India has no national system of general practice and it is hoped the two-year distance learning course will help train doctors in quality family medicine and begin to bring about a change in how the speciality is viewed.
Dr Le Feuvre, a GP at Hawkinge and Elham Valley Practice, said: “We take for granted we have the finest system of general practice in the world. Most of us trust and respect our GPs, but it’s not always the same in India.
“If you are poor, you will be treated in a rural Government clinic by a doctor who has only the basic medical qualification. You may have walked many miles to a clinic which may have no water or electricity and the pharmacy may not have the medicines you need.
“Anyone who has an illness and little money will pay or borrow money to go to see a specialist because they often do not have confidence or respect for their local doctor, even for a minor ailment. They will pay to see a specialist which risks having to pay for unnecessary tests and operations.
“The worst I have seen is a woman who was having irregular periods. She had no internal investigations or tests, but was told she had cancer and it cost her thousands of rupees to have a hysterectomy.
“It is rare to find co-ordinated care, preventive medicine, regular blood pressure checks and most people have no relationship with their local doctor.
"These doctors have the technical skills but it’s about putting them into practice. It’s back to care and compassion – and that’s what the people on our course are motivated by. Hopefully the course will change attitudes to family medicine so it starts to be regarded as a specialty in its own right.”
While candidates study most of the course through distance learning, on three occasions in their two year programme, they must come together for a 10 day face-to-face teaching programme in one of 10 Indian cities. Peter and Sarah were with candidates in Hyderabad, Andhra Pradesh in February and Cochin, Kerala in July.
Dr Le Feuvre said: “We focus on work around clinical decisions, and the importance of evidence-based medicine, including the latest NICE guidance.
“The doctors are accustomed to traditional teaching methods which tend to be passive, so we do a lot of role play work so they can put new skills into action, for example, how to break bad news.We also debate ethical principles.
“While they face very different conditions to us – patient poverty, a lack of drugs and investigations or tests being available – the middle class is growing and the rich Indian food means many are overweight. So, with a growing diabetes epidemic, some of the work is around how to manage diabetes and hypertension.
“It’s just Sarah and I who deliver the course alongside a local coordinator to around 15 doctors, but every afternoon we have a telelink to Vellore and connect with around 150 to 200 doctors across India to share skills, which is fantastic.”
The couple, who also worked in Tunisia for four years and with asylum seekers in east Kent for almost a decade, are hoping to work for the World Health Organisation to set up a system of family medicine in Iraq.
In 1990 they set up a charity to support a centre for 150 handicapped children in one of the poorest parts of Andhra Pradesh, a southern India state.
Dr Le Feuvre added: “We will return to India in November The centre is an amazing place. The children, who are usually those of landless daily labourers, are incredibly resilient and help each other. Polio has been eradicated but there are a lot of children with deafness, learning difficulties and cerebral palsy.
“This work certainly keeps us grounded.”
10 September 2012