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In January 2017, the first medical doctors completed the new training programme allowing them to carry the title of Medical Doctor in Global Health and Tropical Medicine (MD GH TM/ Arts Internationale Gezondheidszorg en Tropengeneeskunde, AIGT-KNMG)!

Four dutch doctors (Geerte den Hollander, Inge Verdenius, Judith Pekelharing and Juul Bakker) with consultants dr Ann Miriam and Vijay Anand Ismavel at the partner institute Makunda hospital in India

Compared to the old programme, a new element in the training programme that adds significant value to the training of MD GH TM specialists is the six-month training in a ‘low-resource global healthcare’ setting. In addition, it gives the training institute (OIGT) (and the NVTG) an opportunity to build relationships with hospitals abroad and NGOs.

One of these partnerships is with Makunda Hospital and the Emmanuel Hospital Association (EHA) (a large non-profit provider of health-care in India). Makunda Hospital, in the far North-East of India, is one of the hospitals where the residents (IGT aios) are being trained. Two passionate doctors, Dr Vijay Anand Ismavel, paediatric surgeon, and his wife Dr Ann Miriam, anaesthesiologist, moved to the hospital in March 1993, which was then a run-down hospital in the remote, densely populated North-East of India. Over the years, despite many difficulties, they have continuously been building up the hospital, where 100,000 patients are now seen in OPD, 5,000 babies are delivered, and 2,400 major operations are performed each year. The hospital also has its own nursing school. Due to the availability of supervision, good equipment, and experienced faculty, this hospital makes a great learning environment. A brief video about the work at Makunda is available at: https://the-sparrowsnest.net/2016/02/19/short-video-of-our-work-made-by-emmanuel-hospital-association/

We reflected on this partnership with Dr Vijay, the medical director of the hospital.

Learn and contribute

The OIGT organizes one of the few training programmes in the world that prepares medical doctors to work in low-resource settings in the developing world. The genuine interest, strong motivation, clinical experience, and expertise in public health enables the residents to also contribute to the hospital during their training. Dr Vijay: ‘The residents are high-calibre individuals who are willing to put up with inconveniences so that they may excel in their work. This provides the basis for a perfect partnership.’

AS MUCH AS THE RESIDENTS NEED TO LEARN AND DEVELOP THEMSELVES IN A LOW-RESOURCE SETTING, THEY WILL ALSO BE ABLE TO CONTRIBUTE TO THE HEALTHCARE SYSTEM.

“Close the gap” – advocacy

There is a growing awareness that the greatest investments of time, effort, and funds in the world are presently going towards making healthcare more convenient, safer and better for people who are already receiving relatively good quality healthcare. Many others are, however, unable to access healthcare due to ignorance, poverty, remoteness, war-like situations etc. Awareness of these problems is vital, and a comprehensive approach is needed to close this gap in healthcare accessibility. Therefore, besides focusing on clinical care, it’s vital to maintain a broad scope, cooperate with NGOs, and promote fund raising and advocacy.

THIS TRAINING COMPONENT FOCUSES ON CLINICAL CARE AS WELL AS PUBLIC HEALTH ISSUES (ADMINISTRATION, ATTITUDES, FUND-RAISING, RECRUITMENT, STRATEGIC PLANNING AND ADVOCACY WITH GOVERNMENTS AND OTHER DECISION-MAKERS).

Exchange of knowledge

Makunda Hospital has established a successful working model of a relatively large volume hospital targeting the poor in a remote rural area. Many of these strategies can be readily applied to other low-resource settings in other parts of the world. Residents are being placed in different hospitals all over the world, often with similar issues that need resolving, like training of staff, development of protocols, etc. (of course adjusted to the local situation).

PUBLIC HEALTH RESEARCH AS PART OF THE TRAINING AND SHARING OF INFORMATION CAN PLAY A ROLE IN THE EXCHANGE OF KNOWLEDGE BETWEEN HOSPITALS AROUND THE WORLD AND CAN CONTRIBUTE TO QUALITY IMPROVEMENTS.

Other facilities where IGT aios are being trained:

  • Walikale Hospital, Democratic Republic of Congo (via MSF)
  • Nigist Eleni Hospital, Hosanna, Ethiopia (via VSO)
  • Rubya Hospital, Tanzania
  • Mnero Hospital, Tanzania
  • CIB Hospital, Pokola, Congo Brazaville
  • Namatanai, Papua New Guinea (via Australian Doctors International)
  • St Francis Hospital, Katete, Zambia

As shown by the partnership with Makunda Hospital and EHA, the new component of the training programme creates opportunities for the OIGT and the NVTG, an important learning environment for the GH TM residents, and valuable cooperation with the hospitals involved.

We want to congratulate Judith Pekelharing and Juul Bakker, the first “new style” Medical Doctors in Global Health and Tropical Medicine, and wish them a bright future in global health – closing gaps, building bridges, and contributing to a healthier and more equal world.

Recently we finished our training in this inspiring hospital in rural India. For six months we, Judith Pekelharing and Juul Bakker, have been working at the Makunda Christian Leprosy & General hospital, mainly in the obstetric & gynaecological department, but also in general medicine, paediatrics, surgery and anaesthesia.
The philosophy of Drs Vijay and Ann is reflected in their daily work in Makunda. They managed to train and employ a team of highly motivated staff, working day and night to give the generally poor patients the best treatment available. The commitment of the staff is impressive and has no limits. When the ventilator breaks down, nurses will ventilate the patient by hand as long as necessary, and even during a cold and quiet night shift, we found nurses in the labour ward studying.
For us, the hospital has been a great learning environment. We had the chance to quickly develop our clinical skills, e.g. caesarean sections, in a hectic setting with large patient numbers and supervision always being available. Moreover, the low-resource setting makes it a perfect place to experience how clinical work and public health problems are intertwined. Patients often reach the hospital when it is (almost) too late, for example after several eclamptic convulsions or in cardiac failure from severe anaemia. Road conditions, low health education, and poverty are some of the underlying factors that we noticed. By being involved in the development of protocols and the teaching of medical staff (i.e. on malnutrition and ante-natal care), we broadened our knowledge of different subjects.
As the first Medical Doctors in Global Health and Tropical Medicine to complete the new training programme, we look back on an unforgettable time and a valuable experience.
Judith Pekelharing en Juul Bakker