GLOBAL NEUROLOGY REPORT: WORLD ASSOCIATION FOR MEDICAL LAW MEETING 2018

Dr. James Christopher Johnston

The 24th World Association for Medical Law (WAML) Congress held on 2-6 September 2018 in Tel Aviv, Israel.

The 24th World Association for Medical Law (WAML) Congress was held on 2-6 September 2018 in Tel Aviv, Israel.  Leading international experts discussed topics related to Global Health, Medical Law and Bioethics, with a particular emphasis on Humanitarian Medicine, Law and Ethics.

Drs. James C. Johnston and Mehila Zebenigus discussed the urgent need for guidelines to improve relations between the North and South, and thereby advance healthcare access in the least developed regions.

Dr. Johnston was the only member and representative from New Zealand, and Dr. Zebenigus represented Ethiopia.  They explained that the most effective way to improve healthcare access is to establish local training programs in developing regions.  However, this requires international support which has been hampered by the unprecedented growth of global health programs, especially at United States academic medical centers.  This growth is attributable to a number of factors unrelated to improving patient care – factors such as establishing a reputation or ‘brand,’ increasing publications, and generating revenue through government, private and charitable sources.

Dr. James Christopher Johnston discussed how these academic global health programs have created a scramble for Africa characterized by self-serving short term medical missions that are highly beneficial to the sending institution but fail to provide any substantive benefit to the host country.  In fact, he described how these types of medical missions can and do cause actual harm, thereby impeding medical care in the very regions where it is most needed.

Dr. James C. Johnston discussed the urgent need for guidelines that focus on ethically advancing collaborative partnerships between the North and South to improve health care. This topic followed Dr. Johnston’s lectures last year at the WAML meeting in Baku, Azerbaijan and the prior year in Los Angeles, USA, where he and Dr. Zebenigus highlighted the medical, ethical and legal problems created by Western countries engaging in short term medical missions to resource limited nations.

This year, Drs. James Christopher Johnston and Zebenigus focused on the specific guidelines and policy recommendations which they presented to the United Nations High Level Political Forum last year and earlier this year.  James C. Johnston, MD, JD is dually qualified and licensed as a board-certified neurologist and barrister, and uniquely qualified to deal with this very specialized area of international medical law.  Mehila Zebenigus, MD is a board-certified internist and neurologist well-versed in the intricacies of global health.

Dr. James Christopher Johnston was honored for his paper on this subject with the Davies Award for Public Health.  He dedicated this inaugural award to Dr. Zebenigus and the Ethiopian team.

In terms of disclosure, Drs. Zebenigus and Johnston are Directors of the non-profit organization Global NeuroCare® which focuses on advancing neurological services in sub-Saharan Africa and particularly Ethiopia.  Dr. Johnston serves as an Honorary Professor of Neurology at Addis Ababa University in Ethiopia.

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Global Neurology Report: Access to healthcare in Africa

Gondar Outpatient Waiting

Gondar Outpatient Waiting

The Economist Intelligence Unit recently published a report on access to healthcare in Africa and the Middle East. (www.accesstohealthcare.eiu.com). The report recognized the complex challenges of improving access to healthcare in sub-Saharan Africa, a region plagued by the ‘double burden’ of ongoing communicable diseases and rapidly increasing non-communicable disorders. These problems are compounded by a severe shortage of healthcare workers, poor infrastructure, limited transportation, and a dearth of supplies, equipment and medications.

The Economist Intelligence Unit Index ranked the countries on both (1) accessibility for most disease categories and access to medications, and (2) the healthcare system including coverage, infrastructure, efficiency and innovation. The Index evaluated progress considering current global policy agendas, such as the UN Sustainable Development Goals. It also adopted a forward-looking approach, asking whether each country is implementing the right mechanisms today for optimal access in the future.

Ethiopia ranked at the bottom in a cluster of other sub-Saharan countries. These least developed countries struggle with additional challenges such as underdeveloped supply chains for medications, a significant urban-rural gap in access and, most importantly, a continuing shortage of healthcare workers.

The increasing incidence of non-communicable diseases including neurological disorders is exacerbating poverty and significantly adding to the disease burden. The EIU reports that financial expenses of healthcare drive 11 million Africans into poverty every year. But, as Drs. James C. Johnston and Mehila Zebenigus discussed at the July 2017 United Nations High Level Political Forum, the situation is magnified by neurological disorders which afflict tens of millions of people, typically the young, causing cognitive impairment and physical disability, leading to loss of employment, marginalization, increased vulnerability and exclusion, contributing to a profound impact on the economy.

This EIU Report raises several suggestions for improvement including national health insurance, mobile technology applications, artificial intelligence platforms and focusing on specific disease threats. However, while these proposals may be beneficial if enacted, they do not address the key problem – a shortage of healthcare workers.

Drs. James C. Johnston and Mehila Zebenigus discussed these concerns at the 2017 World Association for Medical Law (WAML) conference and, while recognizing the many overwhelming challenges, recommended focusing on the root of the problem – the shortage of physicians and other healthcare workers. Africa has one-quarter of the global burden of disease but less than 3% of the world’s healthcare workers. The only way to ensure sustainable improvement if to ethically advance collaborative partnerships between developed countries and the least developed regions, with clearly defined goals, focusing on the needs of the South to establish self-sustaining programs that incorporate training, patient care and research, and provide triangular cooperation to improve South-South relations.

This focus on collaborative partnerships is the approach Global NeuroCare has adopted in working with the Addis Ababa University Department of Neurology, and that autonomous program has been extraordinarily successful, soon entering the 12 th year, having graduated 32 board certified neurologists, with 21 more physicians in the three-year training program.

Drs. Zebenigus and Johnston serve as Directors of the non-profit organization GlobalNeuroCare.org and will discuss guidelines for developing sustainable collaborative partnerships at future meetings with the UN, WAML and other organizations.