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PHOTO FREDERIKE ROOZEN SLIEKER
This edition of MTb breaks with tradition. Instead of highlighting a particular field in global health as we normally do, the Editorial Board invited Heleen Koudijs (Medical Doctor Global Health in training) to be our guest editor. Heleen is one of the driving forces behind the Into the World project – the campaign aimed at public support for the training programme for medical doctors in Global Health and Tropical Medicine, an accredited programme that is endangered because of a lack of a sustainable funding base.
Heleen explains:
“The Netherlands has a long history of doctors practicing tropical medicine. The training programme on international health and tropical medicine – going back to the 1960s – gradually grew in professionalism, eventually resulting in its formal accreditation in 2012 by the Medical Specialties Council (‘College Geneeskundige Specialismen’). Accreditation however has so far not resulted in a sustainable financing base. In 2015, the former Minister of Health, Edith Schippers, decided not to provide government funding. She argued that trained doctors in global health and tropical medicine (Medical Doctors Global Health, AIGT in Dutch) would not contribute to the Dutch health care system, thus could not be funded from the same budget as the other medical specialisations. [See for background on the request to the Ministry of Health also the interview with Matthijs Botman elsewhere in this edition of MTb.]
Some two years ago, Matthijs Botman and Barend Gerretsen – together with Uitgeverij Boekschap and some enthusiastic NVTG members – started a project aiming to raise awareness for the work of global health doctors, explaining to a wider audience the profile of the Global Health doctors and outlining their work and contribution to the health system in the Netherlands and in low- and middle-income countries. The core of this project was the publication of a book containing the stories of twelve global health doctors and five vision articles.
It didn’t end there. The book was just the start of the wider social media campaign that was carried forward by a team consisting of global health doctors in training and medical students. We actively started to collect stories and posted them on the project’s website, Facebook page, Twitter and Instagram accounts, highlighting the broad spectrum of locations where global health doctors work and the various dimensions of their career. These locations included the Netherlands and high-income settings as well as places where they worked abroad.
It was not long before endorsements for the work of the global health doctor came in. In the summer of 2017, we received support from international experts such as Professor Rose McGready of the Shoklo Malaria Research Unit on the Thai-Myanmar border and Mr Stuart Ferguson, leader of the ‘Global Citizenship in the Scottish NHS’ movement.
One of the highlights of the campaign was the ‘Into the World’ public event on the 9th of December 2017, where the book Into the World was presented to an audience of over 400 stakeholders, including medical practitioners, supervisors, students, policy makers and NGO representatives.
The press was invited to attend, but serious media attention only took off some weeks later with the publication of two articles in the Dutch national newspaper ‘Trouw’. The articles examined the role of the global health doctor in international health and in low- and middle-income countries, and their contribution to the Dutch health care system. Other media channels picked up this message and asked why there was no sustainable funding for an apparently much needed training programme. Initially most attention was directed towards the role of the medical doctor global health for tropical diseases and preventive medicine. Soon other stakeholders, such as the hospitals involved in training global health doctors started to advocate too, highlighting the role in curative medicine and urging the government to provide funding.
| Triodos foundation Ted van den Bergh ‘The Netherlands has a long tradition of training ‘tropical doctors’, who have been able to widely spread their knowledge. There is a growing need for these experts in the field of international health and tropical medicine because of increased migration, globalisation and exchange between the Western world and low- and middle-income countries, especially since climate change is causing tropical diseases to spread northwards. We can’t let this expertise disappear because of lack of funding. That would be a terrible waste.’ |
| Global citizenship in the nhs Stuart Ferguson ‘It is morally correct for health workers from well-resourced health systems to stand together with counterparts in low- and middle-income settings, who battle daunting health challenges with precious little resource. But there is also a compelling pragmatic argument. As recent infectious disease outbreaks have highlighted, the health and safety of our populations depend – at least in part – on the functionality of healthcare systems far from our own. Our health systems and our health workers will also gain resilience, fresh perspectives, and new experiences in thinking and acting globally. We are one global village of interconnected and interdependent people who must work together to meet the health challenges of our time.’ |
| Médecins du monde/ dokters van de wereld chair ΤΟΝ Teunissen ‘Médecins du Monde advocates for continued investment in the training programme for Medical Doctors Global Health (AIGT in Dutch). The training programme is unique and offers doctors a solid base and opportunity to support other countries with their experience and expertise. They bring back to the Netherlands this unique expertise and their valuable experience of dealing with resource constraints. Working in the tropics is a unique speciality. We should not return to the days when doctors went abroad out of goodwill without a proper training. We need to encourage doctors to look beyond the walls of our health care system. It presents us with an opportunity to continue improving and optimising the health system in the Netherlands.’ |
In this MTb we provide a bird’s eye view of our campaign with a wide selection of snapshots of how international global health experts value the training programme and of how global health doctors themselves value their work experience abroad and how that relates to their current day-to-day work in the Netherlands.
Epilogue: the way forward
The campaign has picked up pace and continues to receive support from a variety of public, political and (global) health stakeholders. Public awareness of global health doctors is greater than ever, after several late-night talk-show appearances and a prime-time documentary episode of Floortje naar het einde van de Wereld, featuring a Dutch global health doctor in Papua New-Guinea. This media attention finally led to questions being asked in the Dutch Parliament and discussions are underway with the Ministry of Health (VWS) on funding options.
The journey that started last year is far from over. With renewed vigour, the NVTG, the ‘Into the World’ campaign team and other stakeholders continue to build an evidence base for sustainable funding. You will find more information on our website and social media channels: www.artsinternationalegezondheidszorg.nl, and you are most welcome to join our advocacy!”
| Capa care ‘The recent West-African Ebola outbreak was an important wake-up call, demonstrating that failed health care systems may turn small epidemics into large global threats. In the same way as climate change demands international collaboration and solutions, many health issues demand similar international approaches. By spearheading programmes where the focus is to innovate, transform, improve and rationalize, often under very challenging conditions, the Dutch global health doctors are an important part of the development of healthcare systems in resource-poor countries, and build invaluable bridges to our Western health systems.’ |
| Rose Mcgready ‘Global health doctors have profoundly influenced and inspired our work. They have a solid training in the basics and know how to implement these. They also have a goal to pass on their skills in our setting to those who missed out on training opportunities due to conflict as well as a vision to make a difference in the corner of the world where they work. I do not know of a country as generous as the Dutch in this area – the global health doctors are excellent ambassadors for the Netherlands.’ |
| Médecins sans frontieres / doctors without borders ‘The Medical Doctors Global Health train local staff and transfer practical knowledge and skills. They have been trained to do this in a culturally appropriate way. Global health doctors ‘think outside the box’ and look beyond the borders of their examination room and / or hospital. They are, for example, also advocates for equity in access to health for all.’ |
