REFLECTIONS ON GHC HOBART 2010

Day 1: Nuclear power is “a hell of a way to boil water”

The first morning of the GHC. My room mates and I dragged ourselves groggily out of bed, but the waking process became easier once we realised what an incredible view we had from our massive window! After enjoying a leisurely breakfast while taking in a glorious sunrise over the water, we hurried through the cold to the University of Tasmania.

If our morning coffee and the chilly winter morning walk hadn’t been enough to completely wake us up, this year’s first GHC keynote speaker certainly was. Past Nobel Peace Prize nominee Dr. Helen Caldicott, who has dedicated her life to speaking out against global warming and the threat of nuclear war since 1980, and has written a number of books and co-founded the Physicians for Social Responsibility in the process, opened the conference with a crash course on the dangers of nuclear power. A fiesty, unapologetic character, Dr. Caldicott demanded the absolute attention of everyone in the room as she discounted the argument that nuclear power is “cleaner and greener and the answer to global warming” and re-established instead the idea, first articulated by Einstein, that nuclear power is a “hell of a way to boil water”. Not only is nuclear power a threat to global warming because of the amount of CO2 given off in the process of breaking down uranium, but the damage caused by meltdowns like Chernoble and the dumping of radioactive waste contribute to a disease burden that we will carry in our genes for years to come. And what role does Australia play in all of this? We have our own radioactive waste problem. The radioactive waste of Australia is currently being dumped on Aboriginal lands, with the Australian government having paid Aboriginal leaders $12 million to do so. Unwilling to allow her audience of students to throw up their hands into the air at the magnitude of the problem, Dr. Caldicott closed with an emphasis on the power of an informed public in acting politically and so bringing about a national change of view on nuclear power.

For this year’s GHC, the delegates had each chosen a “stream”, each of which represented a theme according to which the more specific talks were divided. The streams were “Fire”, “Water”, “Earth”, “Wind”, and “Human”. My stream was “Earth”, which focused on preventative medicine, alternative medicine, and the global allocation of human resources. After Dr. Caldicott’s passionate opening address, the delegates divided for the first time into our “streams”. I attended an engaging introduction to integrative and complementary medicine given by Dr. Craig Hassed and Dr. Elizabeth Brophy. Dr. Hassed and Dr. Brophy both stressed the need for integrative medical practice (the integration of alternative medical knowledge into mainstream practice). To practice integrative medicine, Dr. Hassed argued, is not a step backwards, allowing various forms of quackery into medical practice, but instead a step forward, advancing toward best medical practice. Studies have found that 89% of people using complementary and alternative medicine (CAM) were also getting treatment from their doctor at the same time. Most did not inform their doctor. Part of the problem is that allopathic medicine and CAM are still widely regarded as opposed, and so taking an alternative treatment may be seen as a betrayal of the doctor. However, CAM has become an “invisible mainstream”, and thus as doctors we must decide whether to integrate a CAM understanding into our practice or risk alienating our patients. Dr. Hassed suggested that the practice of any good doctor involves knowing what might work for the patient, whether this means drugs, diet, meditation, or other forms of treatment. The persuasiveness of his presentation lay in its heavily researched support, drawing upon reliable studies as evidence. Dr. Hassed presented good evidence for the importance of diet in preventing depression, heart disease, and breast cancer, among other things, and the effectiveness of exercise and relaxation and focusing techniques in reducing stress and pain. He also drew our attention to the hypocrisy demonstrated by many medical practitioners regarding CAM. Although doctors may criticise patients for pursuing CAM treatments for which there is no reliable supporting evidence merely because “they work”, daily medical practice is often based on methods that are similarly untested. A recent study investigated all the statements proclaimed as unquestionable “medical facts” in an American hospital on morning rounds, and found that of those “medical facts”, only one third were evidence-based. For half of the statements, literature could be found to contradict the statement, and one sixth of the statements were not supported by any evidence in the literature. Furthermore, some of the treatments that we commonly use have very little evidence to support them. The facts that he gave regarding chemotherapy were particularly memorable. Apparently, the total published data investigating chemotherapy suggests that it makes only a very minor (2%!) contribution to cancer survival!

