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We are now well into May so I hope you are in a position to make your annual contribution to boosting health in the developing world.

So far your colleagues have contributed over $30,000 for this year’s campaign.

Recall that your dollar contributions go a very long way in countries  such as East Timor and DR Congo where the annual health care spending was about $30 per capita in 2020 and since then less!

By contrast it was $8,600 per capita in Australia in 2020 and since then, more.

Our DRC partners Surgicalife have had great success in training surgeons with Dr Justin Tsandiraki being awarded his full Fellowship in General Surgery by COSECA ( College of Surgeons of East Central and Southern Africa) in December. It takes 5 years at least to train a specialist. There remain only 0.4 surgical, obstetric and anaesthetic specialists per 100,000 population in DRC. The recommendation is for 50 times as many! Two new trainees were selected to commence this year and 4 are currently in more advanced training.

Our Barbara May Foundation collaboration has helped staff new hospitals. In just the Kivulini Maternity Hospital, run on a shoe-string budget, 288 babies were safely delivered in March alone. Since its opening, the hospital has been providing fistula surgeries, clinics, outreach programs, maternity services, and more. Additionally, we’re planning to build a new hospital in Tanzania near Dodoma, at the country’s centre, with construction expected to begin this year. Furthermore, we’re partnering with an organisation in Northern Uganda to construct another hospital.

Our support of the Fred Hollows foundation is shifting towards cataract treatment in Sub-Saharan Africa. Cataract surgery not only delivers QUALYs at incredibly low cost but also achieves an enormous economic return with $1 invested resulting in $23.4 economic benefit to the country.

TTD’s collaboration with UNICEF has shifted slightly Westward from PNG to East Timor. (This is after a very generous donor fully funded the PNG project). Details of the new program are attached.
     
Thank you for your continuing support of health in the developing world. By your actions you are likely greatly extending your impact as a physician working for this planet.

We have now had a 10 year collaboration with the Fred Hollows Foundation and attached is a PDF of feedback on some of our impact. I am particularly pleased about the ROI  figures indicating a 10-20 fold return on investment for eye health projects. This of course is no surprise to TTD who have always tried to focus on projects that are both efficient and effective and deliver “bang for the buck”.

This way you know that your donation allows you to multiply your impact as a doctor. A relatively little donation provides for a whole lot of extra medical impact (let alone economic impact).

We also continue to strongly support UNICEF in New Guinea, Barbara May Foundation in Ethiopia and SurgicaLife in Democratic Republic of Congo all of which we believe do and will provide greatly needed services effectively and efficiently.

“Doctors day in May” is just around the corner… please consider your annual contribution.

Dear colleagues and supporters,

I am delighted to report that we have now achieved the significant milestone of 

                                    $ 1 MILLION  RAISED

I am immensely proud of my co-directors, medical colleagues and supporters for all their contributions over the years and hope one and all feel justly proud of their achievement.

As I have outlined and stressed in numerous newsletters over the years, this substantial sum does so much more where it is most needed in the developing world where it could easily translate to 100x the effect compared with medical costs and effect locally.

In terms of DALYs prevented, for those of you who have contributed a total of $10,000 over the last 10 years you could justifiably consider yourself to have doubled your impact as a medical care provider on this planet over this period.

This is not hard to believe when you consider that The Barbara May Foundation, one of our long-term partners, runs a hospital in Ethiopia that delivers 2600 babies and does 16000 clinic visits a year for just over $500,000. This information is totally up to date and direct from Dr Andrew Browning. Considering maternal and infant mortality and fistula rates without this facilities, just imagine the lives saved and the misery averted.

If you haven’t already contributed to this year’s effort. There is still time to “be part of the million dollar milestone” prior to the end of the financial year.

Regards to all

Rob Baume

On behalf of the Directors of Twice the Doctor Foundation

PS:  Just to remind one and all that our efforts do not go unappreciated, attached is a video from a couple of years back which some will have seen but I always love to see (as I hope you do) as it crystallises the effect of our efforts. We should, daily, be cognisant of the need and how we have helped.

Dear colleagues and supporters,

We are nearing the end of May so if you haven’t already contributed this year, I hope you will consider doing so soon. Please recall the initial concept was donating a day’s pay or part thereof sometime in May in lieu of physically going to work in the developing world for a period.

So what is the actual good that can be achieved in donating? What is the actual bang for your buck? It is in fact more, and probably much more, than most of us (in the Western world) would like to believe. 

