SMA UK Ireland_Galway Conference Report_2012

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					The Sudanese Medical Association (SMA)
            UK & Ireland
    THE CONFERENCE REPORT




              Zuhair Ali, Emam El-Higaya, Nuha Ibrahim,
              Khalifa Elmusharaf, Abobakr Shadad, Mohammed
              Elshafei & Mohamed Ahmed
Suggested citation:

Ali Z, El-Higaya E, Ibrahim N, Elmusharaf K, Shadad A, Elshafei M, Ahmed M, Editors.
Migration of Sudanese Doctors: Dynamics & Opportunities, Conference Report. The Sudanese
Medical Association (SMA) UK and Ireland. 9th June 2012, Galway, Ireland.




                  © Sudanese Medical Association (SMA) UK and Ireland – 2012

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Information concerning this publication can be obtained from:
Sudanese Medical Association (SMA) UK and Ireland
No.9 Ros Caoin, Roscam. Galway, Ireland
Or
P O Box 80. Morden Surrey. SM4 9AS. UK

Copies of this publication can be ordered from:
www.sma-ukandireland.org/
info@sma-ukandireland.org
                                              Table of Contents
TABLE OF CONTENTS .................................................................................................................... 1


INTRODUCTION ........................................................................................................................... 2


ABBREVIATIONS........................................................................................................................... 4


EXECUTIVE SUMMARY ................................................................................................................. 5


THE CONFERENCE SESSIONS ......................................................................................................... 8


1. THE OPENNING SESSION ........................................................................................................ 8
2. DYNAMICS OF DOCTORS MIGRATION ...................................................................................... 10
3. MODELS OF NOVEL INTIATIVES ............................................................................................... 14
4. PARELLEL WORKSHOPS ........................................................................................................... 19
5. CONDUCTING RESEARCH IN A CHALLENGING IRISH HEALTH SYSTEM......................................... 26
POST CONFERENCE ACTIVITIES ................................................................................................... 28


ANNEX....................................................................................................................................... 32


THE CONFERENCE ORGANISING COMMITTEE .......................................................................................... 33
CONFERENCE PROGRAMME .............................................................................................................. 34
SPEAKERS’ BIOGRAPHIES .................................................................................................................. 37




         1                                                                  SMA UK & Ireland conference- Galway June 2012
                                                                   Migration of Sudanese Doctors: Dynamics & Opportunities
                              INTRODUCTION

It is my great pleasure to introduce this report summarising the activities of the 1st Sudanese
Medical Association conference in Ireland: Migration of Sudanese Doctors: Dynamics &
Opportunities.
The conference was a reflection of the increasing awareness of the ongoing high level world-
wide discussions about health care workers migration and its impact on the human resources
for health and on the health service delivery in general.
The conference focused on the migration of Sudanese doctors with emphasis on the push and
the pull factors behind their migration. At present there are more than 600 Sudanese doctors
registered with the Irish Medical Council. This number, without any doubt, is on the rise. In
2000, there were less than 80 Sudanese doctors in Ireland.

The first session of the conference analysed the phenomenon of Sudanese doctors migration
to Ireland in details and explored the historical dimensions of this phenomenon as well as the
current trends. The conference also examined the whole area of doctors’ migration in Ireland
with reference to the ethical and practical implications as migration of doctors represents a
brain drain and creates a critical shortage of health workers in low-income countries such as
Sudan.

Having said that, there are great opportunities created by doctors’ migration including better
training, up-skilling and transmission of knowledge. The conference dedicated special
sessions that focused specifically on the opportunities for cooperation created by doctors’
migration. A number of outreach initiatives by Sudanese Irish doctors were presented at the
conference and their details are included in this report.

For Ireland, this conference addressed the country's over-reliance on foreign doctors. In 2008,
Ireland ranked second in the OECD (following New Zealand) for recruiting doctors from
overseas. According to 2006 figures, 54% of Ireland's Non-Consultant Hospital Doctor
(NCHD) posts were filled by non-Irish nationals.

The conference also included five parallel workshops which gave participants the opportunity
to participate in discussions about thematic topics of special interest to them. Details of these
workshops are included in this report. The last session of the conference incorporated short
presentations of distinguished research projects conducted by Sudanese-Irish doctors, along
with lessons learnt and recommendations by these doctors. A summary of these presentations
is included in this report.

This conference aimed at providing a platform for senior health policy makers and academics
in Sudan and Ireland to get together and share their experiences and discuss avenues for
collaboration and cooperation. I believe this objective has been achieved to a great extent as
very successful meetings were held, as part of the post conference activities, between the high
level Sudanese delegates and key Irish academics and health policy makers. The outcomes of
these meetings will be announced in the near future.


      2                                               SMA UK & Ireland conference- Galway June 2012
                                             Migration of Sudanese Doctors: Dynamics & Opportunities
I hope that you will find the contents of this report useful and interesting.
Thank you.

Dr. Mohamed Ali Ahmed
Chair, Conference Organising Committee,
Galway, Ireland.


                             “Trí na chéile a thógt na chaisléain”

                      “Only by working together, we can build castles”

                                       "An Irish Proverb"




      3                                                SMA UK & Ireland conference- Galway June 2012
                                              Migration of Sudanese Doctors: Dynamics & Opportunities
                          ABBREVIATIONS

BST         Basic Surgical Training.

