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Editor,—I agree with many of the sentiments expressed by Williams1 in his helpful article. I qualified in a developing country and started to practise as a part time general practitioner in “the capital”. I must confess that it did not take me long to realise that I was not prepared to recognise or handle the problems that were presented to me in my surgery. I became confused and disillusioned. I thought I needed to go to the West to learn, as my medical school had failed to prepare me properly.
In England in the late 1960s I soon started to work in hospitals, and despite the language barrier, I had no difficulties in recognising or managing problems. However, it took me several years to realise that the initial problems that brought me to the West were universal—namely, that teaching hospitals throughout the world do not prepare doctors to function in their communities. Patients in hospital are not representative of the population as a whole, yet almost 100% of medical teaching takes place in these centres of excellence. Graduates are ignorant about the sociomedical problems of the society. The introduction of vocational training schemes for general practitioners training in the UK is a response to this problem.
Medical schools worldwide still ignore this need or at best pay only lip service. If the native medical schools fail to impart appropriate knowledge to enable graduates to work and function in their own communities, how much more difficult will it be for a doctor from an entirely different cultural background? Even a well qualified community physician with great expertise in one country cannot assume that his or her skills will be appropriate in a completely different culture.
I have no doubt that both developed and less developed countries can learn from each other, but extreme care must be exercised not to have fragile and immature systems overtaken by pure philanthropic enthusiasm or self interest.
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