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18 MT BULLETIN OF NVTG 2017 MARCH 01
TRAINING
News from the Training Institute of Global Health
and Tropical Medicine
In January 2017, the first medi-
cal doctors completed the new
training programme allow-
ing them to carry the title of
Medical Doctor in Global Health and
Tropical Medicine (MD GH TM/ Arts
Internationale Gezondheidszorg en
Tropengeneeskunde, AIGT-KNMG)!
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 relation-
ships 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, anaesthesiolo-
gist, moved to the hospital in March
1993, which was then a run-down hos-
pital in the remote, densely populated
North-East of India. Over the years,
despite many difficulties, they have con-
tinuously 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 hos-
pital also
has its own
nursing
school.
Due to the
availability
of supervi-
sion, good
equipment,
and expe-
rienced
faculty,
this hospi-
tal makes
a great
learning
environ-
ment. 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 partner-
ship with Dr Vijay, the medi-
cal 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 devel-
oping 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, remote-
ness, war-like situations etc. Aware-
ness of these problems is vital, and
a comprehensive approach is needed
to close this gap in healthcare acces-
sibility. 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
Four dutch doctors (Geerte den Hollander, Inge Verdenius, Judith Pekelharing
and Juul Bakker) with consultants dr Ann Miriam and Vijay Anand
Ismavel at the par tner ins titute Makunda hospital in India
MARCH 01 2017 MT BULLETIN OF NVTG 19
TRAINING
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 QUALIT Y
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 com-
ponent of the training
programme creates opportunities for
the OIGT and the NVTG, an impor-
tant learning environment for the GH
TM residents, and valuable coopera-
tion with the hospitals involved.
We want to congratulate Judith Pekel-
haring 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.
DR VIJAY ANAND ISMAVEL, IVIJAYANAND@YAHOO.IN
DRS. MAARTJE GOUDSWAARD, MGOUDSWAARD@OIGT.NL
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
