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Global health training: the graduate perspective

15 Apr 2014

By Dr Ramona Muttucumaru, Medecins Sans Frontieres/Alfred Health Infectious Diseases Fellow, Uzbekistan

After completing the marathon that was the basic physician training exams, I was resolved to pack my bags and embark on something different.

I was fortunate enough to stumble into a position working with Medecins Sans Frontieres (MSF) treating multi-drug resistant tuberculosis (MDR-TB) in Uzbekistan.

This position had been set up a few years earlier, and is accredited for the non-core component of Infectious Diseases (ID) training, with supervision through the Alfred Hospital in Melbourne and the Manson Unit of MSF in London.

For me, it was the perfect opportunity to gain experience in a resource-limited setting with MSF, a non-government organisation I’d always dreamed of working with, while also making strides towards my goal of completing ID training.

Up to then, I had only seen a handful on TB cases, all in a Melbourne tertiary hospital and had never encountered MDR-TB, so I felt no small amount of trepidation about what was awaiting me.

Supporting the local Ministry of Health, our role was to provide resources and training in diagnosing and treating TB.

The burden of MDR-TB in the region was significant, accounting for up to 40 per cent of new cases of tuberculosis, and up to 80 per cent of re-treatment cases.

 The challenges of managing MDR-TB, a disease whose horror is matched only by that of its treatment, was compounded by the deficiencies and dysfunction of the local health system. The medical aspects turned out to be the easier part.

Other than the invaluable experience in treating a drug-resistant TB, an entity that remains mercifully rare in Australia, I honed many other skills during my time in Uzbekistan, all of which I expect will prove useful in future.

In the absence of ready access to expensive tests, we had to rely heavily on clinical skills and judgment.

Non-clinical skills turned out to be equally as valuable.

Trainees in Australia rarely have the opportunity or expectation that they will manage and train staff, barring perhaps medical students and junior members of their team.

In contrast, this is an important role of expat medics working in developing world settings.

Additionally, the difficult task of choosing between multiple important and competing priorities was something we were often faced with as a project team.

It’s very clear to me that spending time working in a resource-limited setting has a lot to offer trainees.

But what about the flip side of the equation? Should we not ask what trainees can do for the developing world?

Other than the bringing their energy and enthusiasm, trainees, I am certain, are more likely to actually uproot their lives and seek experience overseas. In my experience, many of the needs of the health system and its patients were so basic, that quite often not a great deal of specialist expertise was required to address them.

When more complex problems arose, MSF’s internal hierarchy enabled escalation to obtain advice from in-country or overseas experts. Links to my supervisors in Melbourne and London meant that I had an added degree of support.

Readjusting back to a metropolitan hospital setting in Australia has also had its challenges, and it was with mixed emotions that I left Uzbekistan.

There was some degree of guilt for not having done more, but the overwhelming feeling has been a sense of privilege for having being a part of something so important.

The Alfred MSF Infectious Diseases Fellowship is co-supervised by Dr James McMahon at the Alfred Hospital in Melbourne and Dr Philipp du Cros from the MSF Manson Unit in London.

Dr McMahon can be contacted via email:

Published: 15 Apr 2014