written by Edie Jones & edited by Anisa Jafar
Summary
28th February brought 60 emergency care practitioners together online, for an exciting evening, focussed on the ongoing conversation as to how some of our UK EM colleagues engage in global health back home. Following a brief opening, we had 6 panellists (see their bios below) who presented themselves and their experiences of moving between healthcare systems. This was followed by a structured Q&A where delegate questions were posed to our panellists. Next we split into breakout rooms, 3 groups discussing one topic, 3 discussing another, and finally we regrouped as a whole, briefly fedback and had time for a couple of final questions.
Panelists
Dr Zaynab Moloo
Tanzania
Zaynab is an Emergency Medicine doctor working in Coventry, UK. She is originally from Tanzania, East Africa where she grew up and went to Medical School. Zaynab spent all of her clinical years in some of the busiest hospitals in Dar es Salaam she then worked at the biggest Emergency Department in Tanzania for 2 years before moving to the UK.
Dr Ahmed Ali
Sudan
X: @ahmedeoali
Ahmed is a Consultant in Emergency Medicine at Salford Royal Hospital, Manchester. He graduated from the University of Khartoum with a career in Public Health and Emergency Medicine across Switzerland, Sudan and the UK. Ahmed was a research fellow at the Sudan Public Health Institute before moving to the UK and undertaking Emergency Medicine training in the North West of England.
Mr Ayman S Jundi
Syria
Ayman has been a Consultant in Emergency Medicine at Lancashire Teaching Hospitals NHS Foundation Trust, since 2000, a post he currently part-time. He qualified from Damascus University Medical School in 1980, and worked at the American University in Beirut at the height of the civil war in Lebanon 1980-84. He moved to the UK in 1985, and trained in Emergency Medicine in the North West of England. He has professional interests in medical education, resuscitation training, emergency planning, major Incident and disaster Management.
In 2019, Ayman became a Clinical Senior Lecturer in Disaster Medicine at the University of Central Lancashire (UCLan) where he developed, delivers and leads their Masters in Disaster Medicine.
A founding member of the Syrian British Medical Society (SBMS), which was established in 2007, he served as their president from 2014-16. Ayman is also a founding trustee of ‘Syria Relief’ (recently rebranded to “Action For Humanity”). Between 2018-23 he was chairman of the Board of Trustees, Ayman is heavily involved in the humanitarian and relief work undertaken by the charity, which was set up following the start of the crisis in Syria in 2011. The charity has since raised and spent over £180m.
Dr Angharad Spencer
Malawi
X: @AngSpencerM
Angharad is a Consultant in Paediatric Emergency Medicine and Emergency Medicine working in the North West. She has family connections in Malawi: her husband and children are Malawian citizens so as a family, they have spent as much time as is practical living and working there and spending time with their Malawian family. Angharad has been involved in a variety of projects in Malawi through local connections, ranging from work with the local child protection committee supporting children living with disabilities to a Quality Improvement Project establishing a local pre-hospital emergency care service. She looks forward to discussing the challenges of how those of us in the diaspora can best support our local colleagues and communities to move forward in achieving health equity.
Dr Kene Maduemem
Nigeria
X: @KMaduemem, Instagram: @childrensdr_kene
Kene is a consultant in Paediatric Emergency Medicine (PEM) in North West, England. Whilst he received his primary medical degree in Nigeria, Kene did postgraduate paediatric training in Nigeria, the Republic of Ireland, and England with PEM subspecialty training. He also has a Masters degree in PEM, and postgraduate diploma in allergy.
Kene is very passionate about cultural intelligence and health equity in the care of children and families. He is also the clinical director of Ark Missions Outreach; a voluntary organisation for indigent Nigerian communities.
Kene believes that “no matter who you are or where you come from, you can choose to be who or what you want to be”. When not working, he can be found in cinemas, or taking long walks.
Dr Rizwan Riyaz
Pakistan
X: @Riztoxik
Rizwan is a pioneering Medical Toxicologist and Emergency Medicine (EM) Consultant providing teaching and training in both specialities to several sites in Pakistan as well as working on the cHALO project with other EM colleagues. He trained clinically at Emory University, USA and completed his EM training in Pakistan then in the UK and has worked as a Major Trauma Center EM Consultant. Rizwan is the current Chair of the Toxicology Committee at the UK’s Royal College of EM and has presented nationally on Acute Thallium Toxicity and contributed a chapter on Cardioactive steroids in the AAEM/RSA Toxicology Handbook. Currently, he serves as an EM Consultant and Toxicology Lead at the University Hospital of Derby and Burton, Royal Derby Hospital, UK.
