A Bit Of Philosophy

A bit of philosophy:


  1. There is not a person on earth who chose his genome, or the country of his birth, or the political and economic conditions that prevailed at moments crucial to his progress. (Sam Harris – neuroscientist / philosopher)


  1. Given that we are equipped with the capacity to sympathize with others, nothing can prevent the circle of sympathy from expanding from the family and tribe to embrace all of humankind, particularly as reason goads us into realizing that there can be nothing uniquely deserving about ourselves or any of the groups to which we belong. We are forced into cosmopolitanism: accepting our citizenship in the world. ( Steven Pinker- cognitive psychologist)


  1. Thought experiment: You walk past a lake and see a child drowning. Do you jump in and save her life even though it will cost $500 to replace your ruined suit? (Peter Singer-philosopher)


A bit of reality:


Here is an analysis of the good that doctors likely do. You may find it quite interesting and a bit sobering.


Interview with Greg Lewis



A bit of economics:


  1. Successive Australian governments have severely cut back foreign aid.
  2. You can almost certainly double your impact as a medical care provider on a global basis for a few hundred dollars. (If in doubt, read the article above)
  3. Your donations are fully tax deductible…..and it’s nearly June 30th.



Mercy Ships

Dear colleagues,


Recently there was an article in Medscape about volunteering on Mercy Ships which go to Africa to perform surgery on the desperately deprived. There is no doubt that this would be a fantastic experience but as the comments section of the article revealed, there are certain drawbacks and limitations of this type of volunteering such as;


  1. The dollar cost and substantial opportunity cost of going.
  2. The fact that, for example, a paediatric endocrinologist or a rheumatologist is not exactly what’s needed nor a specialist cardiologist or a dermatologist.
  3. The time away from one’s family and one’s own patients back home. (Usually many months.)


I think this is where the Twice the Doctor concept comes in. Just one day’s work a year (or part thereof) and you can effectively empower/ train/employ the precisely required African health worker for the most pressing medical needs. These doctors and nurses speak the local language and use their wages to help enrich the local community. They are also there for effective follow up. The training is often specific in order to avoid “brain drain” through emigration.


It would certainly be an unforgettable experience to work on a Mercy Ship but in reality we can all do a whole lot of good for African patients without ever leaving shore.


Remember, Twice the Doctor is about using your heart AND your head to leverage your medical skills for maximum effect to help developing world patients.




Regards to all


Rob Baume

(on behalf of the directors of TTD)

  1. Doctors Day in May is this Friday.
  2. Your contribution is fully tax deductible.
  3. The directors of TTD cover all the administration fees of the foundation so your donation goes even further.


Annual Doctors Day in May 2018

Dear colleagues,

May is well and truly upon us and it’s time consider your donation to Twice the Doctor foundation for this year. You have been generous in the past and hopefully will be again. You should not lose sight of the fact that in terms of quality adjusted life years of health (QALYs) your donation of about $500 can double your yearly impact as a doctor! Hard to believe isn’t it? But less difficult to understand when considering:


  1. Donations go to specific, highly efficient targeted programmes in African countries where health budgets can be as little as $30 per person per annum.
  2. Trained nurses delivering high end medical care (including lid surgery for trachoma) are often paid about $2500 per annum.
  3. In Australia we routinely pay $50,000+ for medical services/ procedures and especially certain medications to deliver a single QALY.
  4. All administration fees for TTD are covered by the directors so your donation goes even further.


Just this week I had the pleasure to meet Dr Ciku Mathenge from Kigali, Rwanda where she is 1 of 12 ophthalmologists……. for 12 million people. (See photo attached). In Australia we have About 40 ophthalmologists per million people.


Dr Mathenge helps coordinate and advise ophthalmic programmes for East Africa supplied by one of our partners, The Fred Hollows foundation, in order to deliver the most essential and most efficient interventions for the resources available. She is also starting a programme to train more ophthalmologists via resources in her private clinic – something that has not been done before in Rwanda.


Please remember there is a whole other world of medical need out there and how very privileged we are to live and work in Australia.


Donate at twicethedoctor.org.au


Regards to all


Rob Baume

( on behalf of the directors of TTD foundation )

New Twice the Doctor Project

Dear colleagues and supporters,


The Twice the Doctor foundation in collaboration with resident medical officers (RMOs) are currently working on a new project which will hopefully expand our reach significantly. It involves partnerships between local doctors and their patients to deliver resources to medical providers in Africa thereby expanding medical services to developing world patients.


It is envisaged that patients will help and encourage us to be “Twice the Doctor” while in a sense being “Twice the Patient”.


The concept should be seen as a ‘twinning exercise’- namely patients and doctors together contributing to providing services to other less resourced doctors and their patients in Africa. (So “while” patients here are being cared for, they are also being cared for in Africa.)


