1. The Changing Role of Mission Hospitals: Mbingo Baptist Hospital Candice North, MD Family Medicine Resident Mayo Clinic, Jacksonville FL

2. 2 Activity Disclaimer I have no relevant financial relationships to disclose.

3. Objectives Describe the goals of the Alma Ata convention for primary health care Review barriers to advanced medical training in low resource settings Understand how Mbingo Baptist Hospital in Cameroon has developed an innovative residency program that aims to train local physicians and surgeons 3

4. Alma Ata Declaration of 1978 International Conference on Primary Health Care with the goal of ‘Health for All’ Defined health as: "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The definition seeks to include social and economic sectors within the scope of attaining health and reaffirms health as a human right. Goal was the attainment by all peoples of the world by 2000 of a level of health that will permit them to lead a socially and economically productive life. 4

5. Barriers in Achieving this goal Ratio of physicians to patients 5

6. Barriers- 2 International community focuses on disease specific targets and fundraising Brain Drain – the best doctors leave Lack of access to post-graduate training for medical school graduates…and it costs money to go to residency! 6

7. Partnerships are starting University of Michigan – Komfo Anokye Teaching Hospital in Ghana –1980s:OB-GYN (85 graduates) –2009: Emergency Medicine 7

8. Missionary Hospital Role If one of the missions of missionary hospitals is to improve access to medical care throughout the world, should they also be involved in local physician training in order to prevent brain drain? 8

9. Mbingo Baptist Hospital Cameroon Originally a leprosy village and rehab center Has been granted accreditation for Internal Medicine and General Surgery Residencies by the country of Cameroon Faculty and Program Directors are North American Baptist (NAB) Missionary Physicians Graduates credentialed to sit for board exams; COSESCA (College of Surgery for East, Southern, and Central Africa) and WACPS (West Africa College of Physicians and Surgeons) 9

10. CIMS Christian Internal Medicine Specialization: 4 year paid program similar to our FM training. 3 residents per year. 10 Well paid, ‘western’ structure emphasizes EBM Started in 2008, 7 graduates so far Emphasizes staying in Cameroon; graduates now work for their rural outposts when finished

11. CIMS Faculty are full time, supported through World Medical Mission and NAB funds. Highly dependent on additional NAB volunteer physicians 11 No oversight or partnership with any academic institution Possibly only situation of its kind?

12. PAACS Pan African Academy of Christian Surgeons 12

13. PAACS The five-year program began at Banso Baptist Hospital in Cameroon in 2004 then moved to Mbingo 70+ PAACS grads have all stayed in Africa upon completion of their training Now partnered with Loma Linda University and the Christian Medical and Dental Associations of the United States for funding and volunteers Expanding: Gabon, Nigeria, Kenya, Ethiopia, Kenya 13

14. Future Directions Mbingo applying for ENT fellowship (would be only one in Cameroon) and OB-Gyn residency Need for surveying quality of care from their graduates 14

15. Final Thoughts Increase in QUALITY general practitioners and training options is the only way to bridge the gap in physician/patient ratio More partnerships needed with ‘western’ institutions to train high quality local physicians. The return on that investment far exceeds our short term mission trips Christian residency programs will alienate non-Christian Africans from attaining advanced training 15

16. References World Health Organization 2010, World Health Statistics 2010, ISBN 978 92 4 156398 7, World Health Organization, Geneva 27, Switzerland, viewed 16th September, 2010 University of Michigan Center for Global Health: Ghana Platform Textbook in International Health, sec edition. Paul Basch. Table 3-1 ‘Trends in Internation Health,’ p48. www.paacs.net Lancet 2009; 373:1993-95. ‘Towards a common definition of global health.’ Jeffrey Kaplan. Lancet 2000; 356:841-846. ‘Public Health in developing countries.’ 16

17. 17 Questions?