Event in detail
Panel questions began with “What can emergency care in the UK bring to the lower-resource settings?” Ayman Jundi spoke of the role of the Royal College of Emergency Medicine providing support in the development of a training program for newly recognised EM physicians in Syria. Angharad Spencer gave the example of the formal, decade-long partnership between the Malawian government and Scotland. This collaboration between Scottish and Malawian healthcare professionals has been supporting and developing emergency care in Malawi. It was reflected that such continuous relationships between healthcare systems can help an emergency EM speciality to become self-sustaining, using existing expertise from within the UK.
This emphasis on bilateral collaboration came through in the next question: “Which aspects of emergency care in other countries, especially those with lower resource, could help improve UK EM?”. Rizwan Riyaz, described what he had learnt from his extensive work within the healthcare system in Pakistan. Having worked alongside local Pakistani clinicians, Rizwan suggested that resourcefulness, community involvement, adaptability and interdisciplinary collaboration were key strengths which could be learned from and adopted in the UK. Zaynab Moloo gave examples of resource savers e.g. using suture trays or kits that are sterilised and then reused for cost-effective and environmentally conscious practise.
Moving to explore how global health could be better integrated within UK EM, Ahmed Ali, highlighted that currently, the UK EM training curriculum is very UK-focused, as well as offering limited pre-hospital training and with little focus on the EM system as a whole. Given that global issues are paralleled by similar pressures within UK emergency departments, including crowding and boarding, it would be effective for the NHS to use global solutions to address these – in his words: ‘thinking globally and acting locally’.
GECCo has an interest in practical, responsible and sustainable involvement of global health work in the careers of emergency care practitioners, so naturally the next question asked how our panelists balance their careers in the UK with global health work. Kene Maduemem expressed that carving out time as a trainee can be challenging, and often requires using annual leave. This may be particularly difficult for international medical trainees if it impacts their visa and settlement within the UK. Organisations which can offer shorter projects can be helpful and Rizwan Riyaz added that good time management and forward planning alongside using study leave and/or specialised leave can provide other opportunities. In addition, online working with international colleagues has opened up the potential for pragmatic long-distance collaboration.
When asked how these collaborations are nurtured most successfully Zaynab Moloo suggested that exchange programs can be a practical way for each partner to learn from the challenges faced in the other healthcare system, along with sharing ideas and research possibilities. Ahmed Ali added that any interest in working with another healthcare system should be combined with thorough knowledge of what is really needed and what you can practically provide.
Finally, panelists were asked, in their experience, which global health partnerships they felt had been the most effective. Ayman Jundi reflected that often global health work, although beneficial, is done with short-term goals, in isolation and without effective involvement of the local staff and therefore does not deeply consider what is in the best interests of patients and staff in that specific context. However education programmes such as those delivered by the David Nott Foundation, can have much longer-term benefits. Kene Maduemem added that community participation and collaboration with local teams, empowering them to lead healthcare projects, is an effective way to develop such partnerships especially when the outcome is to bolster work that already exists.
We ended the panel with a strong sense of the importance of collaboration, as well as involvement of healthcare professionals with vastly different experiences to address how we, in UK EM, engage in global health in an appropriate, practical and effective way
Our break-out groups led on from this panel discussion – their task was to consider two questions:
- What are the barriers to diaspora/non-diaspora working together in global health settings?
- How can UK EM better support diaspora engagement in global health?
The feedback from this demonstrated some in-depth and varied discussion between group members. A number of key ideas emerged – one of them really focussed on the importance of supporting UK-based international colleagues in actually getting through training and exams themselves, given that exams are often written with a UK-trained person in mind. The rationale behind this was very much that if we can support more of our non-UK colleagues to successfully reach the end of training and join the consultant body, they will be in a much stronger position to establish and embed ongoing global health work. Furthermore, whilst lots of rhetoric was noted to exist around diverse and inclusive workplace practice, it was felt that this was out of balance with pragmatic, formal ways to support LMIC diaspora within UK EM, especially with respect to being able to work between the home healthcare system and the UK.
It was felt that one way forward might be for RCEM to encourage and even recognise as part of training, out-of-program experiences which involved establishing health partnerships between hospitals to allow bilateral learning. In combination with more remote opportunities for online commitment, this may combat some of the logistical and financial barriers that are often experienced by healthcare professionals, especially international colleagues, keen to participate in global health
The wealth and breadth of experience contributed by our panelists, alongside our participants was both humbling and inspiring. We hope that this event seeds some further ideas and joint working in this space – let us know if anything develops, we are sure our GECCo community would love to hear more!
Find the event recording below.