SMA UK & Ireland. Galway conference report 2012

The Sudanese Medical Association (SMA)

UK & Ireland

THE CONFERENCE REPORT

Zuhair Ali, Emam El-Higaya, Nuha Ibrahim, Khalifa Elmusharaf, Abobakr Shadad, Mohammed Elshafei & Mohamed Ahmed

Suggested citation: Ali Z, El-Higaya E, Ibrahim N, Elmusharaf K, Shadad A, Elshafei M, Ahmed M, Editors. Migration of Sudanese Doctors: Dynamics & Opportunities, Conference Report. The Sudanese Medical Association (SMA) UK and Ireland. 9th June 2012, Galway, Ireland.

© Sudanese Medical Association (SMA) UK and Ireland – 2012

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1 SMA UK & Ireland conference- Galway June 2012 Migration of Sudanese Doctors: Dynamics & Opportunities

Table of Contents

TABLE OF CONTENTS .................................................................................................................... 1

INTRODUCTION ........................................................................................................................... 2

ABBREVIATIONS ........................................................................................................................... 4

EXECUTIVE SUMMARY ................................................................................................................. 5

THE CONFERENCE SESSIONS ......................................................................................................... 8

1. THE OPENNING SESSION ........................................................................................................ 8 2. DYNAMICS OF DOCTORS MIGRATION ...................................................................................... 10 3. MODELS OF NOVEL INTIATIVES ............................................................................................... 14 4. PARELLEL WORKSHOPS ........................................................................................................... 19 5. CONDUCTING RESEARCH IN A CHALLENGING IRISH HEALTH SYSTEM ......................................... 26 POST CONFERENCE ACTIVITIES ................................................................................................... 28

ANNEX ....................................................................................................................................... 32

THE CONFERENCE ORGANISING COMMITTEE .......................................................................................... 33 CONFERENCE PROGRAMME .............................................................................................................. 34 SPEAKERS’ BIOGRAPHIES .................................................................................................................. 37


INTRODUCTION

It is my great pleasure to introduce this report summarising the activities of the 1st Sudanese Medical Association conference in Ireland: Migration of Sudanese Doctors: Dynamics & Opportunities.

The conference was a reflection of the increasing awareness of the ongoing high level world-wide discussions about health care workers migration and its impact on the human resources for health and on the health service delivery in general.

The conference focused on the migration of Sudanese doctors with emphasis on the push and the pull factors behind their migration. At present there are more than 600 Sudanese doctors registered with the Irish Medical Council. This number, without any doubt, is on the rise. In 2000, there were less than 80 Sudanese doctors in Ireland.

The first session of the conference analysed the phenomenon of Sudanese doctors migration to Ireland in details and explored the historical dimensions of this phenomenon as well as the current trends. The conference also examined the whole area of doctors’ migration in Ireland with reference to the ethical and practical implications as migration of doctors represents a brain drain and creates a critical shortage of health workers in low-income countries such as Sudan.

Having said that, there are great opportunities created by doctors’ migration including better training, up-skilling and transmission of knowledge. The conference dedicated special sessions that focused specifically on the opportunities for cooperation created by doctors’ migration. A number of outreach initiatives by Sudanese Irish doctors were presented at the conference and their details are included in this report.

For Ireland, this conference addressed the country's over-reliance on foreign doctors. In 2008, Ireland ranked second in the OECD (following New Zealand) for recruiting doctors from overseas. According to 2006 figures, 54% of Ireland's Non-Consultant Hospital Doctor (NCHD) posts were filled by non-Irish nationals.

The conference also included five parallel workshops which gave participants the opportunity to participate in discussions about thematic topics of special interest to them. Details of these workshops are included in this report. The last session of the conference incorporated short presentations of distinguished research projects conducted by Sudanese-Irish doctors, along with lessons learnt and recommendations by these doctors. A summary of these presentations is included in this report.

This conference aimed at providing a platform for senior health policy makers and academics in Sudan and Ireland to get together and share their experiences and discuss avenues for collaboration and cooperation. I believe this objective has been achieved to a great extent as very successful meetings were held, as part of the post conference activities, between the high level Sudanese delegates and key Irish academics and health policy makers. The outcomes of these meetings will be announced in the near future.


I hope that you will find the contents of this report useful and interesting.

Thank you.

Dr. Mohamed Ali Ahmed Chair, Conference Organising Committee, Galway, Ireland.

“Trí na chéile a thógt na chaisléain”

“Only by working together, we can build castles”

"An Irish Proverb"


ABBREVIATIONS

BST Basic Surgical Training.

COSECSA College of Surgeons of East, Central and Southern Africa

CME Continuing Medical Education

CMPS

EU

FMOH

Council for Medical Postgraduate Studies

European Union

Federal Ministry of Health in Sudan

FRCS Fellowship of Royal College of Surgeons

GPT General Professional Training

IELTS International English Language Testing System

IMC Irish Medical Council

MRCPI Membership of Royal College of Physicians of Ireland

NCHD Non-Consultant Hospital Doctor

OECD Organisation for Economic Co-operation and Development

RCSI Royal College of Surgeons in Ireland

SDMLE The Sudan Medical Licensing Examination

SHO Senior House Officer

SMA Sudan Medical Association

SMC Sudan Medical Council

SNF Sudan National Formulary

SNMSB Sudan National Medical Specialisation Board

SpR Specialist Registrar

T2DM Type2 Diabetes Mellitus

TRAS Temporary Registration Assessment Scheme

UNCTAD United Nations Conference on Trade and Development

WHO World Health Organisation


EXECUTIVE SUMMARY

The Sudanese Medical Association UK & Ireland held its first conference in Ireland in Salthill Hotel, Galway on Saturday the 9th of June 2012. More than 100 delegates participated in the conference sessions. Participants were Sudanese doctors working in Ireland and UK, Irish health policy makers and health workers as well as researchers and academics with interest in health and migration issues.

Five key delegates represented the Sudanese health system lead by his Excellency, Sudan Federal Minister of Health, His Excellency Mr Bahar Idriss Abugarda with two of the Ministry senior health policy makers; Dr. Hassan Abdul Aziz and Dr. Elsheikh Badr. The presidents of two important Sudanese regulatory bodies and medical institutions also attended the conference; the president of Sudan Medical Council; Prof. Zein Karrar and the president of Sudan Medical specialisation Board; Prof. Osman Taha.

The First Session commenced with opening remarks and welcome by Dr. Mohamed Ali Ahmed, the chair of the organising committee who welcomed the delegates and called for developing and enhancing Sudanese Irish relations in health and medical training domains through the establishment of long term institutional commitments that benefit both sides. Dr. Ahmed emphasised that this relationship could become a good example of a North-South partnership aiming for a win/win situation for both countries.

Dr. Abobakr Shadad then reflected on the main theme of this conference; the migration of Sudanese doctors and emphasised on the unique public diplomacy between Sudan and Ireland represented by the role of Sudanese doctors in Ireland. Then the previous and current presidents of the SMA; Dr. Faisal Mihaimeed and Dr. Mahir Hamad gave two short talks about the SMA vision & mission, brief account of the previous achievements and the future projects. They emphasised on the non-political nature of the organisation and that it does not claim any trade union representation role. They invited the delegates to attend the upcoming SMA conference in Sudan in December 2012.

Sudan Federal Minister of Health, His Excellency Mr Bahar Idriss Abugarda, then gave a brief overview of the current challenges facing the health system in Sudan and the achievements in health care indicators in the period 2006-2010. He then outlined the Ministry's plans and ambitions for the future. The Minister thanked Ireland for hosting Sudanese doctors and called for future collaboration between the two countries in improving health services delivery and health/ medical education and training.

The Second Session discussed many issues relating to the Sudanese doctors migration to Ireland and also looked at the phenomenon of health workers migration as an International trend as well as the implications and challenges from an Irish perspective.


The conference has learned that the last few years have witnessed increasing numbers of young male and female Sudanese doctors coming to Ireland for postgraduate training and long term employment with no clear plans to go back home.

The push factors in Sudan include limited and poorly funded postgraduate medical training in Sudan as well as poor economic situations. Also the ambitious nature of Sudanese doctors and desire for better training opportunities abroad, played a major role. The Irish pull factors include internationally recognised postgraduate medical training, employment opportunities with good income in a friendly country. Another very important pull factor is the large number of Sudanese doctors already in Ireland which encourage and attract more and more young Sudanese doctors to migrate to Ireland. The conference has also learnt that there has been a huge surge in production of doctors in Sudan, this created a bottle neck at postgraduate specialisation level associated with a severe lack of nurses and other healthcare professionals. This deficiency is not an exception within the African context as the whole African continent has only 3% of global health workforce while facing 24% of worlds’ burden of disease. Regional attractive destinations to the migration of large numbers of Sudanese doctors include Saudi Arabia and other Persian Gulf states in addition to the emerging destination of post-conflict Libya.

Local retention strategies in Sudan remain behind the strength of local pushing and regional pulling factors. The optimal efforts should target Diaspora mobilisation activities through initiatives by migrant Sudanese doctors such as outreach campaigns, workshops in health and clinical sciences, relief efforts and the contribution in health services delivery in general.

The conference has also learnt that Ireland witnessed a three folds increase of foreign trained doctors working in Irish hospitals; from 13.4% in 2000 to 33.4% of all doctors registered with IMC in 2010, with 6 fold increase in the numbers of Sudanese doctors from 63 to 403 in the same period.

However, following the financial crisis, Ireland started to lose large numbers of its own graduates who migrate to countries as USA, Canada and Australia looking for better career progress pathways. The negative effect on incomes will be added to other difficulties already facing non-EU doctors such as limited access to specialist training, unfavourable immigration status for spouses and fluctuating visa policies and naturalisation prolonged processing times.

The Global Code recently adopted by WHO would urge recipient countries such as Ireland to participate in the promotion of health services and medical training in sending countries such as Sudan. These two countries can set a model example of collaboration that support technology and skills transfer through training bodies in both countries.

In the Third Session, good examples of health collaboration between Sudan and Ireland were highlighted. As part of this session, the FMOH's Academy of Health Sciences in Sudan "FMOH" and the National University of Ireland Galway "NUIG" signed a Memorandum of Understanding aiming to collaborate in provision of training for nurses and midwives in Sudan.


