From the President - November 2017

Photo: Amanda with Dr Dany Daham and Rania the social worker

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‘Measure this’ ….

One of the many challenges of being a family doctor is to try to reconcile different world views. As a family doctor, the tension is often between my own beliefs about what might benefit a patient, and what the system or their own worldview makes possible. At team and service level, it is often about getting enough people together to discuss some key issues, gather relevant evidence, agree to make a change, and actually implement this: keeping everyone on board and carrying through on good intentions. At the macro level, there seem to be an increasing number of players wanting to produce measures of good primary health care – so should such measures be about the patient’s perspective, the clinical activities undertaken, the team dynamic, or of innovation and quality improvement. And what might such measures miss?

They might miss the exceptional work of some family doctors and their colleagues in undertaking genuine whole community based approaches to improving health and life opportunities; as I saw manifested in a visit to the Tahaddi clinic in Beirut (Lebanon), in October.

Tahaddi clinic is next to one of the main Palestinian refugee camps, and provides health services to a population who live mostly in shanty housing. Over 65% of these patients are Syrian refugees, while the remaining 35% are Lebanese residents of the area. This includes a proportion of ‘Dom’ families, who are related to the Roma of Europe, and are among the most socially marginalized communities in the region. The Foundation also provides social services, early years education, literacy skills, and the start of some income stream and new employability through initiatives such as sewing classes. The GP who I met (Dr Dany Daham) has been there 14 years, and he and his colleagues were, clearly, both highly committed and passionate about the importance of their work. You can read more here and an additional document resource is available to download at the end of this article.

I was fortunate to visit Tahaddi while joining the national meeting of the Lebanese Society of Family Medicine, and meeting friends and colleagues at the WONCA East Mediterranean region Council. This was an excellent meeting, and I was glad to learn of a more settled situation in Lebanon, in spite of the tensions over the Syrian border and an estimated two million of the population being refugees.

I then attended my own member organisation’s conference, where a number of WONCA friends were present. There was an excellent workshop on migrant health led by Chris Dowrick (chair WONCA Working Party on Mental Health), Maria van den Muijsenburgh and Christos Lionis (chair and member respectively of the WONCA SIG on Migrant International Health and Travel Medicine). The displaced peoples of the world continue to be a focus of need and there are many lessons to be learned on both how to prevent added distress and maximise health protection.

I am writing this from a crowded airport (six countries and eight overseas trips in two months –and not over yet…) en route back from the European General Practice Research Network (EGPRN) meeting in Dublin, where mental health research in primary care was the key theme. I constantly value the evidence produced by our academic colleagues, also noting how our working parties draw this into guidance for practice (see other recent work of the WONCA Working Party on Mental Health), and thank all of them for bringing together the evidence. We hope to run more events for academic members at our regional and global conferences.

And that brings me back to the joys of the big recurring ‘discourse’ about how to measure primary health care performance. I was amused, and puzzled, by the extreme contrasts between two meetings - one in Paris (Organisation for Economic Cooperation and Development) and one in Washington DC (the third ‘Starfield Summit’ run by the Robert Graham Center), where I was attending as an ‘expert resource’. The Paris meeting reviewing a choice of measures, trying to produce a minimum dataset, and was highly technical; the US meeting was asking much broader questions about ‘what does good look like in primary care, and how could we measure it’? I have not had reports from either meeting so am unclear where this journey has taken me or us. What did trouble me was that more energy seems to be going into measuring than establishing primary health care in many countries. You can argue that by measuring you find the gaps – but we need to encourage energy to go into provision of services, and the very fundamental measurement of who is working in which sector and doing what. As Bob Phillips’ policy bite suggested last month, “… the PHC setting in which the majority of people receive health care—and the setting in which performance often dictates downstream costs—is woefully underfunded in most countries relative to other healthcare settings.”

So the arguments – and the evidence building – continues. On the issue of evidence building, we have also been bidding for grants to conduct projects that will enhance our outputs and strategy – hard work, adds to the busyness, but will be worth it if we get it – and again highlights the importance of our academic work and the colleagues who can lead it.

As the dark months approach in the north, and the light is passed to the south, we look forward to the regional conferences in South Asia (Nepal) and Asia Pacific (Pattaya), as well as our next WONCA World Executive; and another set of regional North America meetings (Canadian College, also the North American Primary Care Research Group, following the American Academy meeting in September).

I look forward to meeting more colleagues, sharing our wisdom, and exploring new arguments and solutions. Thanks, as always, for everyone’s effort everywhere. As I said in one of my (many) recent keynotes – “So remember as you go that there are many, many GPs in this world, working for similar things, and let that be a strength to us all as we try to make both our own careers and those of others work well. You never know where it may take you!”

Amanda Howe
WONCA president

More information about Tahaddi