Crossing Borders: working and training in international public health.

Rebecca Hope and Fred Martineau

Introduction
Where do the majority of us see ourselves in several year’s time? The big question many of us will have is how to combine an interest in international health with the current training systems for health professionals. Alma Mata Global Health Graduates’ Network was set up to help answer some of these questions and this article will highlight current initiatives in international public health and training routes available at present.

In spring this year, Alma Mata conducted a survey of its members to explore their ideas about their future careers. This was timely; as we have detailed in our previous newsletters, the training for UK doctors has been undergoing a major overhaul. With specialist training being streamlined and the traditional post-graduation house officer year being replaced by the Foundation Years posts, a two-year integrated programme, the questions were where does international health work fit in with this?

The Global Health Directions survey

The survey was publicised on the Alma Mata website during June-August 2005. 59 questionnaires were completed, the majority coming from final year medical students and doctors in their first year of training. The graph below shows the most popular planned career paths.

Interestingly although 86% planned to work with humanitarian / development agencies in future, 76% of respondents agreed they planned to follow a UK based career with some periods of overseas work.

This would seem to refute the idea that doctors interested in international health will leave the hospitals which trained them for developing countries. This has been borne out by the experience of Merlin, a UK agency providing medical relief and health care in international emergencies. 'Almost all of Merlin’s UK volunteer doctors return to a career in the NHS', reported Dr Nick Banatvala, writing as a medical advisor to Merlin.

71% were interested in specialist training in public health; 86% of respondents agreed they would be more likely to opt for this training if it included a period of overseas training.

But what are the current opportunities for training in international public health?

Current initiatives for junior doctors

Lewis, in his analysis of the new training of junior doctors, concluded that…'it is entirely possible for these facilities to be put to use in creating training posts in either the proposed broad, specialities or systems based training schemes that include some time working in the international arena. Whether or not such a thing will be possible in the Foundation years remains to be seen.’ (view article)

However, in the pipeline at this time, from University College London’s International Health and Medical Education Centre (IHMEC) and the London School of Hygiene and Tropical Medicine (LSHTM), were plans for an Foundation Year 2 Academic Programme in International Public Health, proposed to the North Central Foundation School. Additionally, a Clinical International Public Health Foundation Year 2 Programme is at proposal stage. These are promising developments for those who are keen to get a broad grounding in public health with an international aspect, as well as relevant clinical experience. The plans for the future Academic Programme are outlined below.

Organised by:
Professor John S Yudkin Professor of Medicine and Director of IHMEC with
Professor Sir Andrew Haines Director, London School of Hygiene and Tropical Medicine. (LSHTM)

Open to: In the first year, August 2006, only those in their FY1 year at the North Central London School.

Duration: 4 month rotation

Content:
The four month rotation will include UK public health training alongside international public health work. It is planned that trainees will spend time attached to a variety of clinical and academic settings, including an NHS Primary Care Trust, the Hospital for Tropical Diseases and short attachments to bodies working in international health. An anticipated one month overseas attachment will be part of the programme, with exposure to community medicine, public health and hospital experience. Formal international health teaching will take place at the collaborating centres, IHMEC and LSHTM.

The remainder of the twelve month rotation would include four months of Accident and Emergency medicine, and four months of a specialty of relevance to the trainee’s career intentions.

Links:
General information on UCL/Royal Free's Academic Year 2 Foundation Programmes can be found at: http://www.ucl.ac.uk/medicalschool/about-nctfs
International Health and Medical Education Centre
London School of Hygiene and Tropical Medicine

The Global Health Directions survey showed that interest in international health work is high. There are a number of routes into international health work. Commonly health professionals start off working for NGOs and governmental organisation, the majority of whom will return to clinical training in their home countries afterwards. The new International Public Health Foundation Programme and the UK Faculty of Public Health’s Specialist Public Health training programme both offer the opportunity to train in international health as well as UK public health. Health professionals then develop the knowledge and skills for overseas work whilst progressing within the UK NHS careers structure. These are welcome opportunities for those, like our survey respondents, who interested in a career in international health but hope to base themselves in the UK.

Rebecca Hope and Fred Martineau
Contact email: rebecca.hope@almamata.net

about postgraduate training and careers in international health.