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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

Dear colleagues,

I am pleased to report we have raised over $80,000 so far this financial year.

A very big thank you to all those who have contributed and a reminder to those that are considering a donation that there’s still time.

Just a brief recap on the reasons you might wish to contribute.

1. Our field partners ( UNICEF, Fred Hollows Foundation, Barbara May Foundation, SURGICALife) have long term experience in achieving effective outcomes.

2. TTD donations go towards training of medical staff so your contribution can and should be considered as a way to expand your medical services in areas that desperately need them. The staff trained by your contribution will in a sense be doing the job you, as a doctor would have done had you actually travelled all the way to Africa. (Please reflect on the logistics, the costs and the dangers of the actual trip.)  Hence, our entire concept of “ Twice The Doctor”; you are working here but at the same time you are empowering a doctor to work in Africa on your behalf.

3. Your contribution goes an awfully long way in countries where a nurse often gets paid less than $200 per month.

4. The directors of TTD pay all administrative costs so your donation goes further and all donations are fully tax deductible.

Regards to all,

Rob Baume 

On behalf of the Directors of Twice the Doctor Foundation

Dear Colleagues,

Thank you so much for your response to this years Doctors Day in May. So far we have raised over $60,000 which as you know goes a very long way in providing health services in the developing world.

Real figures are very difficult to obtain in Africa but major depletion of health workers is and will continue to be inevitable. Just look at the poster below and imagine the situation in countries where PPE is so hard to come by and even testing for Covid is extremely patchy at best.

And what about the patients?

A recent Lancet study found that among 3,077 critically ill Covid patients admitted to African hospitals, 48.2 percent died within 30 days, compared with a global average of 31.5 percent.

A big part of the problem is the lack of training of health workers- something that TTD particularly focuses on.

Further in the Lancet report: 

Almost 16 percent of hospitals had ECMO, but it was offered to less than 1 percent of patients. Similarly, although 68 percent of the sites had access to dialysis to treat kidney failure, which is common in severe Covid cases, only 10 percent of the critically ill patients received it. Half the patients who died were never given oxygen, but the authors of the study said they had little data to explain why.

A Lancet editorial by experts not involved in the study said, “It is common in Africa to have expensive equipment that is non-functional due to poor maintenance or lack of skilled human resources.” Some 40 percent of the medical equipment in Africa was out of service, according to a 2017 report by the Tropical Health and Education Trust, the editorial said. Another factor is that few doctors in Africa have the training in pulmonary and critical care that is considered essential in treating Covid patients. 

May is almost over. 

If you have not already done so, please consider joining with your colleagues who have already contributed and thereby greatly supporting health worker colleagues.

www.twicethedoctor.org.au       

Regards to all

Rob Baume

On behalf of the Directors of Twice the Doctor

Dear colleagues and supporters,

“Doctors Day in May” is now upon us. It is a day when hundreds of your colleagues in Australia have occasionally or regularly made a substantial contribution to train and equip medical workers in Africa. I am hoping you might make a contribution this year.

Here is a bit of an update as to what is going on in Africa, that vast continent of 1.3 billion people of which 500 million live in extreme poverty( <$1.90 per day). According to WHO fewer than 2,000 working ventilators have to serve hundreds of millions of people in public hospitals across 41 African countries, (compared with > 170,000 in the US).

The COVID pandemic has made a worldwide midwife shortage worse with midwifery services being disrupted and midwives being deployed to other health services.

A study in The Lancet in December concluded that alleviating the midwife shortage could avert roughly two-thirds of maternal and newborn deaths and stillbirths, saving 4.3 million lives a year.

One of our partners, the Fred Hollows Foundation, has been deployed (at government request) to help control COVID in Africa by disseminating information and basic resources for preventing spread. Their organisation has vast experience in this type of activity from many years of treating trachoma – a program that has had long term support from TTD.

I am delighted to inform you that Andrew Browning, Medical Director of one of our partners, The Barbara May Foundation, has put out a book. I have personally met Andrew on several occasions and find him a truly inspiring individual and a hell of a nice guy. You will no doubt find his many years as a surgeon in Africa a fascinating read.

So if you feel you can make a contribution, please do so and bear in mind that it’s fully tax deductible.                                    

Regards to all

Rob Baume

On behalf of the Directors of Twice the Doctor