The initiatives discussed in this session included Sudan Online Health Library, a pilot collaboration project of short term training of Sudanese nurses in Ireland, the RCSI/COSECSA project, and the provision of safe and well refurbished dialysis machines to Sudan following nephrologists-led initiative. Potential areas of collaboration were also explored in this session such as the inclusion of Sudan in the RCSI/COSECSA project and the Irish contribution in improving maternal health in Sudan in view of the expertise and the excellent records of maternal health care in Ireland.

The Fourth Session (the 5 parallel workshops) provided an opportunity for the conference delegates to participate in discussions about topics of interest to them.

The first workshop identified six factors that negatively affect the decision to return to Sudan; poor work environment, children education, insufficient income, lack of career pathways and poor professional development opportunities in Sudan, in addition to concerns about major changes in life style.

The second workshop explored the attractiveness of Sudanese private health sector to expatriate Sudanese doctors. The group admitted that private health sector in Sudan provides better income, better work environment and highly trained allied health workers. The workshop also identified lack of academic incentives, lack of job security, long working hours and the limited access to the majority of Sudanese population as major drawbacks of private health sector in Sudan.

The third workshop identified better use of Information Technology (IT), online facilities and mobile phone-based services as the way to go for future medical training initiatives in Sudan. The workshop also emphasised on the need for more group-based (team work) initiatives rather that the individually based ones with a limited impact.

The fourth workshop suggested the facilitation of initial registration through improving communications between the Medical Councils in Sudan and Ireland. The workshop also recommended exploring the organisation of the first part of PRES exam in Sudan. The workshop also recommended that Sudanese doctors practicing in Ireland should be informed of the new three tier registration levels in the specialist register in Sudan Medical council.

The fifth workshop concluded that reasonable medical registration process in Ireland, the use of English language, Internationally recognised medical training, the location of Ireland compared to countries such as USA, Canada and Australia and the presence of well established Sudanese medical community in Ireland; all of these factors made Ireland a favourable destination for many migrant Sudanese doctors.

The Fifth Session provided an opportunity to present and discuss examples of high quality research work conducted by Sudanese doctors in Irish medical institutions with a view to highlight the skills and other requirements of research as well as the challenges facing clinical researchers. A summary of these presentations is included in this report.


THE CONFERENCE SESSIONS

1. THE OPENNING SESSION Dr. Mohamed Ahmed: the chair of the organising committee started this session by opening remarks in which he welcomed the high level delegates from Sudan, representatives from Irish institutions and conference participants. Dr. Ahmed expressed gratitude to the organising committee, speakers and the sponsoring companies and institutions.

Dr. Abubakr shaddad: in his presentation (From Khartoum to Galway), the story of hundreds or thousands of young, enthusiastic Sudanese doctors crossed the boundaries from South to North, since the 70s of the last century up till now. What made them favour this beautiful country? Dr. Shadad explored this phenomenon and reflected on the unique public diplomacy between Sudan and Ireland that has great potentials to bring benefits to the people of the two countries. Dr. Shadad quoted an Irish proverb that encourages collective work and collaboration as essential element to achieve goals and improve outcomes.

Dr. Faisal Mihaimeed: the founding president of Sudan Medical Association (SMA) presented a historical overview SMA which was founded in 2010 as a non-governmental, non-political organisation that involves all healthcare professionals. Dr. Mihaimeed explained that SMA aims to be an agent of change and voice of reason to bring healthcare professionals together in working partnership with a vision to improve health care service in Sudan.

He stressed the scientific nature of the association and its openness to work for the benefit of the Sudan, UK and Ireland without any political affiliation or assumptions. The association membership expanded to over 1000 health care professionals from wide range of specialties including doctors, dentists, pharmacists, nurses, lab technicians, radiographers, chiropodists, etc. He gave a brief account of the previous achievements and meetings held both in UK and Sudan and he invited delegates to attend the upcoming conference in Sudan mid December 2012.

Dr. Mahir Hamad: The current president of the SMA presented some of the SMA achievements and projects such as postgraduate outreach training in the states of Khartoum, Gezira and River Nile as well as undergraduate outreach training projects. He also presented the SMA initiative towards doctors in early training (DET) project which is UK based including workshops for specialty applicants, interview skills and training in conflict resolution.

Dr. Mahir Hamad, president of the SMA addressing the conference


His Excellency Mr. Bahar Idriss Abugarda: the Sudanese Federal Minister of Health gave a brief description of the current challenges in Sudan's health system and the achievements in improving health indicators in the period between 2006 -2010. The Minister welcomed all initiatives aimed to support health system and medical training in Sudan from the migrant Sudanese doctors and their hosting countries such as Ireland. He concluded by thanking Ireland for hosting Sudanese doctors and their families and called for stronger collaboration in health matters between Sudan and Ireland.

His Excellency Sudan's Federal Minister of Health Mr. Bahar Abugarda addressing the Conference.

From right to left: Dr. Mohamed Ahmed, HE Mr. Bahar Abugarda (Sudan Federal Minister of Health), Dr. Abobakr Shadad and Dr. Mahir Hamad (President of SMA).


2. DYNAMICS OF DOCTORS MIGRATION

Mrs Nuha Ibrahim started the second session by presenting her study of pull and push factors for Sudanese doctors migration to Ireland. The aim of this research was to investigate the migration of the Sudanese doctors to Ireland: what are the factors that contributed to their decisions to leave Sudan and come to Ireland, their perception about working in Ireland and what are their future plans?

She identified two main factors, among others, for the male dominated (93.8%) migrant Sudanese doctors to Ireland: the need for better training and professional development (45%) in addition to financial attractions (33.3%) as most of these doctors (80.4%) continued to support extended family members in Sudan. Other push factors included limited employment opportunities in speciality of choice in Sudan, lack of equipments, hospital management difficulties and factors relating to the political situation.

Most of the participating doctors were at the registrar level (65% with only 4.6 in specialist training; SpR) followed by SHO level (23.1%) and only 11 % of the 120 participants were at the consultant level. Around 90 % felt that they do not feel that they have the same chance as Irish doctors to get specialist training. This is the area of their least satisfaction as only 30 % were satisfied with training opportunities, compared to low percentages of dissatisfaction with lifestyle, working conditions and salary.

Nearly half of these doctors (45.6%) had migrated to another country before Ireland, predominantly Saudi Arabia (79%). Most of these doctors stated that Ireland is not their final destination (79.6%), and 89 % expressed their intention to go back to Sudan. Despite only 42% were originally from Khartoum area 66.7% of the participants said they plan to work in Khartoum when they go back.

Dr Emam El-Higaya gave a brief historical overview of modern medical education in Sudan that is backdated to 1924 with the establishment of Kitchener school of medicine (KSM) which graduated its first batch in 1928. In 1937, Sudan started to send graduates to UK for short postgraduate experience with the first Sudanese graduates obtained their MRCP and FRCS in 1948 and 1949, respectively. At that time, trainees were typically general duty doctors who qualified some 10-15 years prior to obtaining government scholarship for overseas training. This long gap following qualification created difficulties for trainees to finish their qualifications. This was evident as only three candidates were able to obtain their FRCS between 1948 and 1960. The first FRCS (Ireland) was obtained in 1973.

In the last two decades, Sudan became a "doctors exporting country" after exponential expansion in undergraduate medical education. The number of medical schools increased from less than 5 in 1990 to over 30 medical schools.


The migration of Sudanese doctors to Ireland started in 1970s with few doctors who came for surgical training and surged in the last decade, from a total of 64 doctors in 2000 to 582 doctors qualified in Sudan and registered with the Irish Medical Council (IMC) in June 2012 representing 9 % of foreign doctors registered with the IMC. The vast majority (74%) are in the general division (n=465), 105 (17%) in trainee specialist division and only 57 (9%) in the specialist division.

Dr. Elshiekh Badr the President of the Academy of Health Sciences (AHS) reiterated the two main push factors for migrant Sudanese doctors described by Mrs Nuha Ibrahim being the need for training and specialisation and the search for better pay.

He gave a brief overview of the current health human resources situation in Sudan with the expanding numbers of doctors versus the limited expansion in nursing and other allied health professionals that lead to the foundation of the AHS. He highlighted the expanding health services in Saudi Arabia as a major attracting destination to Sudanese doctors with minimal mutual formal governmental agreements and the increasing role of private recruitment agencies.

He suggested that, a more structured model of health workers’ migration with mutual agreements and less intervention from recruitment agencies, is needed. He explained that Libya is now a new destination for doctors in the post-conflict era. He gave a brief overview of bilateral and regional arrangements, the Diaspora mobilisation activities and health initiatives including temporary visits with contribution to medical education, health services, relief efforts and the role of private sector in the permanent return of some well qualified doctors to Sudan.

Dr. Ogenna Oduma gave an account of the expanding needs for health human resources estimated globally to exceed 4 million with particular reference to the severe deficiencies in sub-Saharan Africa with the challenges of communicable and peri-natal diseases.

Dr. Oduma explained that disease burden and the crises of human resources for health with very low doctors and nurses are the main challenges facing health services in Africa. Africa has only 3% of global health workforce and at the same time faces 24% of world’s burden of disease. This results in unrealistic workload in already unsatisfactory working environment with poor distribution of limited resources including manpower. This is even more complicated by the lack of updated information, human resources managers and organisational leadership.

An example of the gap of human resources between sub-Saharan Africa and OECD averages per 100000 population doctors and nurses ratios are 15.5 & 73.4 versus 311 and 737.5; respectively. Most of the Sub-Saharan countries have less than the WHO recommended ratio of 20 doctors per 100.000 with 10 countries with ratios less than 5. Dr. Oduma concluded her talk by presenting the estimated saving in training cost made by high-income countries of US$ 184,000 for each professional aged between 25 and 35 years as estimated by UN Conference on Trade and Development (UNCTA).


Dr. Narayanan Subramanian outlined reasons for migration of doctors from Ireland. He described the challenges facing non EU doctors in Ireland predominantly working as Non Consultant Hospital Doctors (NCHDs). He explained that the limited access to formally recognised higher specialist training (SpR) is one of the main reasons. He showed figures indicating that only 20% of SpR posts are non EU compared to 57% of Senior House officers (SHOs) and 76% of registrars. Some of these non EU NCHDs remain to work as registrars for 10-15 years.