It has been estimated that the average doctor averts about 4-5 DALYs (Disability adjusted life years) per year through their medical work. We should be justly proud of this. This estimate is likely to be pretty close to the mark on the following reasoning:

1. In developed countries we pay an average of about $70,000  (between $21,509 and $168,720) to avert a DALY.
2. A full-time salaried doctor might get $250k p.a. The doctor’s entire medical training might cost $500k and she  might work for about 30 years full time equivalent so the amortised cost of training is about $15k per year of work life.  So the total cost to the community is $265,000 pa. This lines up very well with the cost of averting 4 DALYs (4x $70k = $280,000)

In other words, doctors paid at this level are probably worth what they are paid in terms of helping the community avoid disability. If the estimates of what doctors achieve was greatly underestimated then it would be totally remiss of medical economic decision makers to not train and pay a lot more doctors rather than, say, build more hospitals with the available funds. But that is not happening… because it is not worth doing…. because doctors probably do avert about 4-5 DALYS per year on average and not a lot more.

So, if that doctor on $250k pa gave 1 day’s salary….about $1000 and it was donated for use in highly effective medical programs in the developing world, what would that achieve?

An extensive analysis in 2014 determined that cataract surgery in Africa averts a DALY for an average of $US50 (not $70,000). Elective inguinal hernia repair $12-$78. Emergency caesarean section – as low as $18 per DALY averted. It is not difficult to understand that saving a mother’s and a baby’s life (an estimated total of about 60 DALYs) with an emergency caesarean can be this cost effective. An earlier study indicated $17 for tarsal surgery for trachoma in Ethiopia . Preventing blindness with simple surgery is incredibly cost effective. Assuming these cost figures have doubled since (which they haven’t)… the $1000 donation (just less than 1/2% of our doctor’s annual salary can avert 5 DALYs (at least). There is a lot of “low hanging fruit” in terms of possible medical interventions in the developing world.

So what can be achieved? ….DOUBLING the total DALYs your medical efforts have averted in a year. In other words, doubling of your direct medical impact for patients on this planet. You can be “twice the doctor”.

Therefore to be “twice the doctor” you can either work twice as many hours in a week all year or you can donate about half of 1% of your annual income … tax deductible… once a year.

So, on those few days when not everything is going 100% right and a patient may not be 100% happy and let you know it…how would it feel to recall that you have (virtually, yet very effectively) also been working in the developing world that very same day and helping some of the most medically under-resourced  patients in the world… who are incredibly appreciative of your efforts?

We are nearing the $1million total donated since inception. Be part of the milestone.

                                            

Regards to all

Rob Baume

On behalf of the directors of the Twice the Doctor Foundation

    

Dear Colleagues and supporters,

“Doctors Day in May” when we ask you to (at least figuratively)  spend the day working to enhance healthcare in the developing world is fast approaching. This is achieved by donating the equivalent of a day’s salary, or part thereof , to TTD which via its long time established partners, funds projects to enhance medical workforce in Ethiopia and the Democratic Republic of Congo.

In the past we have worked with one of our partners, UNICEF, to bolster health systems in Sierra Leone, Zimbabwe and most recently, helped to shore up Covid vaccination programmes in Africa.

I am proud to say that your contributions over the years through TTD have provided in excess of $500,000 to UNICEF (our most long term partner).

I am also excited to report that we are embarking on a new project with UNICEF based in Papua New Guinea.

The programme includes;

• Training qualified health workers on early essential newborn care (EENC), basic emergency obstetric and newborn care and health promotion.
• Training village health volunteers on health promotion especially pertaining to safe perinatal practices .
• Provision of critical public health care equipment and supplies.

Just some salient information on PNG and it’s health landscape;

• Population- about 10 million.
• Doctors per 1000 people is 0.07.  This is amongst the lowest in the world! The average among small Pacific Islands is nearly 10 times as many.
• In Australia, the figure is 4.12.  

In other words there are about 60 times as many doctors per 1000 people in Australia compared with PNG.

Infant mortality rate is 10 times that  in Australia.

It seems to me that this is a real opportunity to be Twice The Doctor.

Regards to all

Rob Baume

On behalf of the Directors of the Twice The Doctor Foundation

Dear colleagues and supporters,

We are well and truly into May so if you are considering making a contribution, this would be a great time. 

I am pleased to report that so far your colleagues have contributed over $60,000 to this year’s effort.

Please recall- 

1. All contributions are fully tax deductible.
2. The directors of TTD pay all the administration costs so your donation goes a long way.
3. And, your money can indeed go a very long way in Africa. $A1000 employs a nurse in Ethiopia for 6 months and because of the extreme lack of doctors, nurses do a lot of what might be “doctoring” here in Australia.
4. TTD concentrates on programmes that train medical staff so the concept is that you can have a substantial effect on delivering medical care to the developing world without the logistical nightmare, cost and considerable danger of actually having to go there.
5. So you can be working here and your effort can pay for medical personnel delivering services in some of the most under- resourced places in the world.