COSECSA     College of Surgeons of East, Central and Southern Africa

CME         Continuing Medical Education

CMPS        Council for Medical Postgraduate Studies

EU          European Union

FMOH        Federal Ministry of Health in Sudan

FRCS        Fellowship of Royal College of Surgeons

GPT         General Professional Training

IELTS       International English Language Testing System

IMC         Irish Medical Council

MRCPI       Membership of Royal College of Physicians of Ireland

NCHD        Non-Consultant Hospital Doctor

OECD        Organisation for Economic Co-operation and Development

RCSI        Royal College of Surgeons in Ireland

SDMLE       The Sudan Medical Licensing Examination

SHO         Senior House Officer

SMA         Sudan Medical Association

SMC         Sudan Medical Council

SNF         Sudan National Formulary

SNMSB       Sudan National Medical Specialisation Board

SpR         Specialist Registrar

T2DM        Type2 Diabetes Mellitus

TRAS        Temporary Registration Assessment Scheme

UNCTAD      United Nations Conference on Trade and Development

WHO         World Health Organisation




        4                                            SMA UK & Ireland conference- Galway June 2012
                                            Migration of Sudanese Doctors: Dynamics & Opportunities
                     EXECUTIVE SUMMARY
The Sudanese Medical Association UK & Ireland held its first conference in Ireland in
Salthill Hotel, Galway on Saturday the 9th of June 2012. More than 100 delegates participated
in the conference sessions. Participants were Sudanese doctors working in Ireland and UK,
Irish health policy makers and health workers as well as researchers and academics with
interest in health and migration issues.

Five key delegates represented the Sudanese health system lead by his Excellency, Sudan
Federal Minister of Health, His Excellency Mr Bahar Idriss Abugarda with two of the
Ministry senior health policy makers; Dr. Hassan Abdul Aziz and Dr. Elsheikh Badr. The
presidents of two important Sudanese regulatory bodies and medical institutions also attended
the conference; the president of Sudan Medical Council; Prof. Zein Karrar and the president
of Sudan Medical specialisation Board; Prof. Osman Taha.

The First Session commenced with opening remarks and welcome by Dr. Mohamed Ali
Ahmed, the chair of the organising committee who welcomed the delegates and called for
developing and enhancing Sudanese Irish relations in health and medical training domains
through the establishment of long term institutional commitments that benefit both sides. Dr.
Ahmed emphasised that this relationship could become a good example of a North-South
partnership aiming for a win/win situation for both countries.

Dr. Abobakr Shadad then reflected on the main theme of this conference; the migration of
Sudanese doctors and emphasised on the unique public diplomacy between Sudan and Ireland
represented by the role of Sudanese doctors in Ireland. Then the previous and current
presidents of the SMA; Dr. Faisal Mihaimeed and Dr. Mahir Hamad gave two short talks
about the SMA vision & mission, brief account of the previous achievements and the future
projects. They emphasised on the non-political nature of the organisation and that it does not
claim any trade union representation role. They invited the delegates to attend the upcoming
SMA conference in Sudan in December 2012.

Sudan Federal Minister of Health, His Excellency Mr Bahar Idriss Abugarda, then gave a
brief overview of the current challenges facing the health system in Sudan and the
achievements in health care indicators in the period 2006-2010. He then outlined the
Ministry's plans and ambitions for the future. The Minister thanked Ireland for hosting
Sudanese doctors and called for future collaboration between the two countries in improving
health services delivery and health/ medical education and training.

The Second Session discussed many issues relating to the Sudanese doctors migration to
Ireland and also looked at the phenomenon of health workers migration as an International
trend as well as the implications and challenges from an Irish perspective.



      5                                              SMA UK & Ireland conference- Galway June 2012
                                            Migration of Sudanese Doctors: Dynamics & Opportunities
The conference has learned that the last few years have witnessed increasing numbers of
young male and female Sudanese doctors coming to Ireland for postgraduate training and
long term employment with no clear plans to go back home.

The push factors in Sudan include limited and poorly funded postgraduate medical training in
Sudan as well as poor economic situations. Also the ambitious nature of Sudanese doctors
and desire for better training opportunities abroad, played a major role. The Irish pull factors
include internationally recognised postgraduate medical training, employment opportunities
with good income in a friendly country. Another very important pull factor is the large
number of Sudanese doctors already in Ireland which encourage and attract more and more
young Sudanese doctors to migrate to Ireland.

The conference has also learnt that there has been a huge surge in production of doctors in
Sudan, this created a bottle neck at postgraduate specialisation level associated with a severe
lack of nurses and other healthcare professionals. This deficiency is not an exception within
the African context as the whole African continent has only 3% of global health workforce
while facing 24% of worlds’ burden of disease. Regional attractive destinations to the
migration of large numbers of Sudanese doctors include Saudi Arabia and other Persian Gulf
states in addition to the emerging destination of post-conflict Libya.

Local retention strategies in Sudan remain behind the strength of local pushing and regional
pulling factors. The optimal efforts should target Diaspora mobilisation activities through
initiatives by migrant Sudanese doctors such as outreach campaigns, workshops in health and
clinical sciences, relief efforts and the contribution in health services delivery in general.

The conference has also learnt that Ireland witnessed a three folds increase of foreign trained
doctors working in Irish hospitals; from 13.4% in 2000 to 33.4% of all doctors registered
with IMC in 2010, with 6 fold increase in the numbers of Sudanese doctors from 63 to 403 in
the same period.

However, following the financial crisis, Ireland started to lose large numbers of its own
graduates who migrate to countries as USA, Canada and Australia looking for better career
progress pathways. The negative effect on incomes will be added to other difficulties already
facing non-EU doctors such as limited access to specialist training, unfavourable immigration
status for spouses and fluctuating visa policies and naturalisation prolonged processing times.