After lunch, Dr. Jorian Kippax, a diving medicine specialist with experience working for the RFDA, talked us through a number of cases he had encountered treating mountain climbers and divers. What was particularly striking about these cases was that the solution to each problem seemed initially counter-intuitive, but could often be worked out from problem-solving from first principles and clinical knowledge. The day then finished off with a presentation by Ngaire Brown, the CEO of the Australian Indigenous Doctor’s Association, who stressed the importance of cultural competence in providing aid. This was a great reminder at the end of the day: not all help is good help. Ignoring the boundaries of culture and tradition may lead to grave misunderstandings about what constitutes “help”. After all, it was a misguided effort to “help” the indigenous through residential school reform that brought about the tragedy of the “lost generation”. Effective aid involves an awareness and respect for differences.

Our first day ended with an international food fair at the Hobart City Hall, where they had stalls serving dishes from various cultures. These stalls were scattered through the city hall amidst Caritas Australia’s “Blueprint for a Better World” exhibit, which consisted of display boards outlining the UN Millenium Development Goals (UNMDG’s). It was a pleasant, relaxed end to the day, and provided a great opportunity for me to start getting to know my fellow UQ-ers at the conference, as well as some of the new faces from other universities.

Day 2: To improve global healthcare, empower the women!

Day 2 was focused both on the big picture and the small steps needed to get there. The theme running through the presentations that I attended in the morning focused on the importance of empowering women in order to provide significant and lasting improvements to healthcare across the globe. The presentations in the afternoon focused more on the importance of individual growth in order to effect change.

The morning was again opened with a reminder about the importance of environmental health, this time with a presentation from senator Bob Brown, reminding us that the Earth that gives us so much, should be better, not worse, for our having been here. Following Tim Costello, the CEO of World Vision Australia, who discussed UNMDG #4 and 5: reducing child mortality and improving maternal health. He spoke of the importance of strengthening the economy by giving loans to women. When a loan is given to a woman in the developing world, studies have shown that 90% of the earnings goes to the family, whereas only 40% of a man’s earnings go to his family. I was particularly struck by the story he told of his initial confusion upon the tears that these loans prompted in the women he gave them to. For many of them, it was the first time that they had ever been able to touch money.

Once divided again into our streams, I went with the rest of the Earth stream to listen to Peter Deutchmann, the Associate Director of the Nossal Institute for Global Health at the University of Melbourne and Executive Director of the Australian International Health Institute. Deutchmann’s presentation laid out the problem posed by the current “brain drain” of healthcare workers out of the developing world and the creative methods that are being used to maintain, and even improve, health care despite it. Again, empowering women is playing a key role in the solution. In Malawi, the brain drain has been reduced by adding top-ups to the salaries of doctors and nurses to encourage them to stay. In Pakistan, the training of female health workers has led to a 50% reduction in child mortality. As one of the managers of the Manali Medical Aid Project for this year, I found that figure encouraging, since female health workers play a vital role in maintaining the health of the areas around Manali. The ‘female health workers’ are local village women who are provided with basic healthcare training, which enables them to monitor the pregnant women in the village and to recognise any complications and bring the mothers to hospital if necessary; this reduces the number of preventable maternal deaths. The female health workers also monitor the children in the village and check periodically for malnourishment, thus decreasing child mortality. Towards the end of his presentation, Dr. Deutchmann told us of an African village that he had worked at which had a population of 250,000 people sharing 1 doctor but a number of health workers. This village hasn’t had a single pregnancy-related maternal death in 10 years. What an incredible demonstration of the difference that can be made by health workers!

After lunch, the theme of the presentations that I attended shifted to a more personal focus. Dr. Michael Kidd, who was president of the Royal Australian College of Family Practitioners from 2002 to 2006 and is the president elect of the World Organization of Family Doctors, gave an inspirational talk with a number of tips about how to be effective medical leaders. I also attended a workshop that he gave that day on the same topic. What struck me most about Dr. Kidd’s presentations was the extent to which he openly drew upon the ideas, advice, and inspiration of others. Both of his talks included many words of wisdom from well-known and respected figures, from Plato to Dr. Albert Schweitzer. He also discussed the importance of having an effective leader as a mentor. The very first thing he had us do in the workshop was to write down one of our role models. A number of us just sat there for about 5 minutes staring at a blank page. It was interesting to see that for many of us, this idea of a “role model” was almost a forgotten one. One of Dr. Kidd’s key pieces of advice related to this loss: in order to be a good leader and save yourself the grief of making every mistake yourself, refer to individuals who you can learn from, both effective leaders and ineffective leaders. Another great thing to hear as we all compared role models was that a number of people had chosen speakers from the GHC, such as Dr. Helen Caldicott. The rest of Dr. Kidd’s presentation was filled with very simple but good advice. Underlying all of his specific points was an emphasis on the importance of deciding what sort of person you want to be right now and then consistently pursuing that aim without sacrificing your integrity.

