GERMANY: Solving problems locally

Health is a topic the LMU Center for International Health at Ludwig Maximilians University in Munich focuses on. The centre is one of the five winners of the competition Exceed - Excellence for Development.

Millennium Development Goal 6 is aimed at combating Aids, malaria and other diseases and this is also one of the centre's primary fields. Beyond it, however, its activities touch on all the other development goals. For instance, poverty and health are closely linked while women's equality above all plays a role in the Aids context.

Reducing infant and maternal mortality is one of the medical scientists' objectives as is environmental protection since environmental pollution is a chief cause of diseases in developing countries. The Munich researchers are collaborating with institutions in Tanzania, Vietnam, Ethiopia and Chile.

The centre pursues an interdisciplinary approach. "What you mustn't forget," says Thomas Löscher, Professor of Medicine and Director of the LMU's department of infectious and tropical medicine, and also one of the CIH initiators, "is that in developing countries, we are not only dealing with the classical infectious diseases but also, and increasingly, with so-called civilisation diseases such as hypertension or diabetes."

Surgery has a considerable demand for good training facilities taking state-of-the-art knowledge into account, too. This is why the centre brings together scientists and practitioners from several fields for its various programmes - at LMU alone 12 institutes and clinics are involved.

HIV, the human immunodeficiency virus, is one of the biggest problems in countries such as Tanzania or Ethiopia. According to the CIA World Factbook, a constant 8.8% of the population have been living with the disease in Tanzania for years, while in 2008 Aids claimed the lives of 160,000 people there.

But there is hope in Ethiopia where the rate dropped from 10.6% in 2001 to 4.4% in 2008. Behailu Atlaw of Ethiopia's Jimma University attributes this to the more widespread use of condoms nowadays.

"People have become aware of Aids," he says. "Education campaigns on TV and on the radio have had a considerable impact."

Even so, Gelaw Yeshigeta, who heads the Medical School at Jimma University, says HIV continues to be a big problem: "We're working on it with the support of various countries and a number of institutions, and we will try to cope with it as well as we possibly can."

"CIH activities are aimed at developing teaching at the partner universities and boosting research there," Löscher explains. "If as many students as possible are trained, more problems can then also be tackled directly at local level."

The partner universities will be helped to define their own training and research, integrate themselves in international knowledge networks, implement their research results politically and give sound advice to decision-makers.

To attain this target, the centre has developed a concept resting on three pillars: supporting the partner universities in student and postgraduate training, developing a PhD international health doctoral course, and postgraduate and extra-occupational further education for experts from developing countries.

So far, six partner universities in Africa, South America and Southeast Asia have joined the programme, while more are to follow. "We want to train the professors so that they can do modern teaching," Löscher explains.

"We are developing new curricula that of course have to consider local conditions so that students can independently work out solutions from case to case," adds his colleague Matthias Siebeck, Professor of Surgery at the LMU Clinic.

But cooperation is not a one-way street. Views, concepts and experience are exchanged. In Ethiopia, for example, it is customary to send the students out to rural areas for one month each year. The health centres in the rural areas are supervised entirely by students.

"Such community-based education is interesting for us, too," Siebeck says. "This is an entirely different approach to learning and it would do our students no harm to get to know it."

Exchange of students and lecturers between Ethiopia and LMU is already in full swing.

In Vietnam, two renowned institutions are counting on LMU support in training medical students: the University of Ho Chi Minh City and the University of Danang. Especially in Danang, the emphasis is on assisting in the development of the newly launched medical course.

Implementing the concept of problem-oriented learning is to be supported step by step. Only the intensive training of teaching staff and the analysis of any problems occurring, especially in intercultural exchange, will ensure a sustainable impact of the planned measures.

Postdoc teaching is to accompany the development of the medical course. In addition, an intensive exchange of university members at student as well as teacher and research level is to be institutionalised. In the long run, well-trained doctors, using the already established infrastructure, are to have a considerable impact on morbidity and mortality, for example on infant mortality (23.61/1,000 live births in Vietnam versus 4.03/1,000 in Germany according to CIA World Factbook 2008).