Dr. Subramanian added that these doctors will eventually migrate particularly after the failure to create an associate specialist grade. He also highlighted other financial and social issues that would encourage non EU NCHDs to migrate to other destinations such as UK, Australia, New Zealand, Canada and USA.

He described immigration regulation difficulties facing this group of doctors in the past years regarding their residence permit status, unfavourable visa status for spouses and prolonged waiting time for naturalisation that can range from 7-10 years. He presented a case scenario that describes typical challenges facing most of non EU NCHDs.

According to Dr. Subramanian, Ireland is facing outward migration of its own graduated health professionals and overseas doctors when their levels of learning and performance start to plateau.

Territory size shows the proportion of all physicians (doctors) that work in that territory (as per Dr. Oduma's presentation). http://www.worldmapper.org/images/largepng/219.png

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Prof. Ruairi Brugha, the head of Epidemiology and Public health department in RCSI medical school, described threefold increase in foreign trained doctors in Ireland from 13.4% in 2000 to 33.4% of all doctors registered with IMC in 2010.

Prof. Brugha showed figures indicating a 6 fold increase in numbers of Sudanese doctors (63 in 2000 to 403 in 2010). He outlined the dramatic increase in the last decade for the percentage of foreign-trained doctors that made Ireland the second higher country in terms of foreign doctors after New Zealand (38%) and more than UK, USA and Australia.

Prof. Brugha discussed the ethical implications of the Global Code recently adopted as a voluntary document by WHO and suggested that Sudan as a sending country and Ireland as a recipient country can set a model example of collaboration that support technology and skills transfer through training bodies in both countries.

He concluded by giving examples of elements of Ireland-Sudan partnership incorporating agreed training and capacity building initiatives as part of bilateral agreements in health between the two countries.

Prof. Ruairi Brugha from RCSI addressing the conference

.

Dr. Donal Reddan, Vice President of the RCPI addressing the conference.


3. MODELS OF NOVEL INTIATIVES

The third session gave examples of initiatives and collaboration projects between Ireland and Sudan mediated by migrant Sudanese doctors. As part of this session, the Academy of Health Sciences "AHS", Sudan FMOH and the National University of Ireland Galway "NUIG" signed a Memorandum of Understanding aiming for provision of training for nurses and midwives in Sudan.

The signature of the MOU between AHS and NUIG for nurses and midwives training.

Dr. Abobakr Shadad gave an account of the Sudan Health Library project aiming to provide online access to up to date medical educational resources as BMJ and Oxford handbook series free of charge for educational institutions in Sudan. It targets the medical and nursing students in Sudan, allied health students and health researchers. Three forms of individual sponsorship were presented through “memorial folders”. Conference participants were encouraged to sponsor educational folders in their specialities.

Helen Burke described the initiative that involved training of two Sudanese diabetic nurses in the diabetes day centre (DDC) in Galway. She expressed her satisfaction with the training they had received during the 4 week placement, during which a short-term skill focused diabetes training, foot care, retinopathy prevention, and antenatal and paediatric diabetic clinics were provided.

The course preparation involved visa sponsorship, Human Resources paperwork, accommodation arrangements and the development of the short course educational programme according to international guidelines.


Some of the conference participants at one of the sessions

Dr. Arif Mutwali, consultant nephrologist in Letterkenny General Hospital described the burden of renal diseases globally and in Sudan particularly. He highlighted his participation in nephrology training in Sudan during short visits accompanied by other Sudanese nephrologists from UK and Ireland. Dr. Mutwali presented his innovative project of delivering 80 refurbished dialysis machines to Renal Units in Sudan, 40 of which have already arrived there. The cost of these 80 refurbished machines is estimated around 540,000 US Dollars (US$ 6750 per machine) and they will serve 864 dialysis patients annually.

On behalf of the Sudanese dialysis patients, Dr. Mutwali thanked the four Irish hospitals which donated these machines; Letterkenny, Cavan, Sligo and Tullamore General Hospitals. Dr. Mutwali also thanked all those who participated in covering the cost of shipping these machines to Sudan. This initiative was highly appreciated by the conference delegates with requests made to the participating Sudanese health policy makers to facilitate similar initiatives once the quality and safety of such medical equipments was assured.

Dr. Arif Mutwali, Consultant Nephrologist,

Letterkenny General Hospital


Prof. Zein Karrar started his presentation with a historical account of the establishment of Sudan Medical Council (SMC) in 1968. He outlined that the main aim of the SMC is to deliver and safeguard the highest standards of medical education, medical practice and medical ethics in Sudan for the interests of patients, the public and the profession.

Prof. Karrar gave an overview of the progress made in the medical council since he took office in 2009. This progress involved undergraduate accreditation procedures and supervisory visits to medical schools, pharmacy colleges and dental colleges.

He emphasised on the development of Sudan Doctors Medical licensing Exam (SDMLE) in 2000 as a requirement for permanent registration and its subsequent transformation in 2007 into a computer based exam that is held in an equipped hall accommodating up to 140 candidates.

From left to right: Dr. Mahir Hamad (president of SMA), Prof. Osman Taha (president of SNMSB), Prof. Gerry Loftus, Dean of School of Medicine, Nursing and Health Sciences, National University of Ireland Galway and

Prof. Zein Karrar (president Sudan Medical Council). Prof. Karrar also highlighted the new edition of the Sudan National Formulary (SNF) in 2010, the update of the medical register that is extended to include over 22087 doctors, 4574 pharmacists and 2007 dentists in 2010.


Prof. Karrar described the new regulation organising specialist practice at three levels: specialist, senior specialist and consultant levels with a minimum experience of 3, 5 and 8 years of practice in the specialty, respectively. The candidate must provide evidence of good performance, competence and Continuing Medical Education (CME) to proceed to the next tier of the above mentioned levels.

The computer-based examination hall in SMC Some publications of Sudan Medical Council

Dr. Mohamed Eltom started his talk by giving a background about Sudan and its 34.2 million population coming from different ethnicities and living in the sixteenth largest country in the world.

He described the high maternal mortality rate in Sudan and emphasised that Sudan is now considered one of eleven countries responsible for two thirds of global maternal deaths with an adjusted maternal mortality ratio of 750/100.000 live-births in 2008.

The highest maternal mortality ratios of 1000-1600/100.000 were reported in the states of South Darfur, Kassala and West Darfur. Most of these deaths are predominantly caused by preventable conditions such as perinatal haemorrhage, obstructed labour, sepsis, hypertension-induced complications, malaria and anaemia.

Dr. Eltom emphasised the need for training of midwives and birth attendants in rural areas. He proposed some potential solutions such as awareness campaigns, improvement of family planning and the provision of emergency obstetric care in all health facilities.

Dr. Eltom quoted the successful example of collaboration between Cork and Omdurman Maternity Hospitals in reducing hospital maternal mortality in the latter through an initiative lead by Irish and Sudanese medical staff from Ireland.


Mr. Eric O’Flynn presented the last talk in this session covering the experience of the collaboration programme between the Royal College of Surgeons in Ireland and the College of Surgeons of East, Central and Southern Africa RCSI/COSECSA.

This programme provides mutually recognised surgical training in 9 African countries through an online platform of e-learning.

This programme addresses the severe shortage of surgeons in the region with only 1390 surgeons serving a population of 265 million. At present, the COSECSA programme has 144 trainees in 28 active training locations and offers Membership and Fellowship programmes in 7 specialities: General Surgery, Orthopaedics, Paediatrics, Urology, Neurosurgery, Plastic Surgery and ENT. A total of 61 specialist surgeons completed the training programme since 2004.

The programme provides full access to RCSI library and other online resources for trainers in addition to communication skills courses and a full structured basic surgical academic course. The inclusion of Sudan and South Sudan in the programme was extensively discussed in this session.

The award for Excellence in Healthcare Management for the joint project by Cork University Maternity Hospital, Omdurman Maternity Hospital, Khartoum, and UCC at the Irish Healthcare Awards 2009 were from L to R: Dr Tony Ryan; Dr Elzein; Dr Murwan Omer; and Aisling Gannon, then of sponsors Beauchamps Irish Medical Times at: http://www.imt.ie/features-opinion/2011/07/excellence-at-home-and-abroad.html

http://www.imt.ie/features-opinion/2011/07/excellence-at-home-and-abroad.html�


4. PARELLEL WORKSHOPS

Workshop 1: Return of migrant doctors to Sudan

Workshop membership: Prof. Ruairi Brugha, Dr Abdelbagi Ismail, Dr Babiker Ismail, Dr Elsheikh Badr, Dr Hassan Abdelaziz, Dr. Yasir Ahmed, Dr Hatim Kheir, Dr Mahjoub Toar, Dr Mohamed Elshafi, Dr Mujahid Jowdat, Dr Moutaz Abdelrahman, Dr. Sara Mohamed, Dr Samah Abdelsalam Elhag.

Sudanese doctors abroad have high intentions to return to Sudan. In reality, this is not happening. The workshop aimed to identify reasons for this “intention-behaviour gap”. The workshop facilitator initially surveyed workshop members who are working outside Sudan about whether they are considering going back to Sudan. Eighty five percent (85%) of this group expressed high intentions to go back to Sudan.

The participants were able to identify six important reasons that might make them decide NOT to return to Sudan, and listed these reasons in a descending order:

• Poor work environment, lack of well-trained staff and poor resources in health facilities.

• Better quality of education for their children in Ireland and Western countries in general, added to the huge gap in quality of education between private and public schools in Sudan. There is a considerable higher financial cost in Sudan, especially in private schools.

• Less gross income in Sudan compared with the current income in Ireland, especially for those who are planning to return to work in the public health sector in Sudan.

• Lack of clear career pathways for some specialities (e.g. General Practice, Emergency Medicine, Haematology).

• Lack of structured Continuing Professional Development (CPD) opportunities in Sudan.

• Huge differences in quality of life, especially for children who were raised abroad. The workshop participants recommended further quantitative and qualitative research on migration of Sudanese skilled workers, particularly doctors. The workshop emphasised that improving work conditions in Sudan public health sector can play a major role in retaining Sudanese medical graduates and also in attracting highly skilled migrant doctors to return to Sudan.


