It may sound easy, setting up a global health programme in a foreign country, but each programme requires different and specific content, says Krumeich. “Think for instance of the particular need with regard to environment and health. Climate change and health are not working out in the same way in Iran as they would in Europe. So you can have a course on climate change and health both in Europe and in Iran, but the solutions and challenges and possibilities will differ from country to country. The idea is to look at what kind of larger topics are important. How do you need to tackle the problems within the given particularities of the countries in the region we are focussing on?”
 

Many issues

There are plenty of problems in the Iran region, adds Takian: “We are living in a region that does not run short of disasters. Let’s make a list of the various complexities that we have in this region. On top: historically we are still living in countries where peace is comprised. And peace is one of the pillars of sustainable development, Sustainable Development Goal 16: peace, justice and strong institutions. One of the issues that we are facing in this region, including my home country, is insufficient institutionalisation. It varies per country, but more or less, we have inadequate engagement with the civil society and less than satisfactory public participation in policymaking and governance. Second, disasters, both manmade like war and natural such as flooding and earthquakes are very common in the region. There are 70 million refugees worldwide, half of them in this region. The third major issue is climate change: we are facing some particular examples of climate change that you don't see in other parts of the world. For example, in Iran we have the problem of dust storms that are affecting the health of people in various ways. This problem occurs most in the very densely populated South West of our country where we border with Iraq. Both countries suffer from this and we need to collaborate to solve this issue. To complete the list, the issues of cultural tolerance for global health, specifically in this part of the world, requires more work and practice. Another example: if you look at the number of polio cases, more than 95% are in Pakistan, which borders on the East side of Iran. My country has been 20 year without polio, but we still fear it will return in that region, perhaps partially because of people moving across the border, despite a robust vaccination program that Iran is running in its borders. I hope we can include all these issues as well as other concerns in the curriculum.”

The Centre of Excellence will provide TOT (train the trainer) training, conduct research, provide simulations, gamification and case study based approaches for global health training in a truly global way. This means that people from neighbouring countries will come to the centre to teach, conduct research or get training. Staff will not necessarily be permanent, but they will come from our region (a.o. Pakistan, Lebanon, Tunisia, Afghanistan, and MENA) and our European partners. Asked if this centre of excellence is unique in the world of global health, Krumeich answers: “So far, centres of excellence are quite limited in their focus. What is unique in our centre is a real intention to learn from each other. We want to build this together without this old-fashioned notion of capacity building, where European partners train and help others. It is not going to be like that in this partnership. We sometimes tend to forget that outside Europe there are traditions and institutions that have been there for a long time and that we can really collaborate with in a way that is beneficial for both. It is really important to have a regional centre that is at the same time open enough to have collaborations with European and later maybe also with Northern American and African partners. We have enough partners already across the world. It is important to see this centre as the basis for further collaboration.”
 

Sanctions

In May 2018, when the US pulled away unilaterally from the nuclear agreement with Iran and again started this political sanction, the country went back to the time that continuing relationships became difficult. How did Krumeich and Takian, whose departments are in the lead of the project, and the other partners manage to set up and maintain this collaboration? Krumeich: “The collaboration started already years ago when the situation of Iran was better and because we already had this very strong bond, we managed to go on. Also, I have to mention the president and rector of Maastricht University, who in spite of all kinds of political and economic pressures decided to go for signing the contract in spite of current geopolitical trends. We kept believing that in times where the formal channels are kind of abandoned for collaboration it is very important to keep open the more informal channels. This kind of collaboration keeps the world going behind the scenes in times when it is very difficult.”  Takian: “I appreciate the wisdom and support of the top leadership at UM, TUMS and the Ministry of Health and Medical Education of Iran, to be named among a few. We got support from many sides.” Both Krumeich and Takian acknowledge In particular the fundamental role of Dr. Remco Van de Pas from UM and Prof. Reza Majdzadeh from TUMS, without whose enthusiasm and commitment this collaboration was impossible.

For UM people who will wonder if it is possible to implement Problem Based Learning (PBL) in the new master’s programme or that it is too different from the current system, it turns out that Iran is ahead of PBL in the field of healthcare. They don’t simulate, they practice: “Iran has a unique healthcare system, in which public health and medical education and service delivery have been merged for over three decades. We have 67 public medical universities across 31 provinces that are delivering education, conducting research and providing and delivering services from primary medical healthcare such as vaccinations to very advanced secondary and tertiary medical care to the population. At our university, we are responsible for wide public health and global health packages that we are obliged to offer to our population. This provides our students, but also our teachers and researchers with an enormous practical experience from which they will benefit their entire lives.”

text: Margot Krijnen