The Global Code recently adopted by WHO would urge recipient countries such as Ireland to
participate in the promotion of health services and medical training in sending countries such
as Sudan. These two countries can set a model example of collaboration that support
technology and skills transfer through training bodies in both countries.

In the Third Session, good examples of health collaboration between Sudan and Ireland were
highlighted. As part of this session, the FMOH's Academy of Health Sciences in Sudan
"FMOH" and the National University of Ireland Galway "NUIG" signed a Memorandum of
Understanding aiming to collaborate in provision of training for nurses and midwives in
Sudan.

      6                                               SMA UK & Ireland conference- Galway June 2012
                                             Migration of Sudanese Doctors: Dynamics & Opportunities
The initiatives discussed in this session included Sudan Online Health Library, a pilot
collaboration project of short term training of Sudanese nurses in Ireland, the
RCSI/COSECSA project, and the provision of safe and well refurbished dialysis machines to
Sudan following nephrologists-led initiative. Potential areas of collaboration were also
explored in this session such as the inclusion of Sudan in the RCSI/COSECSA project and
the Irish contribution in improving maternal health in Sudan in view of the expertise and the
excellent records of maternal health care in Ireland.

The Fourth Session (the 5 parallel workshops) provided an opportunity for the conference
delegates to participate in discussions about topics of interest to them.

The first workshop identified six factors that negatively affect the decision to return to Sudan;
poor work environment, children education, insufficient income, lack of career pathways and
poor professional development opportunities in Sudan, in addition to concerns about major
changes in life style.

The second workshop explored the attractiveness of Sudanese private health sector to
expatriate Sudanese doctors. The group admitted that private health sector in Sudan provides
better income, better work environment and highly trained allied health workers. The
workshop also identified lack of academic incentives, lack of job security, long working
hours and the limited access to the majority of Sudanese population as major drawbacks of
private health sector in Sudan.

The third workshop identified better use of Information Technology (IT), online facilities and
mobile phone-based services as the way to go for future medical training initiatives in Sudan.
The workshop also emphasised on the need for more group-based (team work) initiatives
rather that the individually based ones with a limited impact.

The fourth workshop suggested the facilitation of initial registration through improving
communications between the Medical Councils in Sudan and Ireland. The workshop also
recommended exploring the organisation of the first part of PRES exam in Sudan. The
workshop also recommended that Sudanese doctors practicing in Ireland should be informed
of the new three tier registration levels in the specialist register in Sudan Medical council.

The fifth workshop concluded that reasonable medical registration process in Ireland, the use
of English language, Internationally recognised medical training, the location of Ireland
compared to countries such as USA, Canada and Australia and the presence of well
established Sudanese medical community in Ireland; all of these factors made Ireland a
favourable destination for many migrant Sudanese doctors.

The Fifth Session provided an opportunity to present and discuss examples of high quality
research work conducted by Sudanese doctors in Irish medical institutions with a view to
highlight the skills and other requirements of research as well as the challenges facing clinical
researchers. A summary of these presentations is included in this report.




      7                                               SMA UK & Ireland conference- Galway June 2012
                                             Migration of Sudanese Doctors: Dynamics & Opportunities
                THE CONFERENCE SESSIONS
                       1. THE OPENNING SESSION
Dr. Mohamed Ahmed: the chair of the organising committee started this session by opening
remarks in which he welcomed the high level delegates from Sudan, representatives from
Irish institutions and conference participants. Dr. Ahmed expressed gratitude to the
organising committee, speakers and the sponsoring companies and institutions.

Dr. Abubakr shaddad: in his presentation (From Khartoum to Galway), the story of hundreds
or thousands of young, enthusiastic Sudanese doctors crossed the boundaries from South to
North, since the 70s of the last century up till now. What made them favour this beautiful
country? Dr. Shadad explored this phenomenon and reflected on the unique public diplomacy
between Sudan and Ireland that has great potentials to bring benefits to the people of the two
countries. Dr. Shadad quoted an Irish proverb that encourages collective work and
collaboration as essential element to achieve goals and improve outcomes.

Dr. Faisal Mihaimeed: the founding president of Sudan Medical Association (SMA)
presented a historical overview SMA which was founded in 2010 as a non-governmental,
non-political organisation that involves all healthcare professionals. Dr. Mihaimeed explained
that SMA aims to be an agent of change and voice of reason to bring healthcare professionals
together in working partnership with a vision to improve health care service in Sudan.

He stressed the scientific nature of the association and its openness to work for the benefit of
the Sudan, UK and Ireland without any political affiliation or assumptions. The association
membership expanded to over 1000 health care professionals from wide range of specialties
including doctors, dentists, pharmacists, nurses, lab technicians, radiographers, chiropodists,
etc. He gave a brief account of the previous achievements and meetings held both in UK and
Sudan and he invited delegates to attend the
upcoming conference in Sudan mid December 2012.

Dr. Mahir Hamad: The current president of the SMA
presented some of the SMA achievements and
projects such as postgraduate outreach training in the
states of Khartoum, Gezira and River Nile as well as
undergraduate outreach training projects. He also
presented the SMA initiative towards doctors in early
training (DET) project which is UK based including
workshops for specialty applicants, interview skills
and training in conflict resolution.



