developed public health services, and inadequate coverage with immunisations.

    The conference to which I am invited is to take place in Durban at the International Convention Centre. Accommodation is reserved at the adjacent five star Hilton Hotel. I begin to sense the anomaly.

    Those of us who work “at the end of the track” in hospitals and clinics or as district medical officers serving rural populations in developing countries are face to face with the daily realities of our patients' suffering. We know their way of life and struggle for survival. We acknowledge their priorities of clan customs, beliefs, and superstitions. And what is more we are here with them. Whereas the agendas, decisions, protocols, and recommendations that issue forth from prestigious international congresses are devised by those whose horizons are not ours. They are the professors and academics in first world ivory tower institutions, the officials of ministries of health in distant capitals, the managers of relief agencies and non-governmental organisations based in rich countries, journalists, and fund raisers. They attend on full expenses. They fly in, ruminate, fix deals, meet like-minded colleagues, ratify predetermined conclusions, shake hands, and fly off to the next meeting.

    Who is ready to sponsor an African district medical officer? They work in areas that the pharmaceutical representatives will not visit, so there is no hope there. And the non-governmental organisations will sponsor only those candidates who are guaranteed to toe the party line. How can a rural doctor possibly aspire to attend such a relevant meeting when one night, without food, in the Durban Hilton is a month's salary? Is it a wonder that rural doctors become discouraged and cynical?

    We work largely in isolation. There is no continuing medical education, no medical libraries, and colleagues are far away. A specialist may not see a fellow specialist from one year to the next. Not, that is, if he or she is dedicated to the patients and does not desert to the distant capital. Government salaries are low and in some countries are paid very irregularly.

    Would it not make more sense to hold such international meetings in much less opulence and take the message nearer to the target? It would have a greater impact on those of us seeking to implement the programmes. It would forge relevant links between the academics, policymakers, and “coal face” workers. It would have much more impact “where the problem is.”

    I take the IVACG conference as but one example of the genre. The criticism goes much further—deafness, mental health, tuberculosis, female genital mutilation—the list goes on. But then again how many of the movers and shakers would be prepared to travel a day or more from the international airport, endure the heat and the flies, eat unusual food, and sleep under a mosquito net? It is, however, just how my patients live always. And it is there that I and very many committed doctors work. We should not be forgotten or ignored.

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