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Dear Colleagues and Supporters,

I requested an update from our long- time partners, SurgicaLife, who are arranging surgical training in the Democratic Republic of Congo, one of the poorest and most medically understaffed countries in the world. This is part of the response I received from ..

Dr Neil R Wetzig AO, MBBS, FRACS, FRCS(Eng), FCS(ECSA)

Consultant & Advisor of Surgical Training Programs, 

HEAL Africa Hospital, Goma, DRC  28 May 2025

“The COSECSA surgical training process continues to build capacity into the surgical services at HEAL Africa Hospital and will ultimately strengthen the health system in North Kivu Province as these trainees return to DRC & train others – hence creating sustainable change. There remain only 0.4 surgical, obstetric and anaesthesia specialists per 100,000 population, compared to the recommended 20/100,000 – so specialist training like this program is essential. This would not be possible without the generous contribution of ‘Twice the Doctor’.”

When you contribute to TTD I hope you truly feel and appreciate the importance of the contribution you are making and the way that it is amplifying your personal medical effect on patients on our planet….including some of the least medically resourced patients in the world. I hope you “meditate on this” regularly and so on some of the more challenging days in the surgery, clinic or hospital you recall and reflect on this and in doing so it helps to lighten the mental load.

Your colleagues have contributed about $65,000 for this years  ‘Doctors’ Day in May’ drive. There is still time for you to contribute (if you have not already done so) prior to the EOFY. Remember all donations are fully tax- deductible and very much appreciated by the recipients.

Regards to all

Robert Baume

On behalf of the Directors of the Twice the Doctor Foundation

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).

So, our luck allowing us the privilege of being doctors in this very lucky country should not be forgotten or taken for granted.

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).

So, if we claim capacity for significant sympathy we should not forget where this sympathy should extend.

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).

So… out of sight ought  not automatically translate to out of mind.

It’s nearly the end of May so please consider making your contribution to TTD to help correct the massive imbalance of health resources in our one world.

Also, never forget the considerable appreciation of your previous and hopefully future contributions. (See attached video).

We are now well into May so I hope you are considering your contribution for this year’s “Doctor’s Day in May” effort. Your Colleagues have contributed over $40,000 so far so I am hoping you will join them.

Please recall the key concepts..

1. This is “virtual volunteering”  in that  you are funding an expansion of medical care in the developing world rather than you actually going there and working in a clinic with all the 

– inconvenience to you, your patients here and your family 

– direct cost in actually getting there

– opportunity cost in lost income

– potential danger involved

2. The “avatar” you are funding has much more of the particular skills and the language required to do the work needed in that particular environment.

3. By contributing to medical wages in Africa, you are supporting their economy with all the multiplier effects implied.

4. Medical wages, particularly for greatly required nursing services, are a fraction of the cost in Africa or New Guinea compared to those in Australia. In Australia, nurses typically earn about $40 per hour. In PNG, it’s $1.50 per hour.

This means your contribution goes a very long way in providing health care… which is after all why we chose medicine as a profession and what we try to do effectively on a daily basis.

Thanks for considering your contribution.

May is just around the corner. Please recall that “Doctor’s Day in May” is a concept whereby we ask doctors to consider giving a day’s pay (or part thereof) just once a year to support medical training in developing world countries. That is like giving 1/2 of 1% of your salary once a year. This money goes a very long way in countries where medical services are far less expensive than in Australia.

It is a good time to reflect upon our great good fortune to be working as doctors in Australia rather than in many other countries in the world.  In some countries just going to work can be a life-risking exercise as illustrated in  this headline from the New York Times just 1 week ago.

“Sudanese paramilitaries killed the entire staff (9 people) of the last medical clinic in a famine-stricken camp in the western region of Darfur”.

In  quite a few countries the remuneration for being a doctor is certainly nothing special. For example in Cuba, medical salaries doubled about a year ago. They are now about $US 16,000 per annum.

Also thankfully, unlike in the USA, we generally do not have the endless red tape surrounding the procurement of certain tests and treatments in order to treat our patients appropriately. Imagine the frustration and hassle!

Please consider your donation to Twice the Doctor while reflecting on this good fortune in practising our chosen profession in this country.

It seems that the world is becoming a more and more dangerous, unstable and unpredictable place. This has been fairly terrible for the world economy and of course seems primarily due to the policies of Trump and his enforces. Whoever is to blame, the people that tend to suffer most in a major downturn are the poor…. worldwide.

They have no significant reserves to cope. Add to this the major de-funding of USAID (U.S. agency for international development) and ever falling foreign aid by U.S. and in fact most countries including Australia and you have an increasingly dire situation for the less fortunate on our planet.

Apparently, on average, Australians think we invest 16% of the Federal budget on overseas aid and believe that we should be spending about 12%. 

Actually, Australia spends about 0.21% of our gross national income on overseas aid. That’s 21cents in every $100.

We live in a lucky country. In 2023 Health care spending per capita in Australia was about $8,000 – the vast majority provided by state and federal government. In the Democratic Republic of Congo it was around $21.

It is only a month till May. Please contemplate the above while considering your future contribution to TTD (and our developing world programmes) where we are trying to redress some of this startling imbalance of what is basically …. luck.

Dear colleagues,

What a crazy world we are living in. Two protracted wars and, in my opinion, a dangerous, uneducated narcissist elected as the most powerful leader in the free world; someone who is trying to appoint a vaccine sceptic whose views contributed to the deaths of dozens of Samoan children by discouraging the use of measles vaccine…..to lead the U.S. Department of Health! 

Trump also nominated, to the post of Head of Medicare, a TV personality doctor who is known for promoting weight loss supplements that did not have any evidence to support their use and who at one point tweeted about astrology being a valuable tool to learn health information from.

And who could forget Trump’s own health intuitions with his famously unhealthy diet choices and insightful and prudent advice during the height of the Covid epidemic when he suggested “it was just a flu; we should go to church (without masks) and pray;  it will be over in a few months, we  should consider ingesting bleach(!)” and “ hydroxychloroquine( Plaquenil) is the answer”. The last one in particular greatly inconvenienced many of my lupus and rheumatoid arthritis patients due to resultant shortages of this medication.

On a related note, global warming is probably the greatest challenge the planet has ever faced and Trump’s nominee for head of the Environmental Protection Agency has a 14 percent score from the League of Conservation Voters on his congressional voting record. Trump himself has cast doubts on whether global warming even exists with words of genius such as “you watch, in a few months it will be cold again”. The EPA is responsible, amongst other things for ensuring that global warming is as limited as possible, and the world looks to the US to help lead the way. The negative effects of climate change are arguably the greatest single threat to world health and is predicted to be particularly impactful on developing nations.

We at TTD continue to support our partners to bolster developing world medical resources in the face of this increasingly dangerous geopolitical environment.

                                                                

Regards to all

Robert Baume

On behalf of the Directors of Twice the Doctor Foundation

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