                                                           Dr. Mahir Hamad, president of the
                                                              SMA addressing the conference

      8                                               SMA UK & Ireland conference- Galway June 2012
                                             Migration of Sudanese Doctors: Dynamics & Opportunities
His Excellency Mr. Bahar Idriss
Abugarda:       the Sudanese Federal
Minister of Health gave a brief
description of the current challenges in
Sudan's health system and the
achievements in improving health
indicators in the period between 2006 -
2010. The Minister welcomed all
initiatives aimed to support health
system and medical training in Sudan
from the migrant Sudanese doctors and
their hosting countries such as Ireland.
He concluded by thanking Ireland for
hosting Sudanese doctors and their
families and called for stronger
collaboration in health matters between
Sudan and Ireland.




                                                    His Excellency Sudan's Federal Minister of Health Mr.
                                                     Bahar Abugarda addressing the Conference.




From right to left: Dr. Mohamed Ahmed, HE Mr. Bahar Abugarda (Sudan Federal Minister of Health), Dr.
Abobakr Shadad and Dr. Mahir Hamad (President of SMA).




      9                                                   SMA UK & Ireland conference- Galway June 2012
                                                 Migration of Sudanese Doctors: Dynamics & Opportunities
          2. DYNAMICS OF DOCTORS MIGRATION

Mrs Nuha Ibrahim started the second session by presenting her study of pull and push factors
for Sudanese doctors migration to Ireland. The aim of this research was to investigate the
migration of the Sudanese doctors to Ireland: what are the factors that contributed to their
decisions to leave Sudan and come to Ireland, their perception about working in Ireland and
what are their future plans?

She identified two main factors, among others, for the male dominated (93.8%) migrant
Sudanese doctors to Ireland: the need for better training and professional development (45%)
in addition to financial attractions (33.3%) as most of these doctors (80.4%) continued to
support extended family members in Sudan. Other push factors included limited employment
opportunities in speciality of choice in Sudan, lack of equipments, hospital management
difficulties and factors relating to the political situation.

Most of the participating doctors were at the registrar level (65% with only 4.6 in specialist
training; SpR) followed by SHO level (23.1%) and only 11 % of the 120 participants were at
the consultant level. Around 90 % felt that they do not feel that they have the same chance as
Irish doctors to get specialist training. This is the area of their least satisfaction as only 30 %
were satisfied with training opportunities, compared to low percentages of dissatisfaction
with lifestyle, working conditions and salary.

Nearly half of these doctors (45.6%) had migrated to another country before Ireland,
predominantly Saudi Arabia (79%). Most of these doctors stated that Ireland is not their final
destination (79.6%), and 89 % expressed their intention to go back to Sudan. Despite only
42% were originally from Khartoum area 66.7% of the participants said they plan to work in
Khartoum when they go back.

Dr Emam El-Higaya gave a brief historical overview of modern medical education in Sudan
that is backdated to 1924 with the establishment of Kitchener school of medicine (KSM)
which graduated its first batch in 1928. In 1937, Sudan started to send graduates to UK for
short postgraduate experience with the first Sudanese graduates obtained their MRCP and
FRCS in 1948 and 1949, respectively. At that time, trainees were typically general duty
doctors who qualified some 10-15 years prior to obtaining government scholarship for
overseas training. This long gap following qualification created difficulties for trainees to
finish their qualifications. This was evident as only three candidates were able to obtain their
FRCS between 1948 and 1960. The first FRCS (Ireland) was obtained in 1973.

In the last two decades, Sudan became a "doctors exporting country" after exponential
expansion in undergraduate medical education. The number of medical schools increased
from less than 5 in 1990 to over 30 medical schools.



     10                                                SMA UK & Ireland conference- Galway June 2012
                                              Migration of Sudanese Doctors: Dynamics & Opportunities
The migration of Sudanese doctors to Ireland started in 1970s with few doctors who came for
surgical training and surged in the last decade, from a total of 64 doctors in 2000 to 582
doctors qualified in Sudan and registered with the Irish Medical Council (IMC) in June 2012
representing 9 % of foreign doctors registered with the IMC. The vast majority (74%) are in
the general division (n=465), 105 (17%) in trainee specialist division and only 57 (9%) in the
specialist division.

Dr. Elshiekh Badr the President of the Academy of Health Sciences (AHS) reiterated the two
main push factors for migrant Sudanese doctors described by Mrs Nuha Ibrahim being the
need for training and specialisation and the search for better pay.

He gave a brief overview of the current health human resources situation in Sudan with the
expanding numbers of doctors versus the limited expansion in nursing and other allied health
professionals that lead to the foundation of the AHS. He highlighted the expanding health
services in Saudi Arabia as a major attracting destination to Sudanese doctors with minimal
mutual formal governmental agreements and the increasing role of private recruitment
agencies.

He suggested that, a more structured model of health workers’ migration with mutual
agreements and less intervention from recruitment agencies, is needed. He explained that
Libya is now a new destination for doctors in the post-conflict era. He gave a brief overview
of bilateral and regional arrangements, the Diaspora mobilisation activities and health
initiatives including temporary visits with contribution to medical education, health services,
relief efforts and the role of private sector in the permanent return of some well qualified
doctors to Sudan.

Dr. Ogenna Oduma gave an account of the expanding needs for health human resources
estimated globally to exceed 4 million with particular reference to the severe deficiencies in
sub-Saharan Africa with the challenges of communicable and peri-natal diseases.

Dr. Oduma explained that disease burden and the crises of human resources for health with
very low doctors and nurses are the main challenges facing health services in Africa. Africa
has only 3% of global health workforce and at the same time faces 24% of world’s burden of
disease. This results in unrealistic workload in already unsatisfactory working environment
with poor distribution of limited resources including manpower. This is even more
complicated by the lack of updated information, human resources managers and
organisational leadership.