Please recall that the wage for a specially trained nurse in Ethiopia to perform tarsal surgery in order to prevent blindness from trachoma is approximately……$1 per procedure!


In countries where the annual health expenditure can be as low as $20 per capita per annum, it’s not surprising that just $1 can go an awfully long way.


           (Australia spends $ 4,700 per capita p.a.-2016)


It is envisaged that RMOs will be the prime designers, managers and executors of what is hoped to be a pivotal project and as such will not only leverage their medical status in order to expand their effectiveness in providing for patients (everywhere) but also deeply engage them in a team building project of which they can be justly proud both now and in the future.


 The TTD Foundation feels highly optimistic regarding the project’s potential success partly because of:


       1. Relationships that have been built over a number of years with RMO associations.

       2.The energy and drive displayed by RMOs in the past in support of TTD, and certainly not least of all:

       3. The runs on the “board”, namely  > $500,000 donated so far by you, our supporters.


Without the leveraging power of this impressive figure, I suspect this new initiative would face far stronger headwinds. 


So thankyou to you our contributors for making possible what we hope will be the next considerable expansion of the good that TTD can do while providing RMOs with a potential significant firewall against burnout.


Regards to all

Rob Baume

(On behalf of the directors of Twice The Doctor foundation)

June 2017 donation update

Dear Colleagues
We have so far raised over $100,000 this financial year from your efforts. This goes an awfully long way towards providing medical services in the developing world - quite probably delivering over 1000 QALYs (quality adjusted life years) which translates to about 30 lives saved. It is sobering to recall that a similar amount of money might provide 1-2 QALYs for Australian patients.
I can also announce that we have passed a significant milestone;
over half a million dollars has been raised since TTDs inception just over three years ago.
Thank you to all who have contributed this year, I believe you should be justly proud and for those of you who may still be contemplating a contribution – it is certainly not too late this financial year!
Here are what I hope you might see as some compelling reasons to contribute.
1.      Contributions are fully tax-deductible. There's no doubt you'll be paying tax so would you rather give more to Messrs Turnbull and Morrison to decide how it should be spent or use it to help train general surgeons in the Congo, or obstetric nurses in Ethiopia?
2.      Speaking of money - numerous studies have been done on whether money makes one happy. There is some agreement that beyond a salary of about $75,000 per annum, the answer is "not much if at all".  Moreover, there is widespread consensus that virtually at every income level, money spent on others makes one much happier than money spent on oneself. This is especially so when it is perceived to be spent wisely/effectively.
3.      There is a direct relationship between doctor's burnout and a feeling of lack of making a difference to patients. Please have no doubt that our activities through TTD makes a huge difference to some of the most needful patients in the world. In addition, it is well known that contributing to something larger than oneself is a valuable strategy for avoiding depression.
4.      There has been quite a lot on TV lately about Mercy Ships - which have Western doctors volunteering to provide medical services to Africans. I think this is terrific for those who actually go but when you look at the website you will see that it is only certain types of surgeons that are required for a minimum 2 weeks commitment. Other doctors, if required at all, must generally commit to much longer periods - similar to the situation with MSF. Also, though there is no doubt that this would be an incredibly worthwhile and unforgettable experience for anyone who went, it is almost indisputable that if a surgeon worked in his/her own rooms for 2-3 weeks (remember, you have still got to get there) and donated the proceeds of those weeks' work to highly efficient and effective surgical programmes just waiting to be expanded if the funds were provided........ you get the picture.
So... In many ways we can all be "Mercy Ship doctors" by using our clinical skills, hearts and heads and supporting highly effective medical initiatives.
Regards to all
Rob Baume
(on behalf of the directors of TTD)

What would it take to double your impact as a medical practitioner?

Dear colleagues,

Here is a synopsis of a poster presentation I have been given the opportunity to present at the Australian and New Zealand Rheumatological Association meeting in Auckland in about one weeks time. (I am pretty sure this is a first for this type of presentation at an international meeting.)


The answer is reasoned below and might surprise you. It certainly surprised me!

I thought long about this while the Twice the Doctor foundation was being established and I came up with $12,000 per annum – that being the average wage of a doctor in Sub- Saharan Africa. However a much more sophisticated analysis has been done by Dr Gregory Lewis. He came to the conclusion that at very best the average doctor in the western world might avert about 10- 15 DALYS per year.


A DALY is a disability adjusted life year and costing DALYs averted is probably the best way we have to assess the cost effectiveness of a medical programme, treatment or service.

As a western society we accept a cost of $50,00 to $150,000 or so to prevent a DALY. So if a drug costs $20,000 per annum such as biologics used for Rheumatoid Arthritis and it improves a person’s medical quality of life by 20% it tends to be funded by the PBS as the price to avoid one DALY by use of this drug would be about $100,000. Biologics are the number one best selling drugs by far in Australia and generally in the western world and we pay about $100,000 per DALY averted for them.

