Feature

A need for more foreign exchange

International Health Exchange links health workers in Britain with the projects in developing countries that need their skills. Isobel McConnan explains

The Al Ahli Hospital in the Gaza Strip had been without a manager for six months. Serving a population of 850,000 and providing medical services for Palestinians living under Israeli occupation, the hospital was stretched to capacity. But over the last year health manager Beryl Delve-Sanders has worked with hospital staff to bring about dramatic changes.

’The emergency unit is frequently under pressure dealing with bullet injuries, and the hospital has been raided all too frequently by Israeli soldiers who remove injured patients from their beds’, said Beryl after her return to the UK. ‘There are a lot of cardiac problems and stress-related illnesses which are caused by the difficulties of living under occupation. Women expect to be out of hospital less than two hours after delivering their babies, as they worry about their families.’

After a year’s work with her Palestinian colleagues, her main achievements have been improvements in standards of medical care and hospital cleanliness, and successful international fund-raising, which has enabled hospital departments to be rebuilt and re-equipped.

Beryl is on the international register of health workers maintained by the British-based charity International Health Exchange (IHE). IHE helps to provide experienced health workers for relief and development agencies, rural hospitals and others requiring personnel for work in developing countries. It works closely with aid agencies such as Save the Children Fund, Oxfam and VSO, and well as many smaller and less well-known bodies. IHE recently established the UK’s first emergency and disaster relief register for health workers.

Most of the development agencies seeking health workers are supporting community-oriented health care programmes. The frame of reference is primary health care, with the emphasis on accessible, affordable and equitable provision of care. But as developing countries attempt to establish and maintain health systems, they face extremely difficult economic conditions. The burden of debt, structural adjustment and unfair trading arrangements mean that many countries have less to spend on health care now than in the past.

For example, the Gambia succeeded in creating a new tier of community-based health services during 1982-85, focusing on mother and child health, immunisation and village health programmes. Although the Gambian government managed to increase its health budget despite severe economic hardship -- including servicing foreign debt, and using scarce foreign exchange for buying drugs and supplies -- the value of the budget has fallen. From the equivalent of £2.1m in 1982, its purchasing power declined to only £1.9m in 1989.

Health workers from the West planning to work in countries like the Gambia must be aware of the formidable resource constraints affecting these countries. They can be summed up by the acronym ‘SOS’, suggested by Oxfam’s health adviser, James Tumwine: shortages of staff, supplies and space.

What does this mean in practice? Midwife Barbara Kuypers, who has worked in Zambia and the Gambia, points to the difficulties: ‘I had to come to terms with having no Sonicaid facility, no sterile supplies, no piped oxygen for resuscitation, limited access to pain-relieving drugs, reduced staff numbers when in need of assistance, no petrol for the ambulance -- or no ambulance at all -- and having to use gloves washed in Omo and hung out to dry.’

Working with the same constraints as local colleagues, the role of the visiting health worker is essentially to teach, to pass on skills, and often to act as an ‘enabler’. At the outset it is important to drop many of one’s assumptions and views, and simply look, listen and learn. Only then can decisions -- in consultation with colleagues -- be made about how to improve the situation.

Who is needed for such work? IHE receives a huge range of requests for midwives, nurses, community health workers, nutritionists, doctors, physiotherapists and others. Recent examples include a health education supervisor for a water project in Angola; doctors for district hospitals in Namibia; an area public health nurse in the Sudan; an accident and emergency specialist to accompany mine clearance teams in Afghanistan; and a nutritionist for Somalia.

Previous overseas experience is often required -- a Catch 22 for those who haven’t worked outside their own country. But VSO, Health Unlimited, UNAIS and others accept health workers who have not worked overseas before. Most agencies are looking for understanding of the health needs of developing countries, experience of community and public health, and training skills. Management experience, knowledge of needs assessment and evaluation, and tropical medicine are other useful areas.

A wide range of short courses are available for preparation and training. IHE runs 5 day courses on primary health care (in October and April) and refugee community health care (in July). Courses on training for trainers, needs assessment and stress in emergencies are forthcoming. All relevant courses are published by IHE in its short courses calendar.

The role of IHE is best summed up as that of ‘facilitator’, bringing together health workers and the agencies recruiting for developing countries. Beyond this, it is also concerned to raise the profile of work experience overseas within the NHS. It plans to begin a dialogue with health service management and providers, with a view to identifying ways in which NHS staff can be released for assignments in developing countries. IHE would like to hear from health workers who can assist in this process.

For further information about IHE, the training programme or the register, contact: International Health Exchange, Africa Centre, 38 King St, London WC2E 8JT. Tel: 071- 836 5833.