Specialist training in International Public Health for all health professionals: Interview with Dr Andrew Furber

The UK Faculty of Public Health oversees the training of UK health professionals. It encourages placements overseas during the training program in public health and has approved placements worldwide.

Dr Sarah Anderson, an Specialist Registrar in Public Health said, after her placement with the Stop TB Department, the World Health Organisation: ‘I personally gained essential public health skills in a hugely stimulating environment, increased my awareness of international health issues and brought back a fresh perspective to my UK public health work.’

There are two routes to train as a public health specialist in the UK, as a Specialist Registrar, who has completed at least two years post-registration professional medical training or a Specialist Trainee, who holds a health-related first degree and at least four years experience relevant to public health practice.

On completion of training, many go on to careers in the UK. We spoke to Dr Andrew Furber, a public health consultant, who, having doing exactly that was best placed to explain.

Dr Andrew Furber is a public health consultant who, after initial training in general practice, worked in community health and development for a number of years in Nepal. After completing further training in tropical medicine, and specialist training in public health, he now splits his time between UK public health and his role facilitating further collaboration on international health issues between the UK Department of Health and the Department for International Development.

How, in your opinion, is the best way to combine interests in international health and UK training?

There are various ways to combine interests in international health and professional training. I took time out of my UK medical careers and worked for NGOs [non-governmental organisations] overseas. A system of ‘retrospective recognition’ allows overseas experience to contribute to specialist training schemes in the UK Faculty of Public Health. Many of the other Royal Colleges recognise ‘out of programme experience’ (OOPE), when Specialist Registrars’ work overseas can count towards training. The UK Faculty of Public Health has various approved overseas placements, some at big international centres like the WHO, others in community health programmes.

There are opportunities for international health work without leaving the UK, for example in academic centres in Leeds, Liverpool and London. If you are not in the position to relocate or travel, research work on literature reviews is an option.

I myself completed GP training before spending six months working in a hospital in Nepal. I found GP training was immensely useful, in a practical sense (training in paediatrics, obstetrics and gynaecology, psychiatry etc) it gave me a clinical background for community health; it also gave me a holistic view of health. After completing a Diploma of Tropical Medicine and Hygiene I returned to Nepal to work with the government developing primary health care within a district. A Masters in Public Health at the Nuffield Institute in Leeds gave me the academic basis for public health work [see links] and I subsequently worked on HIV and TB at the Nepal Ministry of Health. Specialist public health training then gave me a UK perspective.

I remember one little boy in Nepal who presented with spinal TB, his whole village having been wiped out by a illness of night sweats, cough and weight loss. This was not recognised as TB as there were no local health facilities. The village was two days from the hospital, the population poor subsistence farmers with no money to pay for care, of low caste which meant they was marginalised, and no schooling, unable to read or write. You quickly see how a whole host of factors influence health outcomes. These are public health outcomes…

How does training in international health apply to work in the UK and why should health professionals be concerned about global health issues?

We live in a global village. We cannot afford to think we are in isolation from the rest of the world and that health problems elsewhere do not affect us, Avian flu is a topical example of this. Currently there is major preparation based on the experiences of the Far East and we need to be engaged with this to ensure that our population is protected and the populations of the rest of the world. HIV and TB are other diseases relevant to the UK, where most cases of HIV were acquired in Africa.

The UK’s National Health Service is failing black and ethnic minority groups. Working abroad gives you a better understanding of diverse cultures which you can apply in the UK, no matter where you work.

For professional development, there is no better training than the experience of managing difficult situations in a resource-poor setting, which expands your skillset.

Finally, the UK has a moral obligation to the world. The UK’s NHS for a long time has relied on doctors and nurses from overseas and this is one way to put something back. The UK government has signed up to the Millenium Development Goals, three of which are directly relevant to health and the NHS has something to offer to achieving these goals.

For more information on global health directions after graduation, read the other half of this article: Crossing Borders: the new F2 Programme for junior doctors in International Public health