International education
After extensive travel and work overseas, John Yudkin helped to set up the International Health and Medical Education Centre at University College London. Padimasayee Papineni finds out about his work and what spurs him on
PHOTO BY FRED SCHUURHOF
How did your medical career begin?
I did my preclinical studies at St John's, Cambridge, and my clinical studies at University College Hospital, London, and qualified in 1967. It was at medical school that I met fellow student Gill, who is now my wife of 39 years' standing; we got married one year into our clinical course.
During our house jobs in London, Gill and I decided that we wanted to work abroad and applied to the Voluntary Service Overseas to go to India. The only placement for two doctors together, however, was in northern Tanzania, which we accepted.
Tell us about your experience working in Tanzania
We arrived to tropical heat and began work in a government hospital in a town called Mwanza. Gill was responsible for the paediatrics, and obstetrics and gynaecology wards, and I was responsible for the general adult medical ward. There were an enormous number of patients, but to our surprise not all had rare tropical diseases. Lots had malaria and hookworm, but also lots of patients had pneumonia, heart failure, and diabetes. You have to bear in mind that we were only a year out of medical school. I approached clinical situations with the arrogance of youth, and looking back I feel embarrassed at my self confidence. But the experience sowed the seeds for my interest in international health and love for Tanzania, and I consider it to be one of the greatest privileges to have been accepted there.
After working there for 15 months, we took the opportunity to travel. We had bought a van in Tanzania; it used to be an old Coca-Cola van and in a certain light you could still see the Coca-Cola sign in silhouette. We got the van onto the boat at Mombasa, went to Bombay, and drove back overland through Pakistan, Nepal, Afghanistan, Iran, Turkey, and Europe--you could say that we took the long way round back to London.
In what ways have your travels shaped your interest in health and development?
I have returned to east Africa on many occasions. For example, I spent two years, 1975-7, working as a senior lecturer at the University of Dar es Salaam. In 1989, when Gill had a sabbatical working with the Voluntary Service Overseas as a selector, I worked with an aid agency called Action Health, and also had the opportunity to visit voluntary projects. This was really interesting--we had the shared experience with the volunteer health workers but also the advantages of hindsight and some degree of maturity to go with it.
When I returned from a trip to Tanzania in 1999, however, I started thinking about the deeper issues to do with health and development, especially as the debates about debt relief had reached the global spotlight. When we were in Tanzania in the 1970s it was the centre of African development, with Western aid being invested to develop health care and education. By the time I was back there in the late '90s, all that had changed. The library in Dar es Salaam in the mid-1970s was wonderful, well stocked with current medical journals. When I went back in 1999, the library had not had a new book in three years and all the journals had been cancelled, as they could no longer afford them. I felt strongly that Tanzania had been abandoned by the rest of the world.
How was International Health and Medical Education Centre created?
The changes I witnessed in Tanzania made me contemplate the deficiencies in international academic relationships, in particular the ignorance of Western medical institutions to the issues of availability that developing countries are struggling with. I felt that focusing on raising consciousness among medical students in a more structured way was a key step. I went to see Bob Souhami, the dean of the medical school. A week earlier he had been visited by a group of student activists--Sarah Finer, Victoria Wykes, and Ella Rachamin--who were concerned about global health issues. When I approached him, therefore, I was pushing against an already open door. He loved the idea of an international health centre and facilitated a grant to employ a tutor and administrator--Catherine Bateman--who played an important role in helping to set up the International Health and Medical Education Centre by 2000.
What do you regard as the most enjoyable aspect of working with International Health and Medical Education Centre?
The enthusiasm of the students. To find a group of people who are interested and concerned, and who are working really hard to acquire new intellectual skills and to argue and debate in a coherent way is exciting. I feel a sort of paternal pride; there is a Yiddish word--"nuchas"--that I learnt from my grandmother, which is a feeling of being plumped up with pride. That describes how I feel when I see and hear of the achievements of the students.
What is your advice for students?
Be curious and ask questions; it is a questioning mind that undoubtedly provides the answers. Follow your instinct, and do, in your training and jobs and career, exactly what feels right for you. In my view the days of "blinkers on and aim for the finishing line" training are over. So if you want to do a special subject module in French literature or an intercalated BSc in (dare I say) international health, as opposed to cancer biology, that is great. And that applies to life after qualifying. Travelling or taking a year or two out to work for a non-governmental organisation or to do journalism or to train in acupuncture adds to a person's quality. People with a portfolio encompassing these sorts of things are usually much better doctors for having done so, albeit a year or two older than if they had gone by the direct route. Medical training is a passport--and not just for travel.
Padmasayee Papineni, final year medical student, University College London
Email: p.papineni@ucl.ac.uk
studentBMJ 2005;13:45-88 February ISSN 0966-6494
