The role of Sudanese diaspora and non-governmental organizations (NGOs) in health system in Sudan: towards better future and a model of social accountability

The legacy of British doctors and their contribution in establishing medical research and the medical school in the Sudanese capital Khartoum was well documented in the literature. For example, the financial and moral support provided by Sir Henry Solomon Wellcome, in the early 19^th century gave Dr. Andrew Belfour an opportunity to build in Khartoum one of the best medical services in the world at that time. This achievement was associated with the establishment of a modern medical school in Khartoum and the Wellcome tropical research laboratories (1-3). Sudan was an attractive place for British doctors to make a fortune and conduct state of the art research work to get promoted within their academic and medical career in the UK (3-5). Dr. John Brian Christopherson was the first clinician in the world to conduct clinical trials in schistosomiasis in Khartoum Civil Hospital, and his study was published in the Lancet. Dr. Albert Chalmers was appointed director of the Wellcome Tropical Research Laboratories in Khartoum (WTRLK) in 1913, succeeding Andrew Balfour. Chalmers’ research concentrated on the taxonomy and pathogenicity of bacteria and fungi but he also worked on miscellaneous dermatological disorders and on sleeping sickness, and a prize in his name is regularly awarded for best research in tropical medicine by Royal Society of Tropical Medicine and Hygiene (RSTMH) (3,4). Over many decades and still going on, large proportions of Sudanese doctors received their postgraduate medical training in the National Health Service (NHS), UK or obtained degrees from British universities. Therefore, it is not surprising that many Sudanese doctors in UK and Ireland continued to support their health system in Sudan through different charitable organizations. Examples of such organisations are Salamat charity (https://salamatcharity.org), Sudan Medical Care Foundation (SMCF) (www.medics-sd.org), Sudanese Medical Association in UK and Ireland (http://www.sssuk.org/drupalSite/?q=content/sudanese-medical-association-uk-i) and Sudanese doctors’ unions in UK and Ireland (https://www.sdu.org.uk). It worth mentioning that the Sudanese American Medical Association (SAMA) in USA (https://sama-sd.org), contributed in similar scale to Sudanese medical charities in UK and Ireland. Other medical Sudanese charities in the Gulf countries also contributed toward the benefit of the health system in Sudan. Abdalla et al. concluded that despite the small scale of contribution of Sudanese medical diaspora, their contribution has remarkable effect in improving academia and specialist services in Sudan. Abdalla et al. recommended the need to establish a coordinating body from within the healthcare sector in Sudan to effectively coordinate diaspora contributions (6).

In this special issue we have tried to highlights the contributions of Sudanese medical diaspora and local non-governmental organizations (NGOs) in the development of the health care system in Sudan. The reader may find the special issue covered different disciplines and this can be attributed to the contributions of different specialists. For instance, the Sudanese medical diasporas in Qatar led by Dr. Osama Yousif Algibali, have adopted an initiative to treat children with congenital heart disease in Sudan for 6 years. Different NGOs in Sudan and outside contributed in this project. For example, Patients Helping Fund (PHF) the largest medical charity in Sudan, Eid Althani charity association in Qatar with collaboration of the Federal Ministry of Health (FMH), Ministry of Health in Khartoum state and both Gezira University and Gezira state. This project has helped in treating large numbers of children with congenital heart disease (7). The special issue included a review article about one of the promising and pioneer NGO in Sudan called Save A Life Initiative (SALI); that considered as second generation of PHF (8). We have also included three articles about medical education in Sudan. Dr. Ibn Auf showed that despite the high perceptions of Sudanese doctors for research, lack of funding remains the most important barrier to research (9). Dr. Husain showed that the level of professional knowledge of the final-year medical students in Sudan is very good and this combined with excellent attitudes in community protection, readiness to serve rural areas and most importantly non-judgemental and non-discriminatory approach (10). Dr. Zulfu showed that pathologist and trainees in pathology have a good level of satisfaction with postgraduate pathology training in Sudan (11). Future reform of the histopathology curriculum will help to increase graduate’s satisfaction and will consequently result in improving pathology training and services. Chronic diseases like diabetes and HIV were also included in this special issue. For example, Dr. Khogali showed that more work is needed in order to enhance knowledge, attitude and practice of Sudanese individuals with type 2 diabetes towards their anti-diabetic medication (12). Dr. Jervase and others wrote comprehensive review article about HIV in South Sudan in collaboration with Dr. Dushyant Mital, consultant in HIV medicine in Milton Keynes University Hospital, UK (13). Joined article by final year medical students at Buckingham Medical School, UK and Dr. Ahmed and Dr. Mital about whether the HIV metabolic clinic established in Milton Keynes University can be replicated in sub-Saharan African countries (14). This reflects parts of the initiative and contributions of Milton Keynes University Hospital towards the global health.