An example of the gap of human resources between sub-Saharan Africa and OECD averages
per 100000 population doctors and nurses ratios are 15.5 & 73.4 versus 311 and 737.5;
respectively. Most of the Sub-Saharan countries have less than the WHO recommended ratio
of 20 doctors per 100.000 with 10 countries with ratios less than 5. Dr. Oduma concluded her
talk by presenting the estimated saving in training cost made by high-income countries of
US$ 184,000 for each professional aged between 25 and 35 years as estimated by UN
Conference on Trade and Development (UNCTA).


    11                                               SMA UK & Ireland conference- Galway June 2012
                                            Migration of Sudanese Doctors: Dynamics & Opportunities
Territory size shows the proportion of all physicians (doctors) that work in that territory (as
per Dr. Oduma's presentation).
http://www.worldmapper.org/images/largepng/219.png

Dr. Narayanan Subramanian outlined reasons for migration of doctors from Ireland. He
described the challenges facing non EU doctors in Ireland predominantly working as Non
Consultant Hospital Doctors (NCHDs). He explained that the limited access to formally
recognised higher specialist training (SpR) is one of the main reasons. He showed figures
indicating that only 20% of SpR posts are non EU compared to 57% of Senior House officers
(SHOs) and 76% of registrars. Some of these non EU NCHDs remain to work as registrars
for 10-15 years.

Dr. Subramanian added that these doctors will eventually migrate particularly after the failure
to create an associate specialist grade. He also highlighted other financial and social issues
that would encourage non EU NCHDs to migrate to other destinations such as UK, Australia,
New Zealand, Canada and USA.

He described immigration regulation difficulties facing this group of doctors in the past years
regarding their residence permit status, unfavourable visa status for spouses and prolonged
waiting time for naturalisation that can range from 7-10 years. He presented a case scenario
that describes typical challenges facing most of non EU NCHDs.

According to Dr. Subramanian, Ireland is facing outward migration of its own graduated
health professionals and overseas doctors when their levels of learning and performance start
to plateau.




    12                                               SMA UK & Ireland conference- Galway June 2012
                                            Migration of Sudanese Doctors: Dynamics & Opportunities
Prof. Ruairi Brugha, the head of Epidemiology and Public health department in RCSI
medical school, described threefold increase in foreign trained doctors in Ireland from 13.4%
in 2000 to 33.4% of all doctors registered with IMC in 2010.

Prof. Brugha showed figures indicating a 6 fold increase in numbers of Sudanese doctors (63
in 2000 to 403 in 2010). He outlined the dramatic increase in the last decade for the
percentage of foreign-trained doctors that made Ireland the second higher country in terms of
foreign doctors after New Zealand (38%) and more than UK, USA and Australia.

Prof. Brugha discussed the ethical implications
of the Global Code recently adopted as a
voluntary document by WHO and suggested
that Sudan as a sending country and Ireland as
a recipient country can set a model example of
collaboration that support technology and
skills transfer through training bodies in both
countries.

He concluded by giving examples of elements
of Ireland-Sudan partnership incorporating
agreed training and capacity building
initiatives as part of bilateral agreements in
health between the two countries.



                                                      Prof. Ruairi Brugha from RCSI addressing the
                                                                       conference


                                                                             .




                                                       Dr. Donal Reddan, Vice President of the RCPI
                                                                addressing the conference.




    13                                               SMA UK & Ireland conference- Galway June 2012
                                            Migration of Sudanese Doctors: Dynamics & Opportunities
               3. MODELS OF NOVEL INTIATIVES

The third session gave examples of initiatives and collaboration projects between Ireland and
Sudan mediated by migrant Sudanese doctors. As part of this session, the Academy of Health
Sciences "AHS", Sudan FMOH and the National University of Ireland Galway "NUIG"
signed a Memorandum of Understanding aiming for provision of training for nurses and
midwives in Sudan.




          The signature of the MOU between AHS and NUIG for nurses and midwives training.

Dr. Abobakr Shadad gave an account of the Sudan Health Library project aiming to provide
online access to up to date medical educational resources as BMJ and Oxford handbook
series free of charge for educational institutions in Sudan. It targets the medical and nursing
students in Sudan, allied health students and health researchers. Three forms of individual
sponsorship were presented through “memorial folders”. Conference participants were
encouraged to sponsor educational folders in their specialities.

Helen Burke described the initiative that involved training of two Sudanese diabetic nurses in
the diabetes day centre (DDC) in Galway. She expressed her satisfaction with the training
they had received during the 4 week placement, during which a short-term skill focused
diabetes training, foot care, retinopathy prevention, and antenatal and paediatric diabetic
clinics were provided.

The course preparation involved visa sponsorship, Human Resources paperwork,
accommodation arrangements and the development of the short course educational
programme according to international guidelines.



    14                                                 SMA UK & Ireland conference- Galway June 2012
                                              Migration of Sudanese Doctors: Dynamics & Opportunities
                       Some of the conference participants at one of the sessions

Dr. Arif Mutwali, consultant nephrologist in Letterkenny General Hospital described the
burden of renal diseases globally and in Sudan particularly. He highlighted his participation
in nephrology training in Sudan during short visits accompanied by other Sudanese
nephrologists from UK and Ireland. Dr. Mutwali presented his innovative project of
delivering 80 refurbished dialysis machines to Renal Units in Sudan, 40 of which have
already arrived there. The cost of these 80 refurbished machines is estimated around 540,000
US Dollars (US$ 6750 per machine) and they will serve 864 dialysis patients annually.