Workshop 2: Innovative Initiatives in Health provision & Medical Education in Sudan

Workshop membership: Dr. Abobakr Shadad, Ms. Brynne Gilmore, Dr. Diarmuid O'Donovan, Mr Eric O'Flynn, Dr Faisal Mihaimeed, Dr. Imad Brema, Dr. Khalifa Elmusharaf, Dr. Mohammed Bashir, Dr. Mona Abbas, Mrs. Nuha Ibrahim, Dr. Safa Abdullah.

The purpose of this workshop was to discuss and recommend practical ways of moving from individual-based to more innovative, group-based and sustainable initiatives to support Sudan's health service, medical educational/training and research. This workshop outlined a number of recommendations that could yield more effective and sustainable collaborations between health and academic bodies in Ireland/UK and Sudan:

• Establishing institutional links should follow a systematic approach or framework within which all initiatives should operate.

• Collaboration between the two sides should be based on mutual benefits, for example collaboration in service development in the area of Non-Communicable Diseases such as Diabetes where institutions in countries like Ireland have considerable and long-term experience that will benefit Sudan. On the other hand, this collaboration will allow good research opportunities for Irish institutions.

• The engagement of all interested stakeholders in UK/Ireland and Sudan will allow better identification of areas of collaboration and cooperation.


• Links should allow for a dynamic process to outline the purposes of the collaboration and identify potential areas of cooperation and mutual interests.

• There should be a built-in mechanism of monitoring and evaluation of this collaboration, and flexibility to revise purposes and plans at any stage to respond to emerging issues and newly identified needs.

• Promoting ownership of projects by the participating institutions.

• Equal opportunities and fair merit-based selection of candidates for training opportunities.

• Minimal expenditure in areas such as travel and equipment, and emphasising the utilisation of local resources.

• Utilisation of IT, social networks, internet and mobile phone-based services which are becoming widely accessible in countries like Sudan.

Workshop 3: The attractiveness of Sudan's Private Health Sector

Workshop membership: Dr. Arif Mutwali, Dr. Babiker Elawad, Dr. Bakri Elymani, Dr. Mahir Hamad, Dr. Rabab Ahmed, Dr. Reem Saied, Dr. Saleem Babiker, Dr. Victor Adenaike, Dr. Mohamed Elkomi, Dr. Nasir Khaleel, Dr. Mogtaba Osman.

The task of this workshop was to explore if there is any potential for the private health sector in Sudan to attract skilled migrant Sudanese doctors.

All workshop participants stated that private sector (private hospitals or private practice) in Sudan will be their likely choice if they returned back to Sudan. In view of the current situation of the public health sector in Sudan, they agreed that private sector will be more attractive option compared to the public sector, which was attributed by the participants to the following reasons:

• Better income

• Better work environment and working conditions.

• Better qualified and trained staff, especially allied health professionals.

However, the following drawbacks of working in Sudan private health sector were identified:

• Lack of access to private hospitals for low socioeconomic classes in Sudan.

• Limited academic incentives or gains while working in private health setting.

• Long working hours.

• Lack of job security.


Finally, the participants made the following recommendations to address these drawbacks:

• Regulation and governance of private health sector by Sudan academic and health regulatory stakeholders.

• The expansion of health insurance coverage to include wider range of Sudan's population and particularly the poor and people with limited income.

• The need for health statistics and data of service provision by private health sectors with a view to integrate such data into the existing health information databases.

Workshop 4: Irish Perspective: Training & Retaining Workshop membership: Prof. Zein Karrar, Prof. Osman Taha, Dr. Eltayeb El-Khabeer, Dr. Alaa Yousif, Dr. Adil Sharafa, Ms. Ashton Porter, Ms. Jane Ryan, Dr. Ahmed Mukhtar, Dr. Mohamed Abdalla, Dr. Zuhair Eissa. Irish health system relies heavily on foreign doctors in delivering healthcare services. Is it fair for the Irish health system to invest in training foreign doctors who will eventually move to work elsewhere? This workshop was attended by two key delegates from Sudan; Prof. Zein Karrar, the current president of Sudan Medical Council (SMC) and Prof Osman Taha the current president of Sudan National Medical Dpecialisation Board (SNMSB), the main and solitary postgraduate training body for medical specialties. The workshop discussed three levels of training:


A- starting from the entry level of the post internship medical council assessment scheme (PRES) which have three components, a computer based theoretical exam held in overseas centres e.g. Cairo, Egypt, an English component IELTS which is held in many centres worldwide including the British Council in Khartoum, and an OSCE component which is held only in Ireland in a relatively unpredictable timing schedule.

The panel suggested to pursue the possibility of hosting the first part of PRES in Khartoum and to share experience with the Sudan Licensing Medical Examination SDMLE. It is also suggested to develop a hotline communication with the Irish Medical Council (IMC) to facilitate correspondence, especially with visa facilitation letters for those attending the last OSCE component which is often announced in a tight timeframe.

B- The panel discussed the recognition of the two years of pre-membership level of training as Basic Surgical training (BST) or General Professional Training (GPT) for the medical specialties, which can count towards the four years Sudanese board training, the shortage of time didn’t allow this discussion to come to conclusion. It is however, recommended this would be further pursued with the SNMSB.

Prof. Osman Taha addressing the conference

C- The third level of training discussed was the specialist training higher specialty training, which is a direct pathway to obtain a certificate of completion of specialist training (CCST). This is unfortunately accessible to only 5-10% of Sudanese doctors as presented in the statistics of the conference presentations. This is a direct pathway to get trainees into the specialist register of the IMC. This is also accessible by some trainees through longer pathways with retrospective recognition of long term accumulation of competencies.

The SMC president informed the panel of the three tiers of specialist registration adopted in the last few years. Those who are registered in the specialist register in Ireland will be directly registered as consultants. This corresponds to at least 8 years of local experience in the specialty with necessary qualifications. Two other levels were described; the senior specialist level with a minimum of 5 years specialty cumulative documented experience and a specialist level with 3-4 basic years


experience in the specialty. It was recommended that these tiers should be widely communicated to doctors practicing in Ireland to tailor their training objectives and pathways if they are not in an already recognised pathway of specialist training.

D- The workshop concluded the discussion highlighting that it would be important for Irish health policy makers to consider the above mentioned three levels of training to maximise the retention of migrant doctors.

Workshop 5: Ireland as a destination for migrant doctors

Workshop membership: Dr. Ahmed Kharief, Dr. Ali Zaki, Prof. Martin Cormican, Dr. Mohamed Ali, Dr. Mohamed Ismaeil, Dr. Omer Mohamed, Dr. Udama Ndubisi, Dr. Noury Salih, Dr. Habib El-Rahman, Dr. Narayanan Subramanian, Dr. Shahir Shakir, Dr. Suha Abdalla, Dr. Inam Ul-Haq.

The key objective of the workshop was to identify why overseas doctors choose Ireland as destination for migration.

The workshop participants were in agreement that doctors migration is influenced by a combination of push and pull factors, in addition to different policies, regulations and legislations. These factors are dynamic, and the complex interplay between these factors leads to a threshold decision to migrate to Ireland or elsewhere. The participants have focused their discussions on identifying the main pull factors that made Ireland one of the attractive destinations for overseas doctors. Many doctors came to Ireland based on recommendations from friends or relatives who were living in Ireland. The presence of positive social networks and well established overseas medical community in Ireland was highlighted by participants as an important pull factor. Many doctors found the IMC registration process taking shorter time in Ireland compared to other countries such as the US, same applies for the application process for the visa for PRES level 2 exam, or to obtain visa for their spouses when they find employment. Since English language has been the language of medical education in Sudan, opportunities for employment in Ireland has been considerably higher for Sudanese doctors as compared with employment opportunities in non-English speaking countries. The IMC recognises Sudanese Medical Qualifications, and some doctors who completed postgraduate qualifications in Sudan were exempted from PRES. Some participants commented that Ireland is not that far away from Sudan compared to countries such as North America or Australasia, particularly for those with very close ties


with their families at home. Other pull factors -which is not specific to Ireland- include: better job opportunities, higher pay, better work environment, prospects for career development and training opportunities, and the high living standards.

Dr. Sean Dinneen from NUIG addressing the conference

Prof. Peter Cantillon from NUIG during one of the conference sessions


5. CONDUCTING RESEARCH IN A CHALLENGING IRISH HEALTH SYSTEM

The fifth session provided an opportunity to present and discuss examples of quality research work conducted by Sudanese doctors in Irish medical institutions with a view to highlight the skills and other requirements of research as well as the challenges facing clinical researchers.

Dr. Safaa Abdallah presented her research work on evaluating mortality rates and other clinical and sociodemographic parameters among the Irish travelling community as a disadvantaged group of the Irish population.

The figures presented by Dr. Safa showed very high mortality rates among male and female members of the travelling community which are different from the rest of the Irish population. These inequalities result from complex pathways that involve direct and indirect effects of health determinants ranging from socioeconomic status, employment, living conditions, environmental factors, education and behavioural factors such as smoking and dietary habits. Dr. Safa concluded that these inequalities should be considered when planning any prevention strategies in keeping with the holistic inter-sectorial approach.

Dr. Imad Brema presented his research investigating the role of novel adipocytokine visfatin in insulin resistance. He provided a brief overview of the worldwide pandemic of obesity and the parallel increase in the incidence of type 2 Diabetes Mellitus (T2DM) that increased from 151 to 221 million between 2000 to 2010. It is predicted to reach 300 million in 2025.

It is well documented that exercise improves insulin sensitivity in middle aged subjects with T2DM. Plasma Visfatin levels have been found to drop significantly post-exercise among obese controls and young subjects with T2DM. Dr. Brema concluded that Visfatin is a promising marker or mediator of aerobic fitness and cardiometabolic risk; however; further mechanistic large studies are needed to clarify this role.

Dr. Ali Zaki, Prof. Ruairi Brugha and Dr. Narayanan Subramanian chairing one of the sessions


Dr. Mohammed Bashir: presented his research investigating the effects of smoking on glycaemic control, lipids, BP, albuminuria, GFR, and region-specific urinary biomarkers in patients with type T2DM.

In his first retrospective case control study that compared 400 smokers with T2DM with 200 non-smokers matched for gender, age, Body Mass Index (BMI) and duration of DM, he found statistically significant difference in control of glycaemic and lipid laboratory values as expressed in higher readings of HbA1c, total cholesterol, triglycerides and LDL with lower HDL among the smoker group.

