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Dear colleagues and supporters,

Thanks so much for your response so far to this year’s Twice the Doctor fundraising drive and
particularly Doctors Day in May.

It is still of course early days but your colleagues have already contributed

                                     over $60,000 towards this year’s effort.

Please view the videos here.      

And also here.

Fortunately , Robert Mugabe who since 1980 has systematically destroyed what was an excellent
health system has been ousted. Amongst numerous problems, abysmal working conditions drove
20% of health professionals abroad each year.

Currently in Australia maternal mortality rate is:       5.5 /100,000 live births.
In Zimbabwe it is:       443 /100,000 … ie nearly 100x as much

There is some hope and expectation that the new administration will be significantly better but the
new government has allocated a disappointing 7.7% to health in the 2017–2018 national budget.
The people of Zimbabwe need our help.

Remember, the central concept of TTD is funding doctors in the developing world to do the work
that we hopefully would/ ?? could do if we went over to volunteer. This is “virtually volunteering” at
its best.

If you have not as yet contributed this year, please consider doing so.
Remember, all donations are fully tax deductible. The directors of TTD cover all our administrative costs so your contribution goes even further.

Regards to all,

Rob Baume (On behalf of the directors of Twice the Doctor Foundation)

Dear colleagues,

Doctors Day in May was last Friday at Gosford/Wyong Hospitals and will be later this month at RPA
and affiliate hospitals. Posters will be displayed at a number of other hospitals encouraging your
colleagues to participate.

At Gosford and Wyong the RMOA organised a number of activities including meditation, lunch,
coffee vouchers, and a “pat-a-piglet” opportunity. Crazy socks were also encouraged.

I am proud that the Twice The Doctor Foundation (TTD) was the initiator of Doctors Day in May and
is an ongoing supporter of this valuable tradition. This is all to do with mental health and well-being
for doctors and I thoroughly believe that involving oneself in charitable activities/opportunities such
as those provided by TTD enhance and magnify the positive effects significantly.

I was recently fortunate enough to be interviewed for an article about TTD by Penny Durham from
Rheumatology Republic. I apologise that it is a little lengthy but I think it beautifully captures the
philosophy of TTD so I would love you to read it if you have time. Importantly it also includes a very
interesting interview with Andrew Browning AM who has worked extensively in Africa. Some of the
key figures he quotes means that it is likely that through an appropriately targeted contribution you
can prevent the obstetric death of a mother and baby for about $A 1,800. Remember, this mother
is quite likely to have other children who are then orphaned. In addition with the same funds you
are very likely to be preventing fistula formation, potential neonatal brain hypoxia and various other
devastating non-fatal potential complications of child-birth.

                http://rheuma.com.au/physician-clone-thyself/15785
 
Please read the article if you have time, and please consider making your contribution for this year’s
Doctor’s Day in May at twicethedoctor.org.au

                                   
Also, please consider sending this on to your medical associates.

Regards to all,

Rob Baume (On behalf of the directors of TTD)

Dear colleagues,

We are fast approaching Doctors Day in May so I hope you are considering your annual
contribution. Please recall that as medical practitioners in Australia we are in really quite a
privileged position for the following reasons;
           
     1. We have interesting and fulfilling (though often stressful) jobs.
     2. We are very rarely unemployed.
     3. We are supported by a health system which, though far from perfect, is fairly uniformly considered
amongst the best in the world.

Couple this with knowledge that for just $300-$400 per annum channelled into highly
effective and efficient programmes in Africa, you can virtually double the QALYs you are
likely to generate in a year!

                 Which other profession has this opportunity?

(Sadly it is an opportunity that only exists due to the huge disparity in medical resources in
much of the developing world.)

Moreover as I write this, I realise that though I am going to donate some of my valuable time
and my hard-earned cash, at no time soon am I going to be dying for the cause, (I am
way too much of a coward!)- unlike some of our medical colleagues.

Please consider taking a bit of time to view the video link. 
 
http://www.stopbombinghospitals.org/

www.twicethedoctor.org.au

Regards to all

Robert Baume (on behalf of the Directors of Twice the Doctor Foundation)

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)

2. 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)

3. 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

https://80000hours.org/2015/08/how-can-doctors-do-the-most-good-an-interview-with-dr-gregory-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.

www.twicethedoctor.org.au

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.

www.twicethedoctor.org.au

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.

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 )

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.)

WHAT WOULD IT TAKE TO DOUBLE YOUR IMPACT AS A MEDICAL PRACTITIONER? (to be “twice the doctor”)

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.

     (https://80000hours.org/author/gregory-lewis/)

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.

SO ….FOR ABOUT $400 A YEAR YOU COULD EFFECTIVELY DOUBLE YOUR MEDICAL IMPACT ON THIS PLANET.

IS THIS REALLY POSSIBLE?

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

… IT IS ENTIRELY POSSIBLE!

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.

www.twicethedoctor.org.au

Regards to all

Rob Baume

(on behalf of the Directors of TTD)

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.”

www.twicethedoctor.org.au

Regards to all

Rob Baume

(On behalf of the directors of TTD foundation)