You work here and your effort is “duplicated” and in fact greatly amplified there. Hence the concept of TWICE The Doctor.

Please share this with colleagues and supporters,

Regards to all,

Rob Baume

On behalf of the Directors of Twice the Doctor Foundation

Dear Colleagues,

We have all had significant challenges over the last couple of years with the COVID-19 pandemic leaving virtually no one unaffected.

Doctors and health workers in particular have had to bear a disproportionate share of the burden. Many of our colleagues, particularly overseas have even paid the ultimate price. 

The WHO estimated that up to 180,000 health workers died from Covid between early 2020 and November 2021. There was recently a memorial service for 50 UK doctors that died. By as early as April 2020, 150 Italian doctors and 40 Italian nurses had died of Covid. More than 3,600 US health workers died in the first year of Covid.

We, in this country are truly lucky that we didn’t have large early surges and that when the larger numbers did transpire we mostly had the strategies and equipment to deal with it fairly effectively.

Most of the developed world is now fairly well equipped to handle future surges as long as the virus doesn’t trick us again with a more lethal variant and as long as the large majority of people listen to science and keep vaccinations up to date.

Unfortunately, this is not the situation in Africa where there is still not enough PPE, not enough oxygen, not enough ventilators and woefully low rates of vaccination. In this extremely dangerous milieu, our colleagues continue to deliver babies, operate on fistulas, cataracts, trachoma sufferers, and deliver the ongoing healthcare that keeps people alive and functioning. 

Here’s an email I received just a few days ago from Andrew Browning, principal and surgeon at Barbara May Foundation. He also sent the photos below.

“Thanks Rob, I hope all is well with you.

I’m just back from Africa and hope to get back in June God willing.

The war in Ethiopia has seen the destruction of many clinics in the Afar area and one hospital. Fortunately, ours is unharmed although the fighting came within about 40km. We received many casualties. There are also around 300,000 displaced people on the move fleeing the fighting with no food, no water, no one to help, but BMF is helping supply food and health care through Valerie Browning’s NGO in Ethiopia.

Andrew.

Also, we’ve been working as normal through the pandemic, so lots of women delivered, lots of fistula treated and there are more fistula patients due to the pandemic as women couldn’t get to hospitals as easily and were more likely to deliver at home.

We in Australia don’t all have to risk our lives and go there personally in order to effectively deliver extra health services and improve safety for all. Please consider this privilege to help. 

“Doctor’s Day in May” has arrived. 

Regards to all,

Rob Baume

On behalf of the Directors of the Twice the Doctor Foundation

10.5.2022

PS: Please consider sending this communication to any or all of your medical colleagues.

Dear colleagues and supporters,

According to the World Bank, the COVID-19 pandemic is estimated to have pushed up to 40 million people in Africa into extreme poverty.

Now, the war in Ukraine is causing an escalation in food prices in view of disruption to grain supplies by two of the largest producers in the world.

More funds required for food means less available for medical needs which of course escalate as malnutrition is thrown into the mix.

Since the start of the pandemic, the continent’s capacity to manage COVID-19 cases has gradually improved, with the increased availability of trained health workers, oxygen and other medical supplies. The number of Intensive Care Unit (ICU) beds has increased across the continent, from 8 per 1 million people in 2020 to 20 per million today. WHO has also helped increase the number of oxygen production plants in Africa from 68 to 115 – a 60% rise – through supporting the repair, maintenance and procurement of new oxygen plants. Where plants have been set-up, the cost of oxygen has decreased by 40%. Despite these improvements, oxygen availability remains a concern, and a large majority of patients who require oxygen as part of their clinical treatment plan are unable to access it.

More than two-thirds of people living in Africa may have contracted COVID-19 over the past two years, about 97 times more than the number of reported infections, a World Health Organization (WHO) report has suggested.

While the SARS-Cov-2 coronavirus has had a catastrophic effect on some parts of the globe, Africa appeared to have escaped the worst and was not as badly hit by the pandemic. 

But ……

South Africa recorded 303,969 excess deaths from natural causes between May 3, 2020 and now – yet official figures show that COVID killed 100,075 people since the start of the pandemic. These excess deaths were almost certainly from unreported COVID.

So……

Although reported mortality and morbidity may not be startling in Africa, true figures are probably much more stark especially in countries where health statistics/epidemiology is not the main priority. Just accessing any health care whatsoever is the priority and can be a real challenge in countries where the total annual spending on health per capita is only $A30-40. (e.g. Ethiopia, Democratic Republic of Congo).

