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![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Mobility of people, services and goods might influence the research culture
Classic Evidenced Based Research is Unrealistic for Physicans Practicing in Sub Sahara Africa
family medicine/vested interests
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Danica Rotar Pavlic, Ljubljana SLOVENIA Senior Researcher, Assistant Teacher, General practitioner
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Nowadays, it is no longer a rare thing that we find ourselves in a crowd of people of various cultures and nationalities, since such global environment is present in all big cities and important transport crossroads. In this environment that was not only showing the mobility of people but also the mobility of goods, I decided to take a personal standpoint towards the research in the undeveloped and the developing world. Not only in the development of an individual - in each important progress - the transfer of knowledge is essential. Research institutions in the countries with well developed research culture are those that render education to young researchers and play the leading role in motivating the researches in less developed countries. An important role is also played by international organisations of researchers, especially those offering support for the researchers from the countries, which are "weak" in the research field. Let me mention the European General Practice Research Network that incited research commitment in Turkey, Bulgaria, Rumania and other countries with its promotional activities. The initiative strategy has already born fruit; on each meeting there are more and more presentations of research projects from those countries that have not presented any studies for years. The research field refers to health problems of a given environment, for instance what it is that the Turkish patients believe in, perception of pregnancy in two various ethnic groups in Bulgaria, use of health care service in Bulgaria (http://www.egprw.org/Files/Antwerp.pdf). If a research question rises from a natural environment, then it is motivation that forces a young researcher to follow his goal and to enable him to get the necessary knowledge. The viewpoints and the orientation of project leaders are also important. Some senior researchers who have for instance led a research project in a less developed country - tell us that it was essential to have looked for dynamic young and ambitious representatives originating from the local level to which the local people trusted. The response rate in such environment might be unexpectedly high and cannot be compared to the percentages encountered in developed countries of Europe and America (for instance 25 or 30% response rate). When a small project is well carried out, there soon appear wishes and needs for a large, more demanding, even international project. This is the point when the local researchers hit against insurmountable financial barriers. It is therefore a must to have as many trusts as possible on the continental level and in the world. The process of development and hindering of research capacities must not be contemplated in an isolated and partial way. It should be enlightened with international social changes. The mobility of people, services and goods is that irrepressible flow that will change the situation of research in primary healthcare and bring us closer to the health needs of people in the developing countries. But will this flow improve health globally? Danica Rotar Pavlič, MD, Senior Researcher,Hon. Secretary of European General Practice Research Network,University of Ljubljana,Department of family medicine,Poljanski nasip 58,1000 Ljubljana,SLOVENIA Competing interests: None declared |
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Thomas S Nighswander MD MPH, Anchorage, Alaska Physician, Clinical Faculty Family Practice University of Washington
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Research in Family Medicine in Developing Countries I have been working on an Aid's Orphans project in Mongochi, Malawi for the past 5 summers, spent a year in the Central Office of the Malawi Ministry of Health in 1984, and started as a Peace Corp Volunteer there in 1964. It is based on these experiences that I will make my comments. Malawi has its own medical school. Its graduates are trained in the core competencies of traditional family medicine. They are expected to do everything, including serving as the District Medical Officer. The medical officer at the local 400 bed Mangochi District Hospital, who supervises eight clinical officers, is the only physician who serves a catchment population of close to 100,000. He is often short staffed, has non-functioning equipment, and has a limited formulary. Classic evidenced based research is only a dream. However, here are other possibilities. Community Oriented Primary Care (COPC) research is deeply rooted in Africa and was conceived there by Sidney Katz and his colleagues, working in Apartied South African Reservations in the early 50's.(1) Their women's nutrition groups formed the nucleus of an immunization program that was so successful at reducing black infant mortality, that Katz and colleagues were asked to leave South Africa. COPC methodology, identifies a local health issue, provides the tools for collecting data, designing an intervention and measuring the results. The research is based on local community need, circumscribed, doable and can make a difference. My African colleagues would be very interested in participating in this venture, and I believe would take the to time to do so. It would be very appropriate for WONCA to support this effort. Thomas S. Nighswander MD, MPH WWAMI Clinical Director, Anchorage, Alaska 1. A Practice of Social Medicine: Sidney Kark MD and Guy Steuart Ph.D, MPH E. & S. Livingstone LDT, London 1962. Competing interests: None declared |
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captain johann samuhanand, bangalorre india retired, govt of india, govt of india
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Sir, in developing countries the bureacrats of the health ministry play a negative role because their main interest revolves around gaining a trip to a developed country in the guise of research and thus increasing the cost of research. but they wield enormous power than the actual researchers. Also there is no law governing the research thus exploitation of the population becomes easy Type 3 trials are speeded up without caring for the patient's safety Mental health issues are of no significance in developing countries. For example the physical damage in rape/aids etc may be highlighted but not the mentral health problem a rape may cause. Even WHO is a big bureacracy without any concern for the real health of the poor. they only act as fscilitators for big MNCs to conduct cheap research so tht the law of their land of developped country can be bypassed. with kind regards Competing interests: None declared |
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