The day’s academic program ended there, but the social side of things was still to come. The theme of the evening’s party was “Captain Planet”. A large number of the UQ-ers had decided to go dressed as rubbish…but that didn’t mean we had to sacrifice our look! So, dressed as the most stylish rubbish, we headed out. Our trashy UQ group was definitely a hit, which started the night out on a good note. It only got better from there. The night ended with hours of rocking out to the raw, earthy beats of didge-infused music provided by Melbourne-based group Ganga Giri.

Day 3: “Mediocrity shits me”

Day 3 at the GHC was opened by Jeremy Picone, the Tasmanian co-ordinator for the Global Poverty Project, who gave us an update on the MDG’s: what has been done to achieve them so far, and how they can better be achieved through actions on a large scale (ie. decrease corruption by holding banks accountable and educating the population, and stop giving uninformed, bad aid, like the “clothing tsunami”, in which donations of clothing were showered down upon a population that is starving to death) and a small scale (ie. what we can and should be doing to help out and increase awareness of the problem).

Following Picone’s presentation, another talk was given which was not on the schedule, but may well have been one of the most moving and memorable talks of the conference. Given by Alphonse Toussaint, a Congolese refugee and Tasmanian Make Poverty History ambassador, it was a simple address from the heart, and it is very difficult to do it justice on paper. Essentially, he spoke about a common challenge: that all of us seek both to maintain our identities and to grow, yet do not want to make the sacrifices necessary to change who we are in order to grow. For many of us at the conference, this definitely hit home. It is easy and enjoyable to hear a vast array of inspiring speakers, to talk about big ideas, and to discuss the idea of bringing about changes and the personal growth that doing so would demand. It is a much more challenging and solitary feat to actually make a move to do something. Alphonse reminded us that we will only ever be able to grow and improve the world around us through opening our minds to others and truly listening, and being ready to actively change in response to what we hear.

These talks were followed by Challenge Day. The delegates were divided into teams of about 12 from different medical school across the country and given a number of scenarios to work through together. The Challenge Day idea was repeated from last year, due to the popularity of last year’s Challenge Day at the GHC in Brisbane (props to UQ!) This year, the U Tas organisers added a refugee theme to the Day. Our teams were confronted with a number of different refugee camp scenarios to solve as a group, including trauma, building a refugee camp, and organising the layout of a clinic when an infectious disease broke out. It was interesting to see how difficult discussions or tasks that would have been quite easy when worked on by 3 or 4 people could become prolonged and over-complicated in a bigger group.

After Challenge Day, we had a few hours of daylight to ourselves. A bus took us to central Hobart to enjoy a few hours of freedom and wander the extensive Saturday markets, filled with a plethora of goods from all over Tasmania. It was an incredible experience to wander down a street with markets as far as the eye could see, stall after stall filled with different goodies. If you couldn’t find what you were looking for, chances were that it was only a few stalls away. And delectable free samples were everywhere. It required a considerable amount of self-restraint in order to resist the impulse to camp out at the fudge stand, but the exploration was definitely worthwhile.

Tonight was the last evening of the GHC Conference, and deciding to end in style, they organised an Op Shop-themed ball for us. There was good food and great company, both old friends and new. The evening talk was given by Dr. Mark Loane, who played rugby union during and after his studies in medicine at UQ, and specialises in glaucoma, ophthalmology, and cataract surgery. As I am not the biggest footy fan, I don’t remember all of the details, but Dr. Loane’s stance on apathy – “mediocrity shits me”- became the unofficial slogan of this year’s conference.

Again, the music provided an energizing and fun focus to the evening. This time the night’s tunes were provided by Fabio Chivhanda and the Jivemasters. One of the night’s highlights was the UQ gang showing the other universities how dancing is done.

Day 4: Small steps. Big picture. Start now.