In Australia it’s $7,500 per capita per annum and this is similar in other OECD countries other than the U.S. where expenditure is about double!

Supporting the infrastructure that supplies medical services to Africans who are in this quagmire through no fault of their own seems the right and fair thing to do.

“Doctor’s Day in May” is almost upon us.

Please consider your contribution if you are in a position to do so.    

Regards to all.

Rob Baume

On behalf of the Directors of Twice the Doctor Foundation

Dear colleagues and supporters,

Hope you are all well and coping with the considerable challenges we are all facing.

While our problems are very real and significant, as always, it’s important not to lose sight of the greater picture. Here are some recent snippets from media to ponder.

“This is precisely what experts have been predicting was going to happen — that the extraordinary inequities and gaps between low income countries and high income countries creates this massive vulnerability and it is going to continue to generate these dangerous variants,” said J. Stephen Morrison, a global health expert at the Center for Strategic and International Studies in Washington. “That point is glaringly obvious and it is painful.”

When people with H.I.V. are prescribed an effective antiretroviral and take it consistently, their bodies almost completely suppress the virus. But if people with H.I.V. aren’t diagnosed, haven’t been prescribed treatment, or don’t, or can’t, take their medicines consistently each day, H.I.V. weakens their immune systems. And then, if they catch the coronavirus, it can take weeks or months before the new virus is cleared from their bodies. When the coronavirus lives that long in their systems, it has the chance to mutate and mutate and mutate again. And, if they pass the mutated virus on, a new variant is in circulation.”

“We have reasons to believe that some of the variants that are emerging in South Africa could potentially be associated directly with H.I.V.,” said Tulio de Oliveira, the principal investigator of the national genetic monitoring network.

Researchers at KRISP have shown that this has happened at least twice. Last year, they traced a virus sample to a 36-year-old woman with H.I.V. who was on an ineffective treatment regimen and who was not being helped to find drugs that she could tolerate. She took 216 days to clear the coronavirus from her system; in that time inside her body, the viruses acquired 32 different mutations.

25 million people live with HIV across sub-Saharan Africa, of whom 17 million are virally suppressed with treatment.

Referring to the “human infrastructure,” Dr. Sheela Shenoi, an infectious disease specialist at Yale University, said  “….any health care delivery system is going to be dependent on the numbers and types of skilled individuals to deliver services. Even if there is vaccine supply, if you don’t have the people to deliver that supply, it is not going to succeed.”

“If the pandemic slows in most parts of the world, it may limit opportunities for the virus to emerge in a radically different form. And that’s an argument for helping other nations immunize their populations rather than boosting our own” Dr. Hensley said.

It seems pretty clear that even if only from a self- interested point of view, bolstering the health infrastructure in Africa is essential. This is what we have always been all about at Twice The Doctor.

Regards to all and stay safe and well,

Rob Baume

On behalf of the Directors of Twice the Doctor Foundation

Dear colleagues, 

I hope most of you are enjoying the feeling of emerging from lockdown and you have remained well and safe.

Looking farther afield … so far, thankfully most of Africa has not suffered huge numbers of COVID- 19 infections. A number of factors are likely at play, the main one being age discrepancy. Mortality from COVID-19 is much higher with increasing age. Average age in Uganda is 16.7. In Canada it’s 41.1 and 18% of people are > 65 years old. In Uganda only 2% are over 65.

However, before we sigh with relief, we need to consider whether the next variant will behave similarly. Moreover, despite the lower numbers compared to much of the west, sub-Saharan Africa is far from unscathed. Stringent lockdowns have taken a serious societal and economic toll; large rises in food insecurity, teenage pregnancy, domestic violence, and disruptions in treatment of malaria, TB and HIV. 

As you are no doubt aware, medical logistics are not always optimum in many underfunded health systems and problems tend to compound. In Kenya, as authorities prepared to receive the first doses of COVID vaccines in early March, frontline workers lamented they didn’t know where to register or get inoculated. And after pausing initial rollouts because of concerns over blood clots, the Democratic Republic of Congo gave away 1.3 million out of the 1.7 million AstraZeneca doses it had received from Covax because it couldn’t administer them before they expired.

Clearly, adequately trained medical staff are an essential link in the chain of successful health care delivery and as you will be aware , this has always been the prime focus of TTD.

Further we understand that a primarily nationalistic approach to our most overarching problems will likely be disastrous. As with climate, the health of our oceans, biodiversity, the current and potential future pandemics …. we are all in this biosphere together. Rolls- Royce treatment for some and virtually no care for others is not only immoral but irrational.

Regards to all

Rob Baume

Director Twice the Doctor Foundation