‘Every healthcare system is only as strong as its weakest link’
SHE Collaborates is part of the Maastricht School of Health Professions Education (SHE), and in simple terms you could describe it as the ‘development cooperation department’ of the Faculty of Health, Medicine and Life Sciences. Director Geraldine Beaujean has been working for years to match up the needs of universities in poor countries with the financial strength of international organisations and the expertise available in Dutch higher education. As a sort of travelling sales rep for educational improvement and innovation in healthcare, how is she coping now the corona crisis has brought international travel to a standstill?
‘Well, my working week has now fundamentally changed. I spend a lot more time sitting still than I’m used to. On my laptop I now have to hold online meetings, develop project proposals, write reports, supervise training courses, coach students and manage a team. I also have other concerns on my mind, about family and relatives, about my team members, and about our partners and their families, relatives and colleagues in many other countries. I miss the personal contact, the inspiring chance conversations, the visitors and the travelling. In this period, I’d planned trips to Sudan, Sierra Leone and Portugal. I got back from Kenya and Ethiopia just in time before the first countries closed their borders…’
What impact are the current worldwide measures and restrictions having on the work of SHE Collaborates?
‘We’ve always worked in countries in crisis, where society is under pressure from natural disasters or war, often accompanied by famine. Like Mozambique, which was hit by a cyclone last year, or South Sudan and Yemen. These areas are hard to reach, and we often have to ask the Executive Board’s permission to travel to so-called ‘code orange’ or ‘code red’ countries.
‘It’s very important to see the local circumstances in which people work, so you get a feel for the way they do things, the way things are organised. You have to be able to use all your senses, so to speak, to create a better connection. In a new partnership you really need to look each other in the eye; then when you’ve known each other for a bit longer, you can get by for a while using online communication tools. But helping people change their medical education requires more than just online knowledge transfer. You need personal involvement, persuasion, role modelling, and meaningful discussions with multiple stakeholders. We also often give workshops aimed at influencing ideas and opinions, using techniques like experiential learning or peer-to-peer discussions. These are all elements of coaching and learning for which people need to meet face-to-face.
‘It’s precisely in the countries and at the institutions that are hard to reach that we make sure we have regular face-to-face workshops and meetings. Afterwards you can then use online knowledge transfer for a while, but due to technical limitations, it’s not usually very frequent, so the content is rather superficial. Now that we can’t travel at all, and at the same time the online facilities are often reduced, our effectiveness seems limited. In the Netherlands it’s not hard to set up a home office, but things are very different in developing countries. For the time being, by staying in touch and regularly asking how things are going, we can keep the lines with our partners open. The people we work with are generally more accustomed to calamities and adversity than we are, and they’re more resilient, which is very impressive.’
So how are you managing to organise online learning?
‘Now that people can only work online, there is automatically more demand for online teaching material. Many teachers aren’t sure how to use it. There, just like here, people are afraid to start working with new e-technology. But this crisis is forcing everyone who has the opportunity to work online to do so. For example, at a school we work with in Kenya, they’ve agreed that every department should have an hour online every day to catch up with one another. This means they’re practising the use of the chat and audio-visual functions on their online platform (mElimu). Once they’ve mastered this, they can start developing material for their students. UM offers a lot of support, which they’re grateful to be able to use in Kenya, because it’s open access.
‘It’s hard to give competence-oriented training online. By this I mean the application of knowledge in a context that is as close as possible to the actual situation in which the student will be using it. We have no doubt that our partners will be able to find theoretical knowledge without us. But it’s precisely in terms of application, experience and the practical lessons we have learnt that we can offer support and contribute ideas. This is where we can really add value. It can also be helpful if we show examples from our own healthcare practice to help students understand what we’re talking about. In concrete terms, I’m talking about visits by foreign partners to MUMC+. But that’s not possible now...
‘The corona measures also have major consequences for our business operations. We fund our own salaries entirely from project revenue. The fact that we can’t travel and can’t receive visitors in Maastricht means that we’re losing income. When the travel bans are lifted worldwide, we can’t all suddenly start travelling much more than usual – we don’t have the capacity. What’s more, not all of our experts will be available because other work takes priority. In short, we won’t be able to make up the revenue we’re now losing. Without the support of the faculty, this means that temporary or permanent contracts will have to be terminated, with the result that we won’t be able to do as much acquisition or carry out as many projects.’
What does this mean in practice for the immediate future of your projects?
‘Nuffic funds many of our projects and is now working with us to find ways to continue this collaboration in a modified form. This global crisis makes it clearer to everyone that our health care system is only as strong as its weakest link. And because we focus on capacity building and strengthening in training for health care workers, this is where we can make a meaningful contribution, with all the expertise we have in Maastricht. Years of cooperation and building trust can lead to lasting improvements in the long term; a lot of people are needed to achieve this, and often it’s only the next generation of professionals that can make a difference. Unfortunately, the political vision often lasts no longer than a four-year term and then there’s a change of direction. Nevertheless, we have some good examples to be proud of, such as the development of GP training courses in Kenya and Indonesia, which we’ve been able to initiate in recent years together with other parties.’
In terms of medical facilities, are the countries in which you work able to cope with a corona outbreak?
‘A lot of mathematical models are currently being applied to predict the course of the crisis. No one knows how things will go, but there are a number of factors that determine the extent. Social distancing is even more complex if you live with a large family, often with several generations, in a small space. Many people in developing countries have poorer basic health due to malnutrition and infectious diseases, and also due to diseases of affluence. Children are a particularly vulnerable group. Hoarding isn’t possible if you barely earn enough to give your family one meal a day. What’s more, it’s a very big expense to be treated in a hospital. So who’s going to pay for it? In short, both the availability and accessibility of healthcare facilities are very limited in many areas.’
So in a country like Kenya, for example, is it practically possible to impose the strict measures we’re taking to prevent the spread of the virus?
‘In Kenya the middle class has become much larger in the recent years of economic growth. For these people, it will be relatively easy to stick to social distancing rules. They have decent living conditions and a monthly salary. But for other groups, it’s simply impossible: the people in refugee camps or the slums…’
Is the way of dealing with illness and death different in the countries where you work compared to the Western world?
‘This is a question I’m often asked. Let me put it like this: I have four children myself – would it matter less to me if something happened to one of my children because I’ve still got another three? I think anyone would see this is nonsense. But because there are others you have to take care of, who you’re responsible for, you carry on. I think this comparison comes close to the picture people paint of the way people cope with illness and death in developing countries. It hurts just as much, but at the same time there’s more care and responsibility for others.'
By: Mark van der Linde