In his second study, Dr. Bashir compared 279 smokers with 200 controls and showed a statistically significant higher risk of micro-albuminuria and higher rate of renal function deterioration as expressed in e-GFR estimates in the smoker group.

Dr. Safaa Abdallah, Dr. Imad Brema and Dr. Mohammed Bashir all agreed that conducting research in a clinical setting requires good knowledge of research techniques and methodology, basic understanding of statistics, availability of databases and assisting staff.

They also agreed that the main challenges facing doctors doing research in Ireland are the huge clinical workload, short-staffed health services, lack of protected time, and the lack of supportive research tools in most Irish hospitals.

The three doctors informed the conference that completing research allowed them to become better clinicians with improved skills in utilising and applying evidence-based medicine. They also agreed that with their research experience they became more competitive for quality medical/clinical jobs.

One of the conference sessions.


POST CONFERENCE ACTIVITIES

Business meeting between the Sudan delegates, SMA executives and the conference organizing committee

Sudan delegates at the RCSI


The meeting at the RCSI

The meeting at the RCSI

From left to right: Dr. Khalifa Elmusharaf, Dr. Mohamed Ahmed and Dr. Abdulmoneim Khalifa


Sudan delegates at the Royal College of Surgeons Ireland (RCSI) Dublin

Sudan delegates visiting St. James’s Hospital, the biggest hospital in Ireland

Sudan delegates at St James’s Hospital, Dublin


The meeting at St. James's Hospital Dublin

From left to right: Prof. Zein Karrar, president of Sudan Medical Council, Prof. Kieran Murphy, president of the Medical Council Ireland and Dr. Abobakr Shadad.

The conference organizing committee


Annex


The conference organising committee

Dr. Abobakr Shadad Dr. Khalifa Elmusharaf

Mrs. Nuha Ibrahim Dr. Emam El-Higaya

Dr. Mohamed Elshafi Dr. Zuhair Eissa

Dr. Mohamed Ali Ahmed


Conference Programme

9:00 to 10:00 Registration

Session “1” 10:00 to 11:00 am Opening Session

Chair: Dr. Mahir Hamad Co Chair: Dr. Abobakr Shadad TIME Speaker Title

10:00 to 10:30

Mohamed Ahmed Welcome and Opening Remarks

Faisal Mihaimeed From Metropole London to Salthill Galway & beyond, the vision & mission

Mahir Hamad SMA: The Present and The Future

Abobakr Shadad From Khartoum to Galway

10:30 to 10:45 Sudan FMOH Mr. Bahar Abugarda

Health services in Sudan: Challenges and Future Plans

10:45 to 11:00 Discussion

11:00 to 11:30 TEA & COFFEE BREAK

Session “2” 11:30 to 13:00

Dynamics of Doctors Migration

Chair: Dr. Ali Zaki. Co Chair: Prof. Ruairi Brugha

11:30to 12:30

Presenting Author Title

Nuha Ibrahim The Migration of Sudanese Doctors to Ireland: Push and Pull Factors

Emam El-Higaya Historical and current trends of Sudanese medical migration to Ireland

Elsheikh Badr Migration of health professionals in Sudan: issues, challenges and prospects

Ogennea Udumma Human Resources for Health: Crisis in Africa

Narayanan Subramanian

Migration of doctors: An Irish perspective

Prof. Ruairi Brugha Trends in foreign trained doctors migrating to Ireland – ethical implications and responses

12:30 to 13:00 Discussion with invited comments from Prof. Osman Taha

13:00 to 14:00 Lunch


Session “3” 14:00 to 15:30 Models of Novel Initiatives

Chair: Dr. Sean Dinneen Co Chair: Dr. Faisal Mihaimeed 14:00 to 15:10 Presenting Author Title

Abobakr Shadad Sudan Health Library: an innovative approach to support learning in health sciences

Helen Burke / Sean Dinneen

Diabetes Care –Crossing Boundaries

Arif Mutwali Initiatives in Nephrology Services in Sudan

Prof. Zein Elabdeen Karrar Sudan Medical Council: Updates and Recent Initiatives

Mohamed Eltom Maternal Health in Sudan: The Need for Initiatives

Eric O'Flynn Innovation in surgical Training in Africa: RCSI and COSECSA project

15:10 to 15:30 Discussion with invited comments from Prof. Kathy Murphy (Maternal Health) and Prof. Osman Taha (COSECSA)

Session “4” 15:30 to 17:15 pm Parallel Workshops and coffee break

Chair Dr. Diarmuid O’Donovan Co Chair: Dr. Mohamed Ahmed 15:30 to 15:35 Emam El-Higaya Introduction and grouping

15:35 to 16:20 Workshop title Description

Return of migrant doctors to Sudan

Sudanese doctors abroad have high intentions to return to Sudan, however, this is not happening. Why do you think this is the case?

Innovative health service/ educational Initiatives

There have been many initiatives by individuals or small groups to support health service and medical education in Sudan. How can we move towards more innovative, group-based and sustainable health service delivery, educational/ training and research initiatives?

The attractiveness of Sudan Private Health Sector

In view of the current situation of the public health services in Sudan, is there any potential for the private health sector (private hospitals or private practice) to attract migrant Sudanese doctors?

Irish Perspective: Training and retaining

Irish health system relies heavily on foreign doctors in delivering healthcare services. Is it fair for the Irish health system to invest in training foreign doctors who will eventually move to work elsewhere?

Ireland as a destination for migrant doctors

Why did you choose Ireland for post-graduate training? Why Ireland not elsewhere?

16:20 to 16:50 Groups Feedback in plenary session 16:50 to 17:15 Discussion


17:15 to 17:50

Presenting Author Title Safa I. A. Abdalla Mortality among Irish Travellers; a population based study Imad Brema Early Onset Type 2 Diabetes: Does Exercise Help?

Mohammed Bashir Effects of smoking on metabolic control and novel urinary biomarker in patients with type 2 diabetes.

17:50 to 18: 00 Discussion

Session “5” 17:15 to 18:00 pm Conducting Research in Challenging Irish Health System

Chair: Prof. Martin Cormican Co Chair: Dr. Mohamed Ahmed

18:00 to 20:00

Closing Remarks Reception and Sudanese Music

The conference will bring to a close with Sudanese music and Mediterranean snacks


Speakers’ biographies

His Excellency Mr. Bahar Idriss Abugarda Sudan Federal Minister of Health

Prof. Gerry Loftus

M.B.,B.CH.,B.A.O.,D.C.H.,M.R.C.P.I. He is the Dean of the College of Medicine, Nursing and Health Science at NUI Galway. Gerard Loftus has been Professor of Paediatrics at NUI Galway since 1988. He was an undergraduate at UCD and undertook postgraduate training in paediatrics in Dublin and London, including research in Paediatric respiratory disease. The topic of his MD thesis was Asthma in Pre-School Children. His areas of clinical and research interest are diabetes and respiratory disease, particularly Asthma. He has over 40 scientific articles published in peer reviewed journals, 70 abstracts, 1 book and several review articles. Current research interests include the influence of atmospheric pollution on acute asthma in children. Professor Loftus has served on Comhairle na nOspideal, The National Task Force on Medical Staffing, and as chair of the Postgraduate Medical and Dental Board, the Health Services Expert Advisory Group on Children, and the National Steering group on implementation of Newborn Screening for Cystic Fibrosis. He is a member of Governing Authority, and is serving his third term as Dean of the College of Medicine, Nursing and Health Science at NUI Galway.

Prof. Zein Elabdeen Karrar

Prof. Karrar is the president of Sudan Medical Council (January 2009 – to date). He graduated from Medical school, University of Khartoum in 1971. He obtained DCH London, DTCH Liverpool, FRCP London in 1989, and F.R.C.P.C.H U.K in 1998. He is a professor of Paediatrics and Child Health at University of Khartoum since1995. He worked as the dean of Graduate College University of Khartoum from June 2000 to April 2008, and as the director of Educational Centre for Health Professions University of Khartoum from 1994 to 2000. He also was the head of Department of Paediatrics and Child Health University of Khartoum from April 1991 to February 1994. Prof. Karrar has more than 50 publications in international, regional and local journals, and published three booklets, and supervises many PhD and MD thesis


Prof Ruairi Brugha

MB, BCh, BAO, MD, FFPHMI, MSc, DCH, Dip Obs, Dip Humanities. He is the Head of Epidemiology and Public Health Medicine in the Royal College of Surgeons in Ireland (RCSI). He qualified as a doctor in 1980, spent six years working in Africa (Ghana and Zimbabwe) in the 1980s and 1990s, and 10 years at the London School of Hygiene and Tropical Medicine. In 2005 he took up the post of first full time Head of the Department of Epidemiology and Public Health Medicine at the Royal College of Surgeons in Ireland. His research interests are in health systems and policy research, globally and in several sub-Saharan African countries. He has been researching and publishing on health worker (nurse and doctor) migration to Ireland since 2006. He was a member of the Global Advisory Council that drafted the Global Code on the International Recruitment of Health Personnel.

Prof. Osman Taha

M.B.B.S, F.R.C.S.I., D.Sc. (H.C.), F.S.M.S.B. He is the President of Sudan Medical Specialisation Board, January 2009 till date. Prof. Taha graduated from the faculty of medicine, University of Khartoum in 1972. He completed his postgraduate training in general surgery in Ireland where he obtained FRCSI in 1978. He is currently a consultant in general and paediatric surgery, Khartoum Teaching Hospital. He was the Dean Faculty of Medicine University of Gazira1996 - 2005, and the Dean of Graduate Studies 2005 - 2007. He worked as consultant paediatric surgeon, Medani Children Hospital. He has a large number of published papers in both national and international peer reviewed journals. He has co-authored two medical books and supervised many M.D thesis's . He is an external postgraduate examiner in many regional and international training programmes; Arab board, Saudi Board, Egyptian Board and College of Physicians and Surgeons of Pakistan (CPSP).