On behalf of the Sudanese dialysis patients, Dr. Mutwali thanked the four Irish hospitals
which donated these machines;
Letterkenny, Cavan, Sligo and
Tullamore General Hospitals. Dr.
Mutwali also thanked all those who
participated in covering the cost of
shipping these machines to Sudan.
This     initiative    was       highly
appreciated by the conference
delegates with requests made to the
participating Sudanese health policy
makers to facilitate similar initiatives
once the quality and safety of such
medical equipments was assured.


                                                            Dr. Arif Mutwali, Consultant Nephrologist,
                                                              Letterkenny General Hospital




    15                                                  SMA UK & Ireland conference- Galway June 2012
                                               Migration of Sudanese Doctors: Dynamics & Opportunities
Prof. Zein Karrar started his presentation with a historical account of the establishment of
Sudan Medical Council (SMC) in 1968. He outlined that the main aim of the SMC is to
deliver and safeguard the highest standards of medical education, medical practice and
medical ethics in Sudan for the interests of patients, the public and the profession.

Prof. Karrar gave an overview of the progress made in the medical council since he took
office in 2009. This progress involved undergraduate accreditation procedures and
supervisory visits to medical schools, pharmacy colleges and dental colleges.

He emphasised on the development of Sudan Doctors Medical licensing Exam (SDMLE) in
2000 as a requirement for permanent registration and its subsequent transformation in 2007
into a computer based exam that is held in an equipped hall accommodating up to 140
candidates.




From left to right: Dr. Mahir Hamad (president of SMA), Prof. Osman Taha (president of SNMSB), Prof. Gerry
 Loftus, Dean of School of Medicine, Nursing and Health Sciences, National University of Ireland Galway and
                              Prof. Zein Karrar (president Sudan Medical Council).


Prof. Karrar also highlighted the new edition of the Sudan National Formulary (SNF) in
2010, the update of the medical register that is extended to include over 22087 doctors, 4574
pharmacists and 2007 dentists in 2010.



     16                                                    SMA UK & Ireland conference- Galway June 2012
                                                  Migration of Sudanese Doctors: Dynamics & Opportunities
Prof. Karrar described the new regulation organising specialist practice at three levels:
specialist, senior specialist and consultant levels with a minimum experience of 3, 5 and 8
years of practice in the specialty, respectively. The candidate must provide evidence of good
performance, competence and Continuing Medical Education (CME) to proceed to the next
tier of the above mentioned levels.




 The computer-based examination hall in SMC          Some publications of Sudan Medical Council



Dr. Mohamed Eltom started his talk by giving a background about Sudan and its 34.2 million
population coming from different ethnicities and living in the sixteenth largest country in the
world.

He described the high maternal mortality rate in Sudan and emphasised that Sudan is now
considered one of eleven countries responsible for two thirds of global maternal deaths with
an adjusted maternal mortality ratio of 750/100.000 live-births in 2008.

The highest maternal mortality ratios of 1000-1600/100.000 were reported in the states of
South Darfur, Kassala and West Darfur. Most of these deaths are predominantly caused by
preventable conditions such as perinatal haemorrhage, obstructed labour, sepsis,
hypertension-induced complications, malaria and anaemia.

Dr. Eltom emphasised the need for training of midwives and birth attendants in rural areas.
He proposed some potential solutions such as awareness campaigns, improvement of family
planning and the provision of emergency obstetric care in all health facilities.

Dr. Eltom quoted the successful example of collaboration between Cork and Omdurman
Maternity Hospitals in reducing hospital maternal mortality in the latter through an initiative
lead by Irish and Sudanese medical staff from Ireland.




    17                                                 SMA UK & Ireland conference- Galway June 2012
                                              Migration of Sudanese Doctors: Dynamics & Opportunities
The award for Excellence in Healthcare Management for the joint project by Cork University Maternity Hospital,
Omdurman Maternity Hospital, Khartoum, and UCC at the Irish Healthcare Awards 2009 were from L to R: Dr Tony Ryan;
Dr Elzein; Dr Murwan Omer; and Aisling Gannon, then of sponsors Beauchamps
Irish Medical Times at: http://www.imt.ie/features-opinion/2011/07/excellence-at-home-and-abroad.html


Mr. Eric O’Flynn presented the last talk in this session covering the experience of the
collaboration programme between the Royal College of Surgeons in Ireland and the College
of Surgeons of East, Central and Southern Africa RCSI/COSECSA.

This programme provides mutually recognised surgical training in 9 African countries
through an online platform of e-learning.

This programme addresses the severe shortage of surgeons in the region with only 1390
surgeons serving a population of 265 million. At present, the COSECSA programme has 144
trainees in 28 active training locations and offers Membership and Fellowship programmes in
7 specialities: General Surgery, Orthopaedics, Paediatrics, Urology, Neurosurgery, Plastic
Surgery and ENT. A total of 61 specialist surgeons completed the training programme since
2004.

The programme provides full access to RCSI library and other online resources for trainers in
addition to communication skills courses and a full structured basic surgical academic course.
The inclusion of Sudan and South Sudan in the programme was extensively discussed in this
session.




