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Editor's Notes

• #3: In the poorest countries, there is only one doctor for every 100,000 people. �� Imagine the City of Hamilton, population 500,000, with only five doctors. That’s what the chronic shortage of doctors in developing countries looks like. We’re talking 400 million people worldwide who lack access to a doctor. The majority of these people live in 57 of the poorest countries. ��
• #4: Where there are no doctors, there are consequences. Each year in developing nations, six million people die from malaria and tuberculosis. Half a million women die from complications of pregnancy and childbirth. Two million people die from diphtheria, measles and tetanus. With few exceptions, these deaths are preventable. By doctors. Enough doctors. So what is the solution?
• #5: Well, we could send doctors from wealthy countries, such as Canada, to treat these patients. That would help some patients. But it wouldn’t solve the doctor shortage. So perhaps, instead, we should train doctors.
• #6: You’ve likely heard the maxim, “Give a man a fish, feed him for a day; teach a man to fish, feed him for a lifetime.” Lao Tzu was onto something, but he only got it half right. Teaching someone to fish is all very well if your goal is to feed one person. But what if your ambition is larger than that? What if your goal is to feed a village? Or a country? Then the math is against you. ��
• #7: You cannot succeed by teaching one person at a time. Instead, you must teach fishing to one person who teaches fishing to many others. Solving a critical global issue requires multiplication, not addition. ��
• #8: That’s why the International Outreach Program of St. Joseph’s Health System trains doctors, who train doctors. We are a non-profit organization that partners with universities, medical schools and teaching hospitals in countries that need more doctors, particularly more specialists and sub-specialists.
• #10: We give medical students and doctors from developing countries the academic knowledge and clinical skills they need to prevent illness, restore health, save lives—and train other doctors to do the same. We teach our students the core clinical curriculum, but customize it to reflect the reality in their country. For example, we do not teach students how to use medical equipment that is not available in their country. In this photo, Dr. Brad Petrisor from McMaster’s division of orthopedics is training a third-year orthopedic resident in the operating room of a hospital in Haiti.
• #11: Our trainees also acquire leadership, communication, negotiation and teaching skills that help them generate lasting change in their communities and countries. This is Dr. Olivia Kit-uu-ka from Uganda. The International Outreach Program brought Dr. Kit-uu-ka to Hamilton to study surgery at McMaster University Faculty of Health Sciences. She returned to Uganda and was given a teaching position in the medical school at Makerere University. We trained Dr. Kit-uu-ka for one year. Now she trains doctors every year.
• #12: The power of multiplication starts in Hamilton, Ontario. We bring over medical students for training at McMaster University and area teaching hospitals. We bring over medical students for six-month residencies. We bring over doctors for clinical fellowships (typically twelve months).
• #13: We also send physicians to our partner countries to deliver training, mentor our graduates and strengthen our relationships with the faculty and leadership of their medical schools and hospitals.
• #14: Our training model is unique. Most non-governmental organizations that deliver medical training to students from developing countries only offer��observerships. Trainees are allowed into patient wards and operating rooms—but only to observe. They are��not allowed to examine��patients, see patients independently, answer patient questions, prescribe medications��or perform procedures. They are given zero responsibility. All they do is watch. This training model, if one may call it that, is commonplace, but ineffective.
• #15: The International Outreach Program, on the other hand,��arranges full licensing and medical insurance for medical students and physicians from developing countries. They talk with their patients and prescribe medications . . .
• #16: They perform surgeries, deliver babies, set broken bones, and plenty more, just as Canadian residents and clinical fellows do.
• #17: This unique approach sets us apart, and, from what our medical graduates tell us,��is the foundation of our success—and theirs.
• #18: In countries where medical resources are in short supply, healthcare can’t be delivered by one person, not even a well-trained doctor. Every doctor is part of a team. That’s why we train other members of the team. First among these vital workers are nurses. We train nurses to deliver safe, effective, evidence-based patient care. We tailor our curriculum to the nursing methods most relevant to local needs. We also train pharmacists and bio-medical engineers. ��
• #19: We work in three countries: Guyana, in South America. Haiti, in the Caribbean. And Uganda, in Africa.
• #20: GUYANA Our focus in Guyana is nephrology. The prevalence of kidney disease is very high in Guyana.�� Currently, there is not a single nephrologist in the country.�� Our partnership involves��the McMaster University Faculty of Health Sciences and Guyana’s��Georgetown Public Hospital and Doobay Medical Centre. We support the hospital and clinic so they can provide dialysis, regardless of the patient’s ability to pay.�� A��training program in Canada will��train Guyana’s��first nephrologist. In this photo, Dr. Azim Gangji of the Division of Nephrology, teaches a class in Guyana.
