Education Exchange Programme
Providing short-term trainee clinical placements at Kumi Hospital, Eastern Uganda
We provide important, reciprocal learning experiences for trainee GPs and clinicians from the UK and local clinical staff through short-term placements at Kumi Hospital in Eastern Uganda.
We aim to send six trainee GPs/clinicians on placements every year.
These placements enrich UK medical training and improve clinical outcomes in both countries.
Each placement costs a little under £3,000, including all clinical expenses, travel and accommodation.
Recognising an opportunity to supplement the training of General Practitioners (GPs) during their clinical placements at Mildmay, Chief Executive Geoff Coleman and Medical Director, Dr Simon Rackstraw FRCP, developed the concept for the Education Exchange Programme (Ed Ex) to facilitate short-term electives for trainee GPs at Kumi Hospital.
The United Kingdom takes pride in the high standards of its medical professionals. Still, we firmly believe that a crucial addition to their training is the experience of delivering healthcare first-hand in a developing world context, where the abundance of facilities, resources, networks and safety nets that our highly trained clinicians are accustomed to are not readily available.
Trainee GPs can greatly benefit from the opportunities provided by working in low and middle-income countries. A small number of doctors, understanding the benefits of doing so, already undertake these exchanges independently, and Mildmay intends to provide this opportunity to all our trainee GPs.
During their Ed Ex placement, our doctors learn about the challenges of delivering healthcare in a
resource-limited setting, gaining direct experience in developing the skills and knowledge to enhance their GP practice. Ed Ex will also help them to develop a greater understanding of the challenges and opportunities of delivering healthcare in low and middle-income countries.
To demonstrate the feasibility of the programme, two doctors completed a successful pilot placement at Kumi Hospital in Uganda in March 2023.
Dr Helen Rochford And Dr Amy Cleese, the trainee GPs who completed the pilot visit in March 2023
Following on from the successful pilot visit, we are widening the programme to encompass other clinical practitioners, such as physiotherapists. We propose to facilitate six placements a year in three groups of two for 14-day placements for an initial programme duration of three years.
The Ed Ex Programme’s benefits for UK clinicians
The Ed Ex Programme offers numerous advantages for clinicians, including widening their clinical skills and experience while applying their training in real-world circumstances that differ greatly from their experience in the UK, engendering greater appreciation for the dedicated clinical teams operating under challenging conditions and bringing their much need skills to bear in a region where the availability of high-quality healthcare is limited.
The Programme is relevant to all clinical experience groups in the Royal College of General Practitioners (RCGP) curriculum. In addition, the education exchange is relevant to many RCGP curriculum capabilities, in particular, “Practising holistically, promoting health and safeguarding”, “Working with colleagues and in teams” and “Maintaining performance, learning and teaching”.
UK-based medics encounter different illnesses and techniques than they would in the UK and learn about differences in how patients are treated, gaining direct experience of how medical professionals must assess and manage communicable and non-communicable diseases. In addition, they increase their exposure to patients presenting with advanced non-communicable diseases and see presentations that are very rare in the UK.
The education exchange allows clinicians to reflect on different approaches to medical management in resource-limited settings and the management of risk in uncertain situations.
Furthermore, some benefits of the education exchange visit link to the NHS healthcare leadership model.
Completing a placement abroad is a valuable addition to a clinician’s CV and can be one of the most exciting and motivating parts of their medical training whilst greatly enhancing their employability.
Time spent overseas teaches useful lessons to implement back home, highlights strengths and weaknesses, and reveals how doctors work under a very different set of circumstances.
It demonstrates a willingness to step outside their comfort zone, have a keen interest in global affairs, and a desire to broaden their horizons. In addition to their general development, their improved ability to work in resource-limited settings, enhancement of soft skills, a greater appreciation for the National Health Service and a better understanding of working within foreign healthcare systems are important gains.
Kumi Hospital
Benefits to the host country
In exchange, visiting GP trainees improve access to healthcare by imparting high-quality, up-to-date knowledge and care to patients who might not otherwise be able to access it.
They can help to improve the quality of care over the longer term by sharing their knowledge and skills with local healthcare professionals, shaping and improving the working practices of the clinicians they are working alongside. Visiting GP trainees can also help to improve the morale of local healthcare professionals by providing guidance, support and encouragement, and in the longer term, build support networks to share knowledge and skills.
These relationships can benefit both sides, as they can share information and resources and help to promote collaboration on research projects and training initiatives. Transferring skills and knowledge is important in capacity building and strengthening health systems.
In Uganda, as in other low- and middle-income countries, the burden of disease is shifting from tropical and infectious diseases to non-communicable diseases (NCDs) such as diabetes, kidney disease, and chronic lung conditions.
A 2021 assessment found that Uganda has been overwhelmed by the growing burden of NCDs - a major cause of death and disability. Of the 97,600 deaths in Uganda in 2016, NCDs accounted for 1 in 3 of them.
“In Uganda, about eighty per cent of the health worker force lives in big towns, which constitute about twenty per cent of the population,” says Dr Robert Kalyesubula, founder of the African Community Centre for Social Sustainability. This creates a great imbalance in the number of health workers available to provide services to the majority of Ugandans and NCDs are “often left untreated”.
Kumi Hospital
Mildmay’s partner in the Ed Ex programme in Uganda
Kumi Hospital is a 300-bed, faith-based, rural hospital (and NGO) located about seven kilometres from Kumi Town in Eastern Uganda, with a reach of approximately 4 million people. Despite being in a resource-limited setting, Kumi Hospital is able to offer medical and surgical interventions using methodologies to World Health Organisation standards. Most patients are on very low income and must meet the cost of their bills, as there is no national insurance policy in Uganda. The doctor-to-patient ratio is high (one estimate is one doctor to 20,000 patients, whereas The World Health Organisation recommends a ratio in Africa of 1 doctor to 10,000 patients).
Founded in 1929 as a leprosy treatment centre, Kumi became a general hospital in 1996, providing rehabilitative and reconstructive surgery. The hospital has an excellent reputation – people come from a long way - even as far as South Sudan, to be treated at there. Kumi is a preferred destination for patients seeking HIV antiretroviral therapy. It registers numerous referrals per day, varying from surgical, orthopaedic, general care and obstetrics, among others.
The hospital has experience in hosting international students as it receives medical students from both local and international universities who come for their internship in tropical medicine and public health and participate in social activities in local communities. Using Kumi as a base, students can travel to remote areas that are difficult to reach to do outreach work. Students placed at Kumi Hospital do not just to extend their medical education but gain invaluable life experience.
Dr Simon Rackstraw and CEO Geoff Coleman with staff at at Kumi Hospital (3rd and 5th from left), respectively
Kumi Hospital clinicians
Patients waiting for treatment
Nurses at Kumi Hospital
GP training in the United Kingdom
GPs (General Practitioners) must train for four to six years at medical school and achieve a medical degree, followed by a two-year foundation training programme in the UK or overseas.
Thereafter, specialist GP training is at least three years full-time, normally including 18 months in approved hospital posts and 18 months in an approved GP practice.
To avoid increasing the financial burden on the trainee GPs/clinicians undertaking a placement at Kumi Hospital, we are asking for your charitable support to run the Ed Ex Programme for an initial three years.
An objectively small amount is required to provide this opportunity for students to enhance the value of their time at Mildmay greatly. It is, however, a significant investment in improvements to healthcare in both the UK and Uganda.
Each placement for two UK practitioners costs a little under £3,000, including all clinical expenses, travel and accommodation.
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Cost of placements per year: £18,000
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Number of placements per year: 3
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Number of trainee GPs per placement: 2
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Duration of placement: 14 days