Today was the final day of the GHC, and the conference ended off as powerfully as it had begun. The day opened with a talk given by Dr. Marianne Gale about her experiences working with MSF as a ‘fieldworker’ contributing to improving global health. This was followed by a talk given by Rob Moodie, the current Chair of the National Preventative Health Taskforce and the current and inaugural Chair of Global Health at the Nossal Institute for Global Health at the University of Melbourne. Professor Moodie spoke about the importance of prevention in global health. He emphasised the need for an economic shift, in order to more accurately reflect the global burden of disease. Currently, the richest 20% of the world’s population account for 7% of the global disease burden, but 85% of the global health expenditure. The poorest 20% of the world’s population account for 35% of the global disease burden but only 3% of the global health expenditure.

We separated again into smaller groups, and I was lucky enough to be in the group that listened to a talk given by Dr. Nitin Verma, who warned us as we came in that he was “just going to tell a story”. But what an encouraging story it was! Dr. Verma is an ophthalmologist, and the founder of the East Timor Eye Program (ETEP). He told us the story of how this successful organization had evolved from what was initially just a temporary project. He had first become involved in 2000, going in to East Timor in response to a request from the WHO for the re-establishment of needed eye health services after the country had successfully gained independence from Indonesia. Initially, he and his small team had focused on providing curative eye treatment. However, once he and his team were involved in the program, the targeted date for withdrawing from East Timor kept being pushed back, and the project gradually evolved into a long-term one, expanding its focus to achieving long-term stability. Currently ETEP has performed over 3,500 eye operations and provided eye consultations to over 33,000 East Timorese. Dr. Verma, through a creative approach and his persistence, has also overcome the problems posed by the language barrier and provided ophthalmological training (certified in Australia!) to a native East Timorese doctor. What I found particularly striking about Dr. Verma’s account was its simplicity. It was refreshing to hear an honest account of the beginnings of such an important project from its grass-roots stage. ETEP did not begin as a venture by a major organisation. It was begun by a single doctor and his team going in to East Timor to answer a need, and had grown from there. And its daily work is still the product of a close-knit team. Dr. Verma’s wife and children are all involved in helping the project in various ways, and continue to spend significant amounts of family vacation time at the ETEP clinic. As a delegate surrounded throughout the conference by successful individuals, many of whom were current managers and CEOs of large organisations, I had found that it was easy to be overwhelmed by the magnitude of the issues and some of the large institutions involved. Dr. Verma’s story provided a much-needed reminder of the possibility of achieving important and lasting results simply from awareness of a need and a move made to answer it. It also reminded me of the beginnings of the Lady Willingdon Hospital in Manali, which like ETEP, has since become a successful source of quality health care to the region around Manali thanks to the passionate and tireless dedication of a number of committed doctors (for more information, see the “About Us” page at the Manali Medical Aid Project website, manalimedicalaid.org).

After lunch, Nick Bearlin-Allardice, the general manager of the Oaktree Foundation of Australia, ended the 2010 GHC with a reflection on his time in India and a challenge to all of us not to waste our GHC experience. The power of his challenge came from its roots in his personal experience. He reminisced about how he had once considered himself “involved” merely from his attending conferences and participating in protests, and compared that to his current involvement, through which he is able to daily re-affirm his values. His reminiscent self-criticism led to his challenge to us to analyse our own involvement and fight the temptation for passivity once we returned home. It brought us back to the theme of the conference. While we had been provided an introduction to the ‘big picture’ and some suggested ‘small steps’ for how to make it a better one, it was up to us to actually take those steps.

Our final motivation was provided by Apil, a fourth year Nepalese medical student who had become well-known at the conference for his friendly nature and approachability. The GHC had provided his first introduction to life outside of Nepal. He thanked the convenors on behalf of all of the international students who had been sponsored to attend the conference, and in doing so reminded us all of how fortunate we were to be there.

Overall Reflection: Looking Back

Looking back upon 4 days of learning, problem-solving, inspiration, and motivation, some of what I learned can be passed on in this blog. On the academic side, I learned a great deal about how global warming and how it cannot be pushed aside while we focus on global health, because it is directly causing some of the health problems in the developing world, and will inevitably bring about more problems, including floods, droughts, and disease, that will hit the developing countries first and hardest. I also learned about how far behind we are in achieving MDG #4 and 5, and how instrumental education and empowerment of the women in developing nations will be to achieving that. On the personal side, I am grateful for words of wisdom and for the chance to meet a number of individual examples of how small steps can lead to a change in the big picture for the better.

GHC 2010 in Hobart was a great introduction to GHC’s, and I’m sure it will not be my last GHC experience. Thanks to TIME for their sponsorship. I hope to see you all at GHC 2011 in Sydney!