     18                                                       SMA UK & Ireland conference- Galway June 2012
                                                     Migration of Sudanese Doctors: Dynamics & Opportunities
                             4. PARELLEL WORKSHOPS

                      Workshop 1: Return of migrant doctors to Sudan
Workshop membership: Prof. Ruairi Brugha, Dr Abdelbagi Ismail, Dr Babiker Ismail, Dr
Elsheikh Badr, Dr Hassan Abdelaziz, Dr. Yasir Ahmed, Dr Hatim Kheir, Dr Mahjoub Toar,
Dr Mohamed Elshafi, Dr Mujahid Jowdat, Dr Moutaz Abdelrahman, Dr. Sara Mohamed, Dr
Samah Abdelsalam Elhag.

Sudanese doctors abroad have high intentions to return to Sudan. In reality, this is not
happening. The workshop aimed to identify reasons for this “intention-behaviour gap”.

The workshop facilitator initially surveyed workshop members who are working outside
Sudan about whether they are considering going back to Sudan. Eighty five percent (85%) of
this group expressed high intentions to go back to Sudan.

The participants were able to identify six important reasons that might make them decide
NOT to return to Sudan, and listed these reasons in a descending order:

   •        Poor work environment, lack of well-trained staff and poor resources in health
            facilities.
   •        Better quality of education for their children in Ireland and Western countries in
            general, added to the huge gap in quality of education between private and public
            schools in Sudan. There is a considerable higher financial cost in Sudan, especially in
            private schools.
   •        Less gross income in Sudan compared with the current income in Ireland, especially
            for those who are planning to return to work in the public health sector in Sudan.
   •        Lack of clear career pathways for some specialities (e.g. General Practice, Emergency
            Medicine, Haematology).
   •        Lack of structured Continuing Professional Development (CPD) opportunities in
            Sudan.
   •        Huge differences in quality of life, especially for children who were raised abroad.

The workshop participants recommended further quantitative and qualitative research on
migration of Sudanese skilled workers, particularly doctors. The workshop emphasised that
improving work conditions in Sudan public health sector can play a major role in retaining
Sudanese medical graduates and also in attracting highly skilled migrant doctors to return to
Sudan.




       19                                                 SMA UK & Ireland conference- Galway June 2012
                                                 Migration of Sudanese Doctors: Dynamics & Opportunities
Workshop 2: Innovative Initiatives in Health provision & Medical Education in
                                    Sudan
Workshop membership: Dr. Abobakr Shadad, Ms. Brynne Gilmore, Dr. Diarmuid
O'Donovan, Mr Eric O'Flynn, Dr Faisal Mihaimeed, Dr. Imad Brema, Dr. Khalifa
Elmusharaf, Dr. Mohammed Bashir, Dr. Mona Abbas, Mrs. Nuha Ibrahim, Dr. Safa
Abdullah.

The purpose of this workshop was to discuss and recommend practical ways of moving
from individual-based to more innovative, group-based and sustainable initiatives to
support Sudan's health service, medical educational/training and research.

This workshop outlined a number of recommendations that could yield more effective and
sustainable collaborations between health and academic bodies in Ireland/UK and Sudan:

         •   Establishing institutional links should follow a systematic approach or framework
             within which all initiatives should operate.

         •   Collaboration between the two sides should be based on mutual benefits, for
             example collaboration in service development in the area of Non-Communicable
             Diseases such as Diabetes where institutions in countries like Ireland have
             considerable and long-term experience that will benefit Sudan. On the other hand,
             this collaboration will allow good research opportunities for Irish institutions.

         •   The engagement of all interested stakeholders in UK/Ireland and Sudan will allow
             better identification of areas of collaboration and cooperation.



    20                                                SMA UK & Ireland conference- Galway June 2012
                                             Migration of Sudanese Doctors: Dynamics & Opportunities
          •    Links should allow for a dynamic process to outline the purposes of the
               collaboration and identify potential areas of cooperation and mutual interests.

          •    There should be a built-in mechanism of monitoring and evaluation of this
               collaboration, and flexibility to revise purposes and plans at any stage to respond
               to emerging issues and newly identified needs.

          •    Promoting ownership of projects by the participating institutions.

          •    Equal opportunities and fair merit-based selection of candidates for training
               opportunities.

          •    Minimal expenditure in areas such as travel and equipment, and emphasising the
               utilisation of local resources.

          •    Utilisation of IT, social networks, internet and mobile phone-based services which
               are becoming widely accessible in countries like Sudan.



              Workshop 3: The attractiveness of Sudan's Private Health Sector
Workshop membership: Dr. Arif Mutwali, Dr. Babiker Elawad, Dr. Bakri Elymani, Dr.
Mahir Hamad, Dr. Rabab Ahmed, Dr. Reem Saied, Dr. Saleem Babiker, Dr. Victor Adenaike,
Dr. Mohamed Elkomi, Dr. Nasir Khaleel, Dr. Mogtaba Osman.

The task of this workshop was to explore if there is any potential for the private health
sector in Sudan to attract skilled migrant Sudanese doctors.

All workshop participants stated that private sector (private hospitals or private practice) in
Sudan will be their likely choice if they returned back to Sudan. In view of the current
situation of the public health sector in Sudan, they agreed that private sector will be more
attractive option compared to the public sector, which was attributed by the participants to the
following reasons:

          •    Better income
          •    Better work environment and working conditions.
          •    Better qualified and trained staff, especially allied health professionals.


However, the following drawbacks of working in Sudan private health sector were identified:
          •    Lack of access to private hospitals for low socioeconomic classes in Sudan.
          •    Limited academic incentives or gains while working in private health setting.
          •    Long working hours.
          •    Lack of job security.


     21                                                    SMA UK & Ireland conference- Galway June 2012
                                                  Migration of Sudanese Doctors: Dynamics & Opportunities
Finally, the participants made the following recommendations to address these drawbacks:

         •   Regulation and governance of private health sector by Sudan academic and health
             regulatory stakeholders.

