New Reflections on Global Health

Professor Nelson K. Sewankambo, MBChB, MMed, MSc

The 2016 International AIDS Society (IAS) conference has just ended in Durban South Africa. This annual gathering is probably the largest annual global health conference. However, this event is not widely advertised or even referred to as a global health conference. I do not know why this is so. Yet, the many important priority issues always discussed at these conferences are priorities for the global health agenda. These include containing the global epidemic, ensuring global health access to HIV care especially in low and middle income countries (LMICs) and vulnerable populations, resource mobilization at national and international levels, equity and equitable research, among others. These are clearly the concern of the global community that is concerned about global health. It is possible that not naming IAS conference as a global health event is not an error, or if it is it is not an error of commission but one of omission because no serious and collective thought has been given to this issue. But what is in a name?

Ironically during this same month “The Lancet” in its July 02, 2016 issue carried an article entitled “When the Doctor Is Sick Too.” It states that “Doctors are notoriously bad at seeking help for themselves when ill” It continues that “According to Gerada, doctors are on par with the homeless in the UK in terms of barriers to access health care. Admission and acceptance of illness in themselves is an alien concept to many doctors, so that presenting late with a serious condition is common.” This starvation amidst plenty by doctors not seeking care until very late when they are sick is not dissimilar to what we observe in Uganda. My regret is that as one of many advocates for evidence-based medicine and evidence-based policy I have no data to back up my assertions. However, others in the profession and general public in our midst have made similar observations. I would think that similar observations have been made not only in LMICs but also in high income countries.  This reminds me that we should not think of global health challenges as only existing in those countries far away from our own environments. Global health challenges exist everywhere, wherever we might be.  Why doesn’t concern for health of health professionals feature (as a priority) on the global health agenda? Is it not a global health issue?

Reflections about the IAS conference and the Lancet article, both of which are very fresh on our minds, should serve to escalate our continuing interest in and struggle to enhance our approaches to how we view and address global health issues. The ever growing number and size of collaborations between the institutions in resource-rich nations and those of resource-limited environments provide great opportunities for creating global learning societies. Building momentum and maximizing benefits arising from these efforts is critical to our understanding as to why each institution, individual faculty member and student gains interest in global health and decides to engage in it. We should aim for true engagements that are long term. In most if not all of these collaborations there are trade offs. There may be losers and winners, and important ethical questions that arise. On both sides, namely the host and the visitor, life may proceed without deep reflections to these ethical challenges.

We need to become much more alert to these ethical challenges and think about potential solutions even though many times there may be no easy solutions. The question is who or which stakeholders should participate in these discussions so that they are well informed and meaningful to those concerned. This may underline the value of learning societies whose intent should be to advance the value and knowledge of global health collaborations. The desire is for us to lay a strong foundation for the next generation of faculty, our students, and the populations we serve.

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