Prof. Martin Cormican

Professor of Medical Microbiology at the National University of Ireland Galway is a consultant at the Department of Medical Microbiology, University College Hospital Galway. Professor Cormican worked in general medicine in UK and obtained the MRCP examination in 1989. His MD awarded in 1992 for work on diagnosis of tuberculosis. He obtained his FRCPath in 1993. From 1994 to 1996 he trained as fellow at the University of Iowa Hospitals and Clinics in the USA. He was appointed to a Consultant Immunology post in Galway in 1996 and was appointed Professor of Bacteriology and Consultant Microbiologist in 1999. He is a former WHO Expert Advisor on Antimicrobial Susceptibility Testing providing training courses in China and has acted as external examiner in Ireland, UK and Sudan. He has published more than 100 papers including publications in many prestigious journals such as British Medical Journal, Lancet, Journal of Clinical Microbiology and Chemotherapy


Prof. Kathy Murphy

RGN,BA,MSc,PhD,RNT,Dip N ED. Prof. Murphy is the Head of the school of Nursing and Midwifery, National University of Ireland Galway. She completed nursing clinical training in UK and Ireland. She has a special interest in teaching topics related to Nursing Education, Nursing Research and Nursing of older age patients. Her clinical Interest is focused on older People, Chronic Disease and Dementia. She has research Interests with extensive publications covering a wide array of areas in nursing such as Quality of life of older people, Chronic Disease and Advanced Practice. Prof. Murphy is a member of the National Steering Group for Dementia and the HIQA Long-Stay Care Standards in Ireland.

Dr. Mohamed Ali Ahmed

Dr. Mohamed Ali Ahmed is a consultant psychiatrist at the Brothers of Charity Services, Galway and honorary research fellow at the department of psychiatry, National University of Ireland, Galway. He graduated from Jordan University in 1996 and completed his basic and higher specialist psychiatric training in Ireland. In addition to the membership (MRCPsych), he obtained master degree in medical sciences (NUIG), diploma in clinical psychiatry (RCSI), higher diploma in clinical teaching (NUIG), diploma in psychopharmacology (CINP) and diploma in health services management (University of Limerick). He is at the final stage of submitting thesis for MD in neuroimaging (NUIG). He has co-authored two MCQ books for the MRCPsych examinations and has published more than ten peer reviewed papers. His interests include medical education and training and his research interests include neuroimaging in schizophrenia and the impact of antipsychotics on regional brain volume and the association of mental illnesses/ psychotropic medications with the metabolic syndrome

Dr. Faisal Mihaimeed

MBBCh, MSc, FRCS (Glasg), FRCS (Eng), FRCS (Gen), CCST. He is a Consultant General Surgeon with Interest in Breast & Endocrine surgery Newham University Hospital – London & Honorary Consultant Surgeon St Bartholomew’s & Royal London Hospitals (Currently, Barts Health NHS). He graduated from Ain shams University (Egypt) in 1980. He has the following qualifications: FRCS: Royal College of Physicians & Surgeons Glasgow, FRCS Royal college of Surgeons, England; Master in Surgical science – Royal Postgraduate Medical School, University of London; FRCS (Gen): Intercollegiate Fellowship in Surgery of the four Royal Colleges of Surgeons in UK & Ireland, CCST (Certificate of Completion of Specialist Higher Surgical Training, UK. His research interest includes Breast cancer hormone therapy and biological markers & Thyroid / Parathyroid surgery.


Dr. Mahir Hamad

FRCP (London), FRCP (Glasgow), FRCPI. He is a Consultant Physician and Clinical Director for Acute Medicine, James Cook University Hospital, and Middlesbrough. He is the President of the Sudanese Medical Association UK & Ireland. Dr Hamad graduated from Ain Shams University (Egypt), worked as junior doctor in Atbara, Saudi Arabia then moved to UK. At the moment he is the clinical director for acute medicine services at James Cook University Hospital. He has written extensive evidenced based guidelines on the management of acute medical emergencies for the trust as well as played a leading role in establishing MRCP teaching (part 1 & part 2) for trainees in the region. His area of interest is thromboembolic disorders, outpatient management of pulmonary embolism and ambulatory care pathways, in which he has numerous publications. He is OSCE and MOSLER Examiner to Newcastle medical school and MRCP Paces Host examiner.

Dr. Abobakr Shadad

Dr Abobakr Shadad MBBS, MRCPI, MSc, MD. He is a clinical lecturer in Medicine, National University of Ireland, Galway. He is the deputy president of SMA (UK& Ireland). Dr Shadad obtained the Membership of the Royal College of Physicians of Ireland in 2006 and a Master degree in Medical Sciences from the National University of Ireland in 2008. Currently, he works as a lecturer in medicine and senior registrar in endoscopy while writing up MD degree in translational research. His research is focus on exploring the complex nature of intestinal immune system. The research is expected to generate a new knowledge and to provide therapeutics insights for the problem of intestinal radiation injury. Dr Shadad continued to strengthen his academic role by pursuing a higher diploma in Learning &Teaching in third level education with interest in learning technologies and postgraduate student supervision. Dr Shadad was a co-founder of the SMA UK & Ireland. He is current deputy president for SMA UK& Ireland and lead of the academic office and research.

Mrs. Nuha Ibrahim

Nuha Ibrahim holds a BA in Biology from University of Khartoum, Sudan (2004) and master of Global Health from Centre for Global Health, Trinity College Dublin (2010). She is currently undertaking a PhD in Global Health at Trinity College Dublin. Her research area is the impact of work environment on the performance of health workers in public hospitals in Sudan. Nuha’s academic areas of interest include Health System Strengthening, Nutritional challenges & Food security


Dr. Emam El-Higaya

MBBS, DCPsych, MPH. Dr. El-Higaya is a graduate of Gezira Medical School in Sudan. He has been interested since his undergraduate years in mental health, medical education, and public health. Following qualification in medicine and working experience in rural Eastern Sudan, he worked as a PBL tutor in the International University of Africa's School of Medicine. Then he joined the Federal Ministry of Health in Sudan and worked as Director of Planning & Monitoring at the Department of International Health, before moving to UK and Sweden for further studies in health policy, health economics, and international health & development. He is currently a Specialist Trainee Registrar in the Western Postgraduate Rotational Training Scheme in Psychiatry. Dr. El-Higaya’s recent interests include evidence-based health policy, financing mental health services in-low income countries and training of under- and postgraduates in psychiatry and mental health.

Dr. Elsheikh Badr

Dr Elsheikh Badr is a consultant public health physician qualified in Sudan and the UK. He is currently the President of the Academy of Health Sciences, Federal Ministry of Health (FMOH)/Sudan and as well the Focal Person for the National Human Resources for Health Observatory (NHRHO). Previous and current work involvement include participation in national health policies and strategic planning in Sudan, preparation of a national HRH strategy for Sudan, strengthening human resource information system (HRIS) and work on health professions education systems and stakeholder coordination for health. Research work and projects include health worker migration, retention and HRH gender issues. Dr Badr is involved in the regional and global health workforce movement and serves as member of the Health Worker Migration Global Policy Council under the auspices of the Global Health Workforce Alliance (GHWA) and ASPEN Health and Development, USA. Dr Badr is designated an Arab Migration and Population Expert by the Arab League and contributed to development of a regional HRH strategy for the WHO Eastern Mediterranean Region.

Dr. Ogenna Uduma

Ogenna Uduma is the Coordinator of the International Doctoral School in Global Health, and the Doctoral Training Officer of the Trinity International Development Initiative (TIDI), Trinity College Dublin. She received her PhD in Parasitology and her Master’s in Public Health from the University of Ibadan and University of Pretoria respectively. She has spent the last 12 years as a research scientist and project manager working with health ministries and UNICEF, UNDP, World Bank, WHO Special Programme for Research and Training in Topical Diseases (TDR). She has managed a human resource for health project in Africa for the Centre for Global Health and took up the position of Doctoral Programme Officer with the Trinity International Development Initiative (TIDI) and Coordinator of the International Doctoral School in Global Health at the Centre for Global Health, Trinity College Dublin in 2009. Dr Uduma has published widely on tropical parasitic diseases and human resources for health in sub Saharan Africa and is currently involved in capacity building partnerships in Africa with TDR and EDCTP.


Dr. Narayanan Subramanian

MBBS, MRCPsych(Lon), MSc Addictions(Lon), Dip.H.Mgt, Dip.Cl.Psych. He is the Vice Chairman of Overseas Medics of Ireland, a pressure group for overseas doctors in Ireland and also a Senior Registrar in Psychiatry based in Nenagh, Co.Tipperary. Dr Subramanian was actively involved in talks with Irish Nationality & Immigration Service (INIS), a division of the Department of Justice in Ireland on Non EU doctors’ immigration issues, through the Irish Medical Organisation. He is known for his editorials and critical letters regarding NCHD matters on Medical newspapers such as Irish Medical Times and Medical Independent. He manages the blog for overseas medics of Ireland and advices overseas doctors on life, cultural and medical practices in Ireland through this blog. Dr Subramanian completed his medical school from India, was based in England before he moved to Ireland. He has done his Masters in Addiction from the renowned Institute of Psychiatry; King’s College London and has a special interest in Addiction and Psychiatry as Dual diagnostic conditions. Dr Subramanian has written book reviews on Addiction matters and written articles on same. He has also done his diploma in health services management from Dublin and also received his diploma in clinical psychiatry from the conjoint board of RCPI &RCSI.

Ms. Helen Burke

She is an advanced nurse practitioner in Diabetes. Ms Burke was certified in Diabetes Nursing in 1988 in Whittington Hospital London and proceeded for a degree in Health Services Management 1998 (Honors) University of Limerick she then obtained a master degree in diabetes nursing with honors level from Roehampton University Surrey United Kingdom. Following that she proceeded for a master in Health Science/Advanced Practice 2003 at the National University of Ireland Galway. Ms Burke obtained a certificate in nurse prescribing in 2008 from the Royal College of Surgeons in Ireland. She has keen interest in research and she was part of major trials undertaken at the Diabetes Day Centre, University Hospital Galway such as DAFNE, DESMOND and BRUCIE Educator. She is heavily involved in teaching undergraduate and post graduate nursing and medical students in diabetes.

