Professor James Tumwine launched an African medical journal two years ago that is already indexed on Medline
Professor Tumwine, associate professor of paediatrics at Makere University, Kampala, Uganda, was just 14 years old when his eye for a good story first caused a stir.
He was editor of his school newsletter, and every day his editorial team would post news stories on the school notice board. One weekend he went to a village dance. “There was a gramophone playing the cha-cha-cha,” he recalls, “and two of our teachers were there. It was below their status to go to this type of dance.” So he was astonished to see them there.
He posted this “great news” the next Monday. The headmaster called an assembly, condemned James for his outrageous lack of discipline, caned him, and suspended him for a month, including two weeks of hard labour in which he had to hoe a section of dry earth. “It was my first time getting into trouble as an editor.”
Professor Tumwine, a specialist in paediatric infectious diseases and formerly Oxfam UK's health adviser for the Africa region, is causing trouble again. Frustrated by the lack of medical journals that will publish the work of African researchers, he ignored his detractors and in August 2001 launched a new journal for research on health and development, African Health Sciences.
Eminent professors had said to him, “Who do you think you are trying to start a new journal? It's a crazy idea. This is a poor country.” Though time and money were scarce, he was convinced that there was enough local talent to “achieve something for Uganda.”
His own faculty members, he thought, deserved to have a credible forum for publishing their research. “We have the brains,” he said. “We are doing a lot of important research. But journals in the ‘north’ aren't interested in our work.” He was fed up with the “hypocrisy” of journals in developed countries such as the BMJ and Lancet telling him and his colleagues that their research was “a good piece of work” but they could not publish it.
He was also fed up with the fact that, working in Africa, he had almost no access to health information published in journals in developed countries. For example, when the World Health Organization asked him to help investigate a mystery illness in southern Sudan called “nodding disease,” in which affected children get seizures when they eat, he could not gain access to research articles on the disease, either in print or online.
“At meetings in Geneva, people say that we in Africa should be able to get everything online. But we have local internet problems, many journals aren't easy to access because you need a password, and it costs $600 [£360; €515] a year for the internet. How many people can afford this? So I thought, ‘Let's publish information ourselves.’”
Professor Tumwine's strategy was to create a local editorial board made up of people “who wanted to move things forward,” together with some “big names” to give the new journal stature. He asked a team of international advisers to help, though he says they were sceptical about whether a new African journal would succeed.
Why not, they suggested, just team up with another regional journal? “But the regional journals weren't serving us,” said Professor Tumwine. “When we sent them a paper, it took two years to get a reply.” Or how about reviving the defunct Ugandan Medical Journal owned by the Ugandan Medical Association? “I refused, because the association was conservative and poorly resourced.”
African Health Sciences is being published not by a medical association but by the faculty of medicine at Makere University, which covers the printing costs—about $2000 per issue. The faculty, he said, allowed him the flexibility he needed. “An editor needs leeway. I had a lot of freedom.”
The journal quickly became talked about. The US National Library of Medicine recognised that it was filling a vital niche and indexed it on Medline in April 2003.
For the time being paper journals are still the only way for doctors in most of Africa to read research related to health. The journal is sent largely to doctors in rural hospitals, and abstracts are freely available online (www.inasp.info/ajol/journals/ahs). In the long run, Professor Tumwine hopes that the Ministry of Health will buy the journal for doctors in Uganda and that other funds will come from subscriptions.
He also believes that there could be a renaissance in medical journals across Africa if editors start collaborating. This kind of networking and sharing of experiences will be made easier by the recent creation of the Forum for African Medical Editors, which was officially launched last week in Addis Ababa and which Professor Tumwine chairs. “We want a credible network of medical editors publishing journals relevant to Africa and contributing to solving health problems.”
The forum grew out of a meeting in Geneva in October 2002, organised by WHO's special programme for research and training in tropical diseases, that explored ways to improve the quality and dissemination of African medical journals. The forum now has a constitution and has published its own guidelines for editors.
African journals can learn from journals in developed countries, said Professor Tumwine. “We can learn how they make decisions, how they ensure quality, what their business model is. The BMJ could help train our people.” The BMJ has officially twinned with African Health Sciences and has supported a training course for 19 African medical editors in Addis Ababa.
”But we're not trying to become the BMJ,” he said. “We want to become the leading journal in Africa. I'm not interested in becoming ‘BMJ East Africa.’ I want my own identity, my own priorities.”
He seems delighted by the controversy that his journal has already provoked. A national newspaper, the New Vision, picked up one study showing that about half of chloroquine tablets and injections in Uganda are fake or substandard (African Health Sciences 2003;3: 2-6). A study showing that university students know how sexually transmitted diseases are spread, yet do not practise safe sex, raised a few eyebrows in this socially conservative country (2001;1: 16-22).
With his lifelong rebellious streak and an editorial vision that cannot be clouded, there seems little danger that any journal in the developed countries could ever dictate Professor Tumwine's agenda.
Competing interests GY was a trainer at the course for editors in Addis Ababa. His costs were covered by the BMJ Publishing Group and WHO's special programme for research and training in tropical diseases.