The Medical Post
March 22, 2011
Canadian doctors face a litany of challenges on a daily basis. Just imagine how daunting they are in Africa, where even the basic ability to treat everyone is not always possible. 
Kenya’s Ngao District Hospital was a demanding experience to say the least for Montreal General Hospital trauma surgeon Dr. Dan Deckelbaum. “There are so many cases you want to stay for, or just add to the end of the list,” he recalls.
It was during rainy season on the Kenyan coast, where water levels can rise one to two metres in a couple of days, that Dr. Deckelbaum was on an outreach mission with five Kenyan surgeons from the African Medical and Research Foundation (AMREF) legendary Flying Doctors Service. They were flying from Nairobi and were determined to make it to the Ngao District Hospital despite the poor runway conditions.
The Ngao hospital serves 500,000 people and is managed by the only doctor on staff, a recent med school grad. When AMREF’s team finally landed, patients were lined up.
In just two days, Dr. Deckelbaum and his team treated everything from elective hernia surgeries to severe infections and inter-abdominal sepsis. One man had a major injury from a buffalo attack. A female patient needed a hysterectomy. There was no blood bank and sourcing blood would take a few days. But by the AMREF contingent would be gone.
“In North America a single hospital would never serve half a million people, even with numerous staff surgeons and a variety of different specialists. It’s hard to imagine a recent medical school graduate managing it all. The need is just tremendous,” Dr. Deckelbaum says.
Today Africa houses 11% of the world’s population, 25% of the global disease burden but only 3% of the world’s health-care workers.
Being a Flying Doctor comes naturally to Dr. Deckelbaum. His father, Dr. Richard Deckelbaum, the current president of the Global Health Education Consortium and faculty at Columbia University’s Medical School was a Flying Doctor in Zambia 40 years before his son.
AMREF’s history dates to 1957 when it was founded by three surgeons in the foothills of Tanzania’s Mt. Kiliminjaro. At the time 85% of East Africans lived in rural areas inaccessible by road, with very limited, if any, access to health care.
An air service was the only means to reach most people. Word of these remarkable Flying Doctors travelled quickly and Kenyan and Tanzanian communities began building airstrips. In the early days the Flying Doctors clinics were set up in the shade beneath the wings of their planes.
Today AMREF has become one of the leading authorities on African health development and medical research and the only one that is African. It has also been awarded with both the Hilton Humanitarian Prize and the Bill and Melinda Gates Award for Global Health.
The approach is rooted in African culture that delivers lasting impacts. Programs are community driven and focus on strengthening health systems, empowering communities while training African health workers.
These days the Flying Doctors are still part of AMREF, although surgical outreach missions like Dr. Deckelbaum’s are always teaching oriented. Every year AMREF conducts thousands of teaching surgeries. Last year alone AMREF surgeons visited 150 hospitals performing 7,500 major operations.
Canada’s AMREF legacy
AMREF’s Toronto-based Can
adian office was founded in 1973. Dr. John Evans, Order of Canada recipient, founding Dean of McMaster’s Faculty of Medicine and former president of the University of Toronto, was an early champion of AMREF and chaired the board of directors for five years in the 1980s.
“It is distinguished as one of the few health development organizations that is African-based, with its leadership and infrastructure in Africa rather than Geneva or New York,” says Dr. Vic Neufeld, national coordinator of the Canadian Coalition for Global Health Research and professor of medicine at McMaster University.
“This is one of the reasons AMREF is so very effective at reaching and working with African communities and strengthening health research across the continent.”
In 1987, Dr. Neufeld was part of the McMaster and Nairobi-based Moi University partnership to establish AMREF’s respected diploma in community health. The program will mark its 25th anniversary this fall.
Today AMREF’s health education programs are more vital than ever—Africa is often in the news because of unchecked epidemics or humanitarian crises. Not everyone realizes, however, that the most critical determinant of the continent’s health is its severe shortage of health-care workers.
“One of the greatest obstacles in fighting deadly diseases like HIV/AIDS, TB and malaria in Africa is the lack of trained health workers at almost every level of the health-care system,” says AMREF’s director of capacity building, University of Alberta alumnus Dr. Peter Ngatia.
The World Health Organization (WHO) estimates countries with less than 2.3 doctors, nurses and midwives for every 1,000 people are “very unlikely” to achieve the health-related UN Millennium Development Goals. Approximately 60% of these countries are in sub-Saharan Africa.
Through innovative and locally relevant training and education programs AMREF is finding effective ways to tackle the crisis, like an E-learning initiative in Kenya that is rapidly upgrading the skills of 24,000 nurses, or a program enhancing the skills of South African traditional healers while linking them to the country’s formal health system.
Sustainable health development also targets strengthening of health systems. Canadians have long supported AMREF’s leadership in strengthening laboratory services across Africa and increasing people’s ability to access expert surgical care in remote regions. In severely under-resourced areas like Southern Sudan, AMREF implements task shifting programs to address the massive shortage of health professionals.
The task of addressing the health challenges in Africa may seem daunting. Fortunately with almost 60 years of experience, much has been learned. The challenges are being met community by community with knowledge and partnerships from Canadians, other countries in the north and African communities.
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