Dr. Seán F. Dinneen

Dr Seán F. Dinneen, MD, MSc, FRCPI, FACP. Senior Lecturer in Medicine in the National University of Ireland, Galway. He is a Consultant in Diabetes and Endocrinology, Galway University Hospitals. He received his medical degree from University College Cork Medical School. He undertook postgraduate training in medicine in Ireland and then went to the United States where he trained in Diabetes and Endocrinology at the Mayo Clinic. After a period on staff at the Mayo Clinic he was appointed as a Community Diabetologist in Addenbrooke’s Hospital, Cambridge. He spent 5 years working in the NHS before returning to Ireland in 2005 to take up a Senior Lecturer post in Medicine in Galway University Hospitals. His professional interests are in delivering programmes of self-management education for people with diabetes, developing optimal models of community-based diabetes care and the diabetic foot.


Ms. Lorna Hurley

Lorna Hurley, RGN, BSc (Hon), MSc. Lorna is the Community Diabetes Facilitator for Co Galway. She graduated in General Nursing from Galway University Hospitals, obtained a BSc (Hon) Podiatry at Queens University of Belfast and an MSc Sports Medicine from the University of Glasgow. More recently she completed a diploma in Diabetes Management in Primary Care. In her current role, she aims to support integrated diabetes care delivery across hospital and primary care. She has a particular interest in patient education and is a DESMOND educator, assessor and trainer.

Dr. Donal Reddan

Dr Donal Reddan is the vice President of the Royal College of Physicians of Ireland. He is a Consultant Nephrologist, General Physician and clinical lecturer at University College Galway Hospitals in Ireland. Dr Reddan earned his medical degree from University College Dublin. After completing general internal medicine training in Dublin at St Vincent’s University Hospital, he completed a further residency in internal medicine at Allegheny General Hospital in Pittsburgh, and fellowship in the Division of Nephrology at Duke University Medical Centre Durham, North Carolina. After attaining American board certification in both internal medicine and nephrology, Dr Reddan went on to earn a Masters in Health Sciences from Duke University and joined the faculty at Duke and the Duke Clinical Research Institute. He currently retains an appointment as adjunct assistant professor at Duke University. Dr Reddan is a Fellow of the Royal College of Physicians of Ireland and is a currently serving Council member of the College. He has published extensively in the area of renal insufficiency and its accompanying cardiovascular risk and on issues relating to contrast nephropathy.

Dr. Arif Mutwali

Arif Mutwali MB MSc MPH MRCPI. He is Consultant Nephrologists & Physician at the Regional kidney Unit, Letterkenny & Sligo Hospitals HSE North West and Clinical lecturer, Donegal Academy, NUIG. He graduated from Faculty of Medicine, Gezira University, and obtained MSc in epidemiology from Jordan University of Science & Technology and a MSc of Medical Sciences from the National University of Ireland Galway. Dr Mutwali is a member of American society of nephrology and the Irish Society of Nephrology


Dr. Mohamed Eltom

Dr. Mohamed Abdelrahman Eltom, MBBS, MRCOG, MRCPI. He is a registrar in Obstetrics & Gynaecology, Portiuncula Hospital, Ireland. Dr. Eltom graduated from the University of Juba School of Medicine in 1994, before completing his basic training in obstetrics & Gynaecology in Ireland Dr. Eltom completed a fellowship programme in Cancer Epidemiology & Genetics at the National Institutes of Health (NIH), Bethesda, Maryland, USA in 2002. He completed two research projects in HIV related cancers in the USA and Nigeria both of which are published in peer-reviewed leading American journals (JNCI, AIDS), he also conducted clinical trials among pregnant women infected with HIV in Malawi in collaboration with the Johns Hopkins University School of Public health, Baltimore, USA. In addition to his membership, Dr. Eltom obtained a diploma in women health and a fellowship in Laparoscopic surgery; he is a member of the European Society of Laparoscopic Surgeons.

Mr. Eric O’Flynn

Eric O’Flynn is the assistant programme director of the RCSI/COSECSA collaboration programme and divides his time between Dublin and east, central and southern Africa. He previously worked in teacher training and worked as a consultant, education manager and director of an education charity in Rwanda.

Dr. Diarmuid O'Donovan

Dr O`Donovan is a senior lecturer in Social & Preventive Medicine at NUI Galway and Director of Public Health in the Health Service Executive (HSE West, Galway). He is a Project Leader in the Health Promotion Research Centre. He qualified in medicine in NUI Galway and in Public Health at the London School of Hygiene & Tropical Medicine. He trained in General Practice and Public Health Medicine in England. He lived and worked in Africa for seven years. His research interests include: Equity in health, Health Policy, Communicable Disease Control and Environmental Health, Reproductive, maternal and child health, Sexually Transmitted Infections and HIV/AIDS, Health and Human Rights, Global Health and Development. He is a member of: Irish Aid Technical Advisory Group on HIV/AIDS and Global Communicable Diseases (member), Irish Forum for Global Health (member, previous chair), European Malaria Vaccine Initiative (member of the Board, current vice-chair Public Health Alliance Ireland (Board member).


Dr. Safa I A Abdalla

She graduated from University of Khartoum with MBBS in 1999, and MD in Community Medicine in 2007. She acquired membership of the Faculty of Public Health Medicine of Ireland, RCPI, 2012. She worked as Teaching Assistant and then Assistant Professor in University of Khartoum, Department of Community Medicine. After moving to Ireland took up academic and research positions at UCD School of Public Health and Population Science, and the Institute of Public Health jointly with University College Cork. She Conducted research in Burden of Disease in Sudan, ethnic and socio-economic inequalities in life expectancy and healthy life expectancy in Ireland and injury epidemiology in Sudan and Ireland. Member of the Sudan Public Health Consultancy Group, a partner of the Federal Ministry of Health in Sudan and the Faculty of Public Health UK

Dr. Imad Brema

Dr Brema graduated from the University of Khartoum in 1998. He started his training in Ireland in July 2003 and obtained his MRCPI in 2005. He worked as a Clinical Research Fellow in Diabetes, Obesity and Insulin Resistance (2005-2007). He then worked in Tallaght Hospital where he was appointed as a clinical tutor for TCD undergraduate medical students and was also appointed as a part-time lecturer to TCD postgraduate MSc students in Clinical Chemistry. Dr Brema presented his research at national and international meetings such as the Irish Endocrine Society (IES) and the American Diabetes Association and has been invited to present at the American Endocrine Society meeting in June 2012. Dr Brema has published in peer-reviewed leading journals such as Diabetes Care, Diabetes, Obesity and Metabolism, QJM and IMJ. He has finished and submitted an MD thesis to TCD, University of Dublin. He is also a member of the Royal College of Physicians and Surgeons in Glasgow, IES and EASD. Dr Brema is currently a senior registrar in endocrinology in St.Vincent’s University Hospital (UCD). His main research interests are in the areas of type 2 diabetes and insulin resistance.

Dr. Mohammed Bashir

Dr.Mohammed Bashir, MBBS, MRCPI, MD. He is a Registrar in Endocrinology in Beaumont Hospital, Dublin. He graduated from University Of Khartoum in1999. He completed his general medical training in Ireland, and obtained the membership (MRCPI) in 2006. He obtained his special training in Endocrinology and Diabetes, and completed MD degree at the University College of Dublin in 2011. Dr Bashir's main research interests include insulin resistance, type 2 diabetes mellitus, and diabetic nephropathy. He is currently a Registrar in Endocrinology


Dr. Mohamed Elshafi

Dr. Mohamed Elshafi, MBBS, MRCPI. He graduated from University of Khartoum, Sudan in 2003. He gained the membership of The Royal College of Physicians of Ireland in 2010. He completed his general professional training in General Medicine (CCBST) in University Hospital Galway in 2010. He is currently appointed as a Registrar in the Department of Respiratory medicine in University Hospital Galway. He is currently working towards gaining an MSc degree in Clinical Research from The National University of Ireland Galway

Dr. Zuhair Ali

Dr. Zuhair Ali, MSc Clin. oncology, PG Dip Med EDu, DPH. Dr. Zuhair is currently working as a Radiology Registrar. He is a member of European society of Radiation Oncology ESTRO, and International Cancer Imaging Society ICIS. He has a special interest in Cancer imaging and Image guided Radiotherapy. He is also interested in medical education curriculum design, assessment and professional development aspects. He is involved in providing guidance for staff development and curriculum design for the Academy of Health Sciences AHS in Sudan.

Dr. Khalifa Elmusharaf

MBBS, PGDip, FRSPH, PhD(c). Dr. Khalifa Elmusharaf is a PhD researcher in Health System & Policy with focus on access and equity for maternal, newborn & child health in fragile states at National University of Ireland Galway. He is the Head of Reproductive & Child Health Research Unit ‘RCRU’ at University of Medical Sciences & Technology ‘UMST’; Khartoum - Sudan. He has ten years of experience as obstetrician, researcher, project manager, lecturer and health system specialist in academia, ministries of health, and International organisations. Dr. Elmusharaf is a Fellow of the Royal Society of Public Health (UK) (FRSPH) and a certified consultant in Reproductive health in crises, Quantitative and Innovative Qualitative Research, with experience in maternal, newborn & child health, human resource for health, community based initiatives, Participatory Ethnographic Evaluation & Research, Participatory Health Communications, Community Readiness Assessment, Critical incidents technique, reflective photography, and health system & policy research.

Frederick House

19 South Frederick Street, Dublin 2

Telephone: +353 1 863 9700 Facsimile: +353 1 672 4704

Website: www.rcpi.ie Email: [email protected]

ID 3175Migration of Sudanese Doctors Dynamics and Opportunities

09 June 2012

Brothers of CharityCo. Galway

Re: Application for Approval of an Educational Event for CPD Accreditation

Dr. Mohammed Ahmed

Further to your application for CPD accreditation for the above activity, please find enclosed a CPD Meeting Approval Form indicating the number of credits your activity has been awarded.

I have also enclosed for your convenience a template CPD certificate which can be photocopied or pasted onto your headed paper and given to those who attended to record their CPD credits, together with an attendance register template. Ideally, certificates should be provided to attendees by email to facilitate recording in the e-Portfolio for Professional Competence. You should retain the signed attendance register in a safe place for a period of five years following the date of the activity.