The numbers in the developing world are vastly different. For example the cost to prevent a DALY for trachoma surgery in Ethiopia is about $27!!

This is not really so surprising as the procedure prevents permanent blindness, (that is a lot of DALYs) and the “surgeon” once trained, gets paid about $1 per surgery.

So back to how much it would cost for you to double your impact as a doctor working in the western world by supporting an activity in the developing world such as a programme to provide trachoma surgery:

     Western doctors average DALY prevention per annum……………15 multiplied by cost to prevent a DALY in Ethiopia with trachoma surgery……$27  i.e 15 x 27=. ………$ 405.



When you consider:

  1. African countries have an annual health budget of as low as $16 per person.
  2. About 1.2 billion people live on $1.25 a day
  3. Ethiopia has 1 doctor/ 40,000 people, Australia has 1/250 people


So this means that even if these figures are out by a 100- 300% (highly unlikely), a senior doctor in Australia can donate the proceeds of a SINGLE DAYS WORK ONCE A YEAR and double their impact on patient outcomes.

That’s a real opportunity!

Please consider this carefully. This year Doctors Day In May is the 24th of May. Your contribution to the highly effective and efficient “DALY-preventing” programmes we help fund would be greatly appreciated not just by us but by patients greatest in need on this planet.


Regards to all


Rob Baume

(on behalf of the Directors of TTD)

Clinical Mentorship / Training Program in Zimbabwe in partnership with UNICEF

Dear Colleagues,

The Twice The Doctor foundation is proud to have contributed  nearly  $250,000 to Unicef programs in Sierra Leone. Other agencies/ NGOs are now providing support to Sierra Leone health systems particularly after the high profile effects of the Ebola epidemic.

Our partnership with UNICEF will now be targeting the huge need in Zimbabwe as I intimated in my last newsletter. The program fits in beautifully with TTD’s philosophy of supporting training for medical staff as a super-effective way to deliver sustained impact and to fulfil our desire to “virtually volunteer”.

We may be sceptical about delivery of medical services in countries that may not have as rigorous checks and balances as we enjoy but this is precisely why we are so pleased that Unicef will be administering/ overseeing.

Clinical Mentorship / Training Program in Zimbabwe

This project builds the capacity of practitioners at district hospitals to provide comprehensive emergency obstetric care services, including Caesarean sections and blood transfusions.

Aim – support for senior specialist doctors from central hospitals to mentor/ train junior doctors and other practitioners at district hospitals, working together at both the central hospital and with the specialist doctor attending the district hospital.

Method – clinical mentorship is recognised as a strategy to save more lives and ‘decongests’ referral hospitals by enabling less complicated emergencies to be handled effectively at district hospitals.

Beneficiaries – emergency care teams in district hospitals, who are able to provide better ante and neonatal care and life-saving interventions for mothers and newborn babies. Emergency care staff includes doctors, nurse anaesthetists, clinical officers, midwives and theatre nurses from hospitals in Kariba, Gweru, Shamva, Binga and Chegutu districts.

Statistics on Zimbabwe

Population – 13.5 million

Population below 15 years of age – 41%

Maternal mortality – 614 per 100,000 births         (c/w Australia – 6.8)

Under 5 mortality – 75 per 1,000 births                     (c/w Australia – 4)

Risk of death for pregnant women – 1 in 42

Number of people living in extreme poverty (< $1.50/day) – 1.6 million

A note from Tony Stuart, Chief Executive, UNICEF Australia

“Twice the Doctor Foundation is working with UNICEF to give Australian doctors like you the chance to double your impact as health workers. By donating a single day’s salary, you can make a huge difference for women and children in Zimbabwe.”


Regards to all

Rob Baume

(On behalf of the directors of TTD foundation)

Effective aid needs to be delivered by appropriately trained staff sensitive to cultural needs

3 April 2017

Dear colleagues,

Here is a brief note from Jo Martin, paediatrician, in response to my last newsletter. It was graciously accompanied by a generous contribution.

“Thanks for the opportunity again to support this worthwhile cause. So grateful to live and work in Australia, yet still support medical work overseas where it is needed most.”

Here is a letter from my current registrar, Kathleen Batty, which I would like to share with you.