Furthermore, Milton Keynes University hospital established educational and research collaborations with more than five Sudanese medical colleges over the last 5 years (please see publications by Almobarak et al., Awadalla et al. and Ahmed et al.). This have helped in term of teaching outcomes, research and development, publications, numbers of postgraduate students supervised, stability and promotion of academic staff in Sudan especially in hard to recruit areas, e.g., females. This kind of knowledge transfer will come not only with the benefit for overseas countries but also will increase job satisfaction for the doctors during their employment in the NHS. This model also meets that inner desire of these doctors to have that sense of contribution towards their home countries.

Therefore, one of our ambitions in the near future is to establish Sudanese-British Medical Research Charitable Foundation (SBMRF). The main aim of SBMRF is to bring the Sudanese medical researchers from around the globe to work with local universities, research centers and hospitals in Sudan. Another aim of SBMRF is to help non-Sudanese researchers to collaborate with Sudanese researchers and apply for research funding. Ultimately, this will help in knowledge transfer (the charity is under development, needs to be registered in the UK and Sudan, website development and funding).

This model for knowledge transfer can be associated with many benefits. The NHS as organization can be involved and promote social accountability towards health system in other resource limited countries at no financial cost. This model provides mutual benefit for UK and African nations, so it can be regarded as one solution for Africa’s “medical brain drain” to western nations (15). This model can be replicated in other countries and other continents particularly with the use of information technology (IT)-based technologies like Skype, WhatsApp and Facetime, make communication and supervision of postgraduate students achievable. The potential benefits for African countries are enormous with improvements of health care systems, staff training, opportunity for staff promotion, retention of high calibre healthcare workers, emphasising a culture of research and development, importance of teamwork and collaboration and eventual increased job satisfaction. This in turn creates future healthcare leadership and opportunities to work and collaborate with other health authorities and local and international NGOs.

Acknowledgments

Dr. Ahmed would like to acknowledge Prof. Joe Harrison, chief executive, Dr. Ian Reckless Medical director, Dr. Vicky Alner director of Division of Medicine, Dr. Dushyant Mital Consultant in HIV medicine, Dr. Clare Woodward HIV lead, Dr. Mansoor Raza (infectious disease and microbiology consultant), Miss Jane Webber (orthopaedic surgeon), Mr. Mohamed Abdel Khaliq (orthopaedic surgeon), Mr. Igbal Anjum (Urology surgeon), Dawar Abbas (orthopaedic surgeon), Mr. Mazhar Raja (general surgeon), Mr. Elamin Elsheikh (Registrar in general Surgery) and Chaplaincy team (Philip Winn and Sarah Crane) and all staff in the Department of Medicine, Department of Blood Borne Viruses, Ambulatory Emergency Care Unit and Maple Unit in Milton Keynes University Hospital, Milton Keynes, UK. Dr. Hisham Osman (gastroenterologist, UK). Dr. Abobakr Shadad (gastroenterologist, UK). Dr. Mahir Hamad and Dr. Vincent Connolly (James Cook University Hospital, UK). Mr. Khalid Amer (Thoracic Surgeon, Southampton University Hospital, UK). Dr. Atif Khalil (renal physician, UK). Dr. Tarig Hassan Elzobair (Consultant Psychiatrist-Khartoum, Sudan). Special gratitude to class mates in the PhD course in Manchester University, UK (Dr. Abdullah Al-Taher, Molecular Pharmacologist, Al-Ahsa, Saudi Arabia and Dr. Abdullah Bashein, Molecular Biologist & Biochemist, Tripoli, Libya).

The authors also acknowledge Prof. Nazik E. Husain, Prof. Wadie Elmadhoun, Prof. Sufian K. Noor, staff in patients helping fund, staff in SALI, staff in University of Medical Sciences and Technology (UMST), staff in Department of Community Medicine in Khartoum University, staff in faculty of Medicine and Pharmacy in Omudrman Islamic University and staff in Nile Valley University, Atbara, Sudan. Dr. Anas Ibn Auf, Prof. Ibrahim Ginawi, Dr. Mougtba Osman, Dr. Ehab Farah, Dr. Osama Yousif Algibali and Dr. Amal Suliman, Saudi Arabia. Dr. Baha Eldin Juma, Dr. Mubashar Faraj, Prof. Ibrahim A. Janahi Doha, Qatar. Dr. Mohamed H. Abdalla, Dr. Mohamed H. Taha and Dr. Muaz Elsayed, United Arab Emirate.

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Journal of Public Health and Emergency for the series “The Role of Sudanese Diaspora and NGO in Health System in Sudan”. The article did not undergo external peer review.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jphe.2019.10.02). The series “The Role of Sudanese Diaspora and NGO in Health System in Sudan” was commissioned by the editorial office without any funding or sponsorship. MHA served as the unpaid Guest Editor of the series and an unpaid editorial board member of Journal of Public Health and Emergency from August 2017 to July 2021. HA and AOA served as the unpaid Guest Editors of the series. The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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Mohamed H. Ahmed

Heitham Awadalla

Ahmed O. Almobarak