Yours sincerely,

Dr Mary HolohanChairEducation Committee

Meeting Title:

Date:

Dear Dr. Ahmed,

REF: 3175

07 June 2012

Registered Charity in Ireland Ref. CHY1897

Frederick House

19 South Frederick Street, Dublin 2

Telephone: +353 1 863 9700 Facsimile: +353 1 672 4704

Website: www.rcpi.ie Email: [email protected]

CPD Event Approval

Title of Event Migration of Sudanese Doctors Dynamics and Opportunities

Please note that 1 hour = 1 credit andfractions of credits are not recorded.

However, 1 credit is allowed if the

meeting runs over for betwen 30-60minutes.

6

Organiser Dr. Mohammed Ahmed

Co. Galway

Approved for CPD

Dr Donal Reddan FRCPIHonorary SecretaryEducation Committee

Assessor

Credit(s):

Brothers of Charity

07 June 2012

Category: External

Event Date 09 June 2012

ID:3175

Registered Charity in Ireland Ref. CHY1897

Sudanese doctors: opportunities in the face ofchallenges

July 9, 2012Submitted by AshtonAlso published on globalhealth.ieCountry IrelandFiled under Resources0 Comments

The achievements, challenges, and future direction of Sudan’s health system were outlined recently by the FederalMinister of Health for Sudan, Bahar Abugarda.

Speaking at the recent Migration of Sudanese Doctors: Dynamics & Opportunities Conference in Galway, Ireland (9 June2012), Abugarda did not shy away from discussing the difficulties Sudan faces, particularly in terms of Sudanese doctormigration. However, Abugarda, like many other presenters, expressed similar sentiments to Dr Faisal Mihaimeed,President of the Sudanese Medical Association UK and Ireland, that the conference “will mark the beginning of a newdawn on the [Ireland-Sudan] relationship.”

Minister Abugarda discussed the double burden of communicable and non-communicable diseases that Sudan’s healthsystem now faces. He noted that coverage of primary healthcare and equitable access remain key challenges. Sudan’shealth workforce is concentrated in the large urban centres, creating problems of access in rural areas. There are stillweaknesses in the nursing, paramedic, and midwifery sectors in terms of training and capacity.

In particular, the minister stated a need to focus on investing in postgraduate education and training, reproductive health,human resources for health, and health systems management. Spending on healthcare as a percentage of the nationalbudget has yet to reach its targets and needs to increase dramatically. While there has been a slight increase inspending over the past few years, reduction of maternal mortality rates, reduction of child mortality, and improvements inTB and malaria control, the figures are still cause for concern.

Nuha Ibrahim, researcher at Trinity College Dublin’s Centre for Global Health, presented the negative impact doctorsmigrating from Sudan is having on its health delivery. She discussed the push and pull factors that lead many doctorsand medical students to emigrate from Sudan to Ireland. With this migration comes a loss of capacity, as well asincreased coordination and sustainability challenges. A retention strategy for healthcare professionals in Sudan andmigration management (a primary focus of the conference) remains a broad area that requires additional attention andwork.

Despite these daunting challenges, there are many opportunities for strengthening Sudan’s health system and tacklingissues of doctor migration. Minister Abugarda suggested several ways forward for Sudan. Interventions being consideredand implemented include scaling up postgraduate medical education, scaling up programmes in nursing, midwifery,and paramedical training, focusing on quality assurance, and using and adhering to the World Health Organization’sGlobal Code of Practice on the International Recruitment of Health Personnel. Notably, Minister Abugarda alsoexpressed the need to focus on collaborative efforts with Sudanese doctors abroad and research institutions (includingIrish institutions, such as the Royal College of Surgeons in Ireland). He suggested a mobilisation of expertise in hostcountries.

In terms of doctor migration, Sudan is using the National Health Observatory to keep a database on emigrating healthworkers. Collecting better data will be essential for improving migration and capacity-building policies. There is now agreater political awareness surrounding migration issues, which will help in the coming years as Sudan, Ireland, andmany other countries seek to become self-sufficient in supplying their own healthcare workforce. While challengesremain, the migration of Sudanese doctors conference also highlighted the progress that has been made in this areaand opportunities for the future.

Posted by Ashton

I work with the Irish Forum for Global Health & I am a recent graduate of the MSc in Global HealthProgramme at Trinity College Dublin. Originally from the U.S., I am passionate about advocacyaround the issues of gender & health, children’s well-being, & food security. Some of my previousexperiences includes work with the Irish Joint Consortium on Gender-Based Violence, EuropeanInstitute of Women’s Health, & the Massachusetts Domestic Violence Council.

Building castles: Sudanese-Irish collaboration on doctormigration challenges

July 9, 2012Submitted by AshtonAlso published on globalhealth.ieCountry IrelandFiled under Resources0 Comments

“Tri na cheile a Thogtar na Caisleain.” (We can only build a castle if we work together.)

These were the words that Dr Abobakr Shadad, lecturer in medicine at National University of Ireland, used to welcomeparticipants to the Migration of Sudanese Doctors: Dynamics & Opportunities Conference in Galway, Ireland last month (9June, 2012).

The conference was the first Irish conference of the Sudanese Medication Association (of UK and Ireland), and tookplace over the course of three days in both Galway and Dublin. Dr Shadad’s phrase set the tone of the event with manyspeakers focusing on the theme of collaboration. In particular, Mr. Bahar Idriss Abugarda, Sudan’s Federal Minister ofHealth (FMOH), echoed these sentiments, stating that he wanted to take the opportunity to “encourage and welcomecollaboration and bilateral agreements with Ireland.”

Why collaborate?

Why is collaboration essential to tackling doctor migration issues? Is there much value in such partnerships, or is itsimply all rhetoric? Currently there’s a large deficit of doctors in Sudan as many emigrate. As Dr Elsheikh Badr,President of the Academy of Health Sciences at FMOH Sudan, reported, in 2005 approximately 60% of Sudanese-traineddoctors emigrated, and the trend appears to be increasing. The doctors tend to leave for the Gulf countries, the UK,Ireland, and more recently Libya.

Ireland is a country that relies heavily on foreign-trained doctors; Sudanese-trained doctors are increasingly important forthe Irish health system. Collaborative efforts allow Ireland’s government and research institutes to develop a clearerpicture of current training needs in Sudan and act on these needs. Overall, partnerships between Sudan and Ireland –through research as well as direct bilateral engagement – aim to help manage doctor migration in the hopes ofmaximising benefits for both countries.

Methods of collaboration

Speakers at the conference suggested several ways Ireland and Sudan may collaborate on issues of Sudanese doctormigration.

MOU/bilateral partnership

On 9 June conference proceedings were temporarily interrupted for the signing of a Memorandum of Understanding(MOU). Sudan’s Federal Minister of Health (FMOH), the Academy of Health Sciences, the School of Nursing andMidwifery at NUI Galway, and the Sudanese Medical Association took part in the signing – a significant step forward inbuilding a bilateral partnership between the two countries. Such collaboration aims to bring about mutual benefits andprotection for professionals against possible exploitation.

Training exchange/twinning

Several presenters focused on the need for training exchange and hospital/medical centre twinning. Ms Helen Burke, anadvanced nurse practitioner in diabetes, discussed the pairing of the Diabetes Day Centre, University Hospital Galway.The centre ran a small training exchange programme that brought two diabetes nurses from Sudan to Ireland. Shereported a positive overall experience, with the nurses being able to take ideas back to their own centre. With astrengthened skill-specific training curriculum, it may be possible to develop similar, larger-scale programmes in otherspecialities.

Mr Eric O’Flynn, of the Royal College of Surgeons in Ireland (RCSI), reported on the RCSI collaboration with the Collegeof Surgeons of East, Central, and Southern Africa (COSECSA). A ‘college without walls’, COSECSA is currently in ninecountries. It is a growing and evolving training programme focused on e-learning and distance exam administration.

COSECSA is unique because it is Africa-centred. The Sudanese Association of Surgeons has applied to join. Mr O’Flynnstated he is delighted to be working with Sudanese colleagues. He thinks “the future is very bright for this” and othercapacity-building initiatives.

Twinning of hospitals is another means of collaboration that received significant attention at the conference. In February2012, Ireland joined the ESTHER Alliance – a network of governments working to tackle major diseases and healthcareissues by twinning European hospitals to those in developing countries. At the conference Dr Mohamed Eltom, ofPortiuncula Hospital, Ireland gave a presentation on saving mothers’ lives in which he briefly shared the experience ofthe Omdurman Maternity Hospital’s collaboration with Irish universities from 2000-2009. He stated that such“collaborations…have proven to be effective in the past” and should similarly be pursued now and in the future.

Dr Ruairi Brugha, of RCSI, discussed practical training for Irish-trained medical students and doctors in Sudan. He andseveral colleagues suggested that a programme for a short training in Sudan (perhaps a month or two) would allowdoctors trained in Ireland to give back to Sudan and also help them to gain practical training in certain areas such astropical medicine.

Continuing open dialogues

Several speakers noted the importance of the conference itself as a forum for engaging on challenging topics. Keepingan open dialogue between medical professionals, academics, and policy makers in Sudan and Ireland is crucial formoving forward on key issues. This will help encourage compliance with the World Health Organization’s Global Code ofPractice on the International Recruitment of Health Personnel, which is not only about ethical recruitment, but alsoincludes regulations for health system development, health system management, and fair treatment of health workers.Continuing the dialogue on this topic between the two countries gives Ireland the opportunity to identify pressing trainingneeds in Sudan on which Ireland can collaborate. Given the volume of Sudanese doctors in Ireland, it is important to askwhat Ireland can be doing to build capacity that would “help meet the health needs of Sudan and help those doctors whowant to return to Sudan”, as stated by Dr Brugha.

It is an exciting time for Sudanese-Irish collaborations around the issues of doctor migration and training. Theseinitiatives must remain truly two-way in nature, as each country has experience and expertise to share with the other. It isonly through partnership and working together that they will build castles – or rather, policies and collaborative initiativesthat benefit both countries.

Posted by Ashton

I work with the Irish Forum for Global Health & I am a recent graduate of the MSc in Global HealthProgramme at Trinity College Dublin. Originally from the U.S., I am passionate about advocacyaround the issues of gender & health, children’s well-being, & food security. Some of my previousexperiences includes work with the Irish Joint Consortium on Gender-Based Violence, EuropeanInstitute of Women’s Health, & the Massachusetts Domestic Violence Council.

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SMA UK & Ireland. Galway conference report 2012

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