Thus originally purely humanitarian activities launched in 2006 by the Department of Infant Cardiology and Paediatric Intensive Medicine at the Großhadern Clinic, which is headed by Professor Heinrich Netz, can be extended by a university component with the colleagues in Danang.

This joint project originally focused purely on establishing a clinic with a complete infant cardiology unit and a heart catheter plant. In the following years, training of specialist medical staff was intensified, recently for example by a workshop on infant echo-cardiography last April by Netz and PD Robert Dalla Pozza.

Löscher is particularly proud of the PhD course, the second pillar: "We want to provide an attractive international research course meeting high standards and proving self-sustainable in the long run that will even be able to compete with Harvard."

Attempts will be made to win over and support top graduates from around the world with the aim of enabling those completing the courses to assume leading roles in the development of all three areas of medicine in their home countries: teaching, patient care and research.

Development and pure research, clinical research and the entire range of the health sciences at LMU are reflected in the doctoral training programme, Löscher explains. Intensive collaboration is also planned with the Global Health Governance programme of the Social Sciences Faculty, which has a strong focus on development issues.

The third pillar of the concept concentrates on courses for specialists and decision-makers that are mainly run in the partner countries. These include a master's course in psychiatry, being developed by Norbert Mueller, Professor at LMU's Clinic for Psychiatry and Psychotherapy, in Jimma.

"Just imagine that in Jimma, a city of 200,000 inhabitants, there is only one psychiatrist," Mueller remarks. "He is the only one in the entire Jimma region with its population of 2.8 million and an area of 18,000 square kilometres."

Out of the 30 psychiatrists in Ethiopia, 28 are working in Addis Ababa. "Anyone becoming a doctor in Ethiopia either works in the capital or emigrates."

But the rate of mental diseases is at a similar level to that of developed industrialised countries. Then Mueller had an idea to improve the state of psychiatric care in the country: "The focus had to be on attaining a level of training lying between the nursing staff on the one hand and the doctor on the other. Thus well-qualified specialists are trained who stay in the country."

This was the birth of the Mid-level Health Worker.

Katja Radon, Professor of Epidemiology at the LMU Clinic's Institute of Industrial, Social and Environmental Medicine has developed different courses specially tailored to countries such as Peru, Bolivia, Chile or Brazil.

"Health at work is a huge issue," Radon says, noting that up to two million people suffer a fatal injury at work world-wide each year. To illustrate her point, she describes the working conditions in a Bolivian silver mine.

There, children work in the same conditions as grown-ups. Dynamite is used to blast lumps of rock out of the tunnels. If the breadwinner dies in blasting, his children have to take over.

In gold extraction in Chile, rubble is removed in open-cast mining and ground into powder that is then mixed with highly toxic mercury in a basin. The mixture of gold and mercury is skimmed off and the lump thus created sold. Work then carries on with Bunsen burners in backyards. Heating up releases the mercury to gain pure gold.

Local goldsmiths use the latter to make jewellery which, according to Radon, "sells very well - to the tourists coming to the district to visit Chile's world-famous observatory". But contamination with mercury turns the young local men into invalids. The children are also affected because they often get close to the mercury vapour.

LMU initially ran its summer courses in Germany exclusively in English. But it soon became clear this posed problems for potential participants from Latin America. "Hardly anyone speaks English there," Radon explains. So next year, the CIH is starting to run summer schools locally, in Spanish.

Usually, a course lasts two weeks. The first week deals with what industrial medicine is, what risks there are at the workplace, and how they can be minimised. Then there is instruction on how data can be collected and processed to convince politicians that industrial medicine measures are needed.

From this, the students develop a project that directly relates to local problems. "After all, that is what all this is about," Radon says. "It is the problems there, in the countries of Latin America, Africa and Asia, that we have to find solutions for, and we will only find them if we work together with the people there at eye level."

* Stephan Weidt is a freelance journalist and author for Lemmens Medien and other publishers in Bonn.