Ghana 2013

Kathleen Batty

In 2013, I undertook a month long placement in a relatively large hospital in Takoradi, Ghana. I worked in the Obstetrics & Gynaecology department, assisting the local doctors as best I could. This experience enlightened me on how poorly we understand Third World health issues. While it was difficult for me to make a meaningful contribution based on language barriers, I was able to observe the treatment of women in childbirth. I was shocked to see women discouraged and shamed for expressing pain or emotional distress in the process of having or losing babies. Women who had stillbirths were told to put on a happy face to encourage a happy womb. They were placed on wards beside mothers of new healthy babies. No psychological support was provided. The surgical theatres were basic to say the least. A bucket and kettle lay on the floor in the corner of the room, and were used to sterilise the surgical equipment between cases. There was a daily struggle to allocate the few oxygen cylinders to the patients most in need, and yet brand new high –tech equipment sat un-used in the hallways. They were undoubtedly donated without considerations for training, education and needs. I found it distressing not to be able to “fix” what seemed unjust to me. I now realise that what I was observing was a deeper cultural disparity that I could not begin to understand as a foreigner. Our contribution to Third World health care should match actual rather than perceived needs.


From Kathleen’s letter I glean the following;


  1. The need is huge! (Ghana is one of the “better off “African nations with GDP per capita of $4,400. For Zimbabwe, it’s $800 per capita.)


  1. The aid needs to be intelligent, targeted, and focused on appropriate training rather than necessarily providing equipment.


  1. Effective aid needs to be delivered by appropriately trained staff sensitive to cultural needs.


I am excited to report that our new project with our partners UNICEF is in Zimbabwe and involves local experts training medical staff in obstetric hospitals. I will elaborate soon!



Regards to all,


Rob Baume

(On behalf of the Directors of TTD)

Burnout and associated mental health issues are distressingly common amongst Australian doctors

Dear Colleagues

Despite our interesting and often rewarding jobs, burnout and associated mental health issues are distressingly common amongst Australian doctors and indeed doctors around the world. A recent survey of US physicians found burnout in just over 51% of doctors.

One of the major factors associated with burnout was found to be a low sense of personal accomplishment.

A major reason for the formation of the Twice the Doctor foundation was to help guard against burnout.

The reasoning was as follows:

I am feeling a bit stressed or even depressed and often feel that much of what I do is “process- driven” or defensive medicine. I spend quite a lot of time on allaying unnecessary anxiety born of misinformation from friends and relatives or debunking google searches. I do lots and lots of paperwork.


What can I do to make my work more meaningful/rewarding?


I will do volunteering work in Africa like I always imagined I would when I first contemplated medicine as a career. I will be working on really sick and relatively young patients and I will be really appreciated.


  1.  I can’t just do highly meaningful medical work in the developing world because I don’t really have the particular skills required.
  1.  I can’t just go for a few weeks. Enquires made with Medecins Sans Frontieres (SF) reveal that I need to spend a minimum of 9 months initially unless I have certain special skills (e.g. anaesthetist, obstetrician).

Solution:  After further research and enquiries I found that the best way I personally could make the greatest difference to some of the most needful patients in the world using my medical skills was to “volunteer” in my own office and use the proceeds of my medical activities to fund highly effective and efficient medical work in the developing world.

This adds significantly to my sense of medical accomplishment so not surprisingly it is a great remedy for, or firewall against burnout.


Regards to all


Rob Baume

On behalf of the Directors of Twice the Doctor Foundation

In this caring, considerate Trumpian Era we find ourselves….

Dear Colleagues

In this caring, considerate Trumpian Era we find ourselves, let’s pause to reflect on the lay of the land in our own neighbourhood.

Currently Australian foreign aid is at the least generous in its history.

Most other donor countries, responding to unprecedented humanitarian challenges and recognising the importance of continued development progress for global stability, have been increasing their aid spending.  Total OECD aid reached a record high in 2015. In embarrassingly stark contrast, Australia has made savage cuts to foreign aid in recent years.

Australia ranks 7th on the OECD scale of most prosperous nations yet  on the ratio of foreign aid to national income – Australia fell from 13th to 16th in 2015.

Six OECD countries – Denmark, Luxembourg, the Netherlands, Norway, Sweden and the UK – have met the United Nations target to provide at least 0.7% of their national income as foreign aid.

In contrast, between 2012 and 2016, Australia’s foreign aid as a share of national income has fallen steeply from 0.36% to 0.23%. That’s less than 1/3 of the target.

Though I know we all studied hard and made sacrifices to get where we are and continue to work hard and with great responsibility, we should be cognisant of the fact that doctors in Australia happen to be among the highest paid in the world. In fact in 2014 we ranked second only to The Netherlands. The average Australian specialist earnings were $250,000 pa and average GP earnings were $100,000.

Contrast this with the country where I was born, Romania, where the salary of an average GP has recently increased to about $15,000 pa. I suspect many of you reading this newsletter where born in countries that generally pay doctors significantly less than we currently receive.

So … Caring about the less fortunate in a new world that in many was feels less caring seems like something that we , as extremely privileged professionals in an extremely privileged country (that perhaps isn’t pulling its weight on foreign aid), ought to consider. After all we are in a caring profession.


Regards to all

Rob Baume (on behalf of the Directors of TTD)