• #21: HAITI Our focus in Haiti is maternal and newborn health. We have a partnership with Centre Medical Beraca Hospital in La Pointe, Haiti.��We are: Providing training and��education to physicians, nurses and other healthcare professionals Constructing a new maternity ward, labour room and delivery room and clinic space Developing community outreach clinics for ante-natal and post-natal care This is Dr. Olès Dorcély, the only obstetrician at the hospital. He came to Hamilton through the International Outreach Program, for a residency in obstetrics. In 2014, he delivered 1,200 babies.
• #22: UGANDA Our focus in Uganda is sub-specialty training. The International Outreach Program��partners with��four medical schools across the country.�� Our partnerships involve exchanges for medical residents and clinical fellows, who come to McMaster University for training. We are also delivering��training in faculty development, nursing, biomedical engineering, and research. In this photo, medical residents from McMaster University teach at Mulago Hospital in Kampala.
• #23: A Brief History 1986:��St. Joseph’s Health System International Outreach Program is formed through��a small partnership with the government of Dominica 1992:��First project in Haiti begins 1995:��First project in Uganda begins 1990s: Limited-time partnerships with��Israel, Yemen, Russia, Sudan and Romania 2010:��International Outreach Program��becomes��a distinct corporate division within the St. Joseph’s Health System and receives its own charitable status from the Canada Revenue Agency 2010:��Volunteer Board of Directors and��part-time President appointed 2015: First employee hired (Director of Development)
• #24: How we are funded. The International Outreach Program of St. Joseph’s Health System is a registered Canadian charity. We raise our entire annual budget through donations from individuals, businesses, foundations and service clubs. We receive in-kind donations as well, such as medical equipment and medical supplies.
• #25: To bring one doctor to Hamilton for 12 months of sub-specialty training costs $30,000. Sometimes, the International Outreach Program raises the entire $30,000. We raise this money to pay for airfare, work permits, visas, insurance, rental accommodation and food. Other times, the $30,000 is paid for by the department that is bringing the doctor over, such as the Department of Medicine. The Department of Medicine often splits the expense with the Division that is training the clinical fellow, such as the Division of Nephrology.
• #26: Faculty donate their time. The visiting doctors donate their labour. Unlike their Canadian counterparts, they do not get paid a salary. They come to Hamilton at considerable professional and personal sacrifice. This is Dr. Peace Bagasha, from Uganda. Left a husband and children for one year to study nephrology. Her salary and billings ended once she stepped on the plane. So what kind of a difference will your donation make? Let me illustrate by telling you about one of our graduates.
• #27: Dr. Sarah Nak-ub-ul-wa, Obstetrician / Gynecologist Sarah is a clinical and faculty leader in one of the busiest maternity wards in the world, where they deliver 30,000 babies per year—82 babies a day. St. Joseph’s in Hamilton delivers 3,600 babies per year. BC Women’s Hospital delivers 7,000 per year. Sarah is a doctor who trains doctors. ��
• #28: In 2009, three women on average were dying every week in her maternity ward from preventable causes. “At least three times a week, we would deliver a baby, admit the mother to the recovery ward and show up the next morning and she would be dead,” says Sarah. ��
• #29: Sarah and her colleagues developed a High Dependency Unit and worked to identify the women most at risk, remove them from the general ward and monitor them every thirty minutes in the 24 hours after delivery. In the first three months following implementation, not a single mother died in childbirth at Mulago hospital.����Not one. Five years later, mothers still die��there, but the number is down to one every other week. Sometimes, only one per month.���� It used to be three deaths a week.
• #30: Sarah saved those mothers’ lives in Uganda because someone in Hamilton helped fund her medical training. In Hamilton. Sarah came to Canada ten years ago as medical resident sponsored by the St. Joseph’s International Outreach Program and McMaster University.���� In that time, she learned new skills, developed a sense of what is possible and went home determined to make a difference.
• #31: Sarah said, “I knew these deaths were all virtually preventable. I knew from my training in Canada with the International Outreach Program that we just needed to take a fresh approach, establish some new protocols, and that we could solve this problem.�� I didn’t want another mother to die unnecessarily.”
• #32: Since Sarah started this program, at least 650 mothers’ lives have been saved. That’s the power of training a doctor, who trains doctors.