         •   The expansion of health insurance coverage to include wider range of Sudan's
             population and particularly the poor and people with limited income.

         •   The need for health statistics and data of service provision by private health
             sectors with a view to integrate such data into the existing health information
             databases.




                 Workshop 4: Irish Perspective: Training & Retaining

Workshop membership: Prof. Zein Karrar, Prof. Osman Taha, Dr. Eltayeb El-Khabeer, Dr.
Alaa Yousif, Dr. Adil Sharafa, Ms. Ashton Porter, Ms. Jane Ryan, Dr. Ahmed Mukhtar, Dr.
Mohamed Abdalla, Dr. Zuhair Eissa.

Irish health system relies heavily on foreign doctors in delivering healthcare services. Is
it fair for the Irish health system to invest in training foreign doctors who will
eventually move to work elsewhere?

This workshop was attended by two key delegates from Sudan; Prof. Zein Karrar, the current
president of Sudan Medical Council (SMC) and Prof Osman Taha the current president of
Sudan National Medical Dpecialisation Board (SNMSB), the main and solitary postgraduate
training body for medical specialties. The workshop discussed three levels of training:


    22                                               SMA UK & Ireland conference- Galway June 2012
                                            Migration of Sudanese Doctors: Dynamics & Opportunities
A- starting from the entry level of the post internship medical council assessment
   scheme (PRES) which have three components, a computer based theoretical exam
   held in overseas centres e.g. Cairo, Egypt, an English component IELTS which is
   held in many centres worldwide including the British Council in Khartoum, and an
   OSCE component which is held only in Ireland in a relatively unpredictable timing
   schedule.

      The panel suggested to pursue the possibility of hosting the first part of PRES in
      Khartoum and to share experience with the Sudan Licensing Medical Examination
      SDMLE. It is also suggested to develop a hotline communication with the Irish
      Medical Council (IMC) to facilitate
      correspondence, especially with visa
      facilitation letters for those attending the
      last OSCE component which is often
      announced in a tight timeframe.

B- The panel discussed the recognition of
   the two years of pre-membership level
   of training as Basic Surgical training
   (BST) or General Professional Training
   (GPT) for the medical specialties, which
   can count towards the four years
   Sudanese board training, the shortage of
   time didn’t allow this discussion to come
   to    conclusion.     It   is    however,
   recommended this would be further
   pursued with the SNMSB.


                                                 Prof. Osman Taha addressing the conference

C- The third level of training discussed was the specialist training higher specialty
   training, which is a direct pathway to obtain a certificate of completion of specialist
   training (CCST). This is unfortunately accessible to only 5-10% of Sudanese doctors
   as presented in the statistics of the conference presentations. This is a direct pathway
   to get trainees into the specialist register of the IMC. This is also accessible by some
   trainees through longer pathways with retrospective recognition of long term
   accumulation of competencies.

      The SMC president informed the panel of the three tiers of specialist registration
      adopted in the last few years. Those who are registered in the specialist register in
      Ireland will be directly registered as consultants. This corresponds to at least 8 years
      of local experience in the specialty with necessary qualifications. Two other levels
      were described; the senior specialist level with a minimum of 5 years specialty
      cumulative documented experience and a specialist level with 3-4 basic years

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                                           Migration of Sudanese Doctors: Dynamics & Opportunities
         experience in the specialty. It was recommended that these tiers should be widely
         communicated to doctors practicing in Ireland to tailor their training objectives and
         pathways if they are not in an already recognised pathway of specialist training.

   D- The workshop concluded the discussion highlighting that it would be important for
      Irish health policy makers to consider the above mentioned three levels of training to
      maximise the retention of migrant doctors.




              Workshop 5: Ireland as a destination for migrant doctors

Workshop membership: Dr. Ahmed Kharief, Dr. Ali Zaki, Prof. Martin Cormican, Dr.
Mohamed Ali, Dr. Mohamed Ismaeil, Dr. Omer Mohamed, Dr. Udama Ndubisi, Dr. Noury
Salih, Dr. Habib El-Rahman, Dr. Narayanan Subramanian, Dr. Shahir Shakir, Dr. Suha
Abdalla, Dr. Inam Ul-Haq.

The key objective of the workshop was to identify why overseas doctors choose Ireland
as destination for migration.
The workshop participants were in agreement that doctors migration is influenced by a
combination of push and pull factors, in addition to different policies, regulations and
legislations. These factors are dynamic, and the complex interplay between these factors
leads to a threshold decision to migrate to Ireland or elsewhere. The participants have focused
their discussions on identifying the main pull factors that made Ireland one of the attractive
destinations for overseas doctors.

Many doctors came to Ireland based on recommendations from friends or relatives who were
living in Ireland. The presence of positive social networks and well established overseas
medical community in Ireland was highlighted by participants as an important pull factor.

Many doctors found the IMC registration process taking shorter time in Ireland compared to
other countries such as the US, same applies for the application process for the visa for PRES
level 2 exam, or to obtain visa for their spouses when they find employment.

Since English language has been the language of medical education in Sudan, opportunities
for employment in Ireland has been considerably higher for Sudanese doctors as compared
with employment opportunities in non-English speaking countries. The IMC recognises
Sudanese Medical Qualifications, and some doctors who completed postgraduate
qualifications in Sudan were exempted from PRES.

Some participants commented that Ireland is not that far away from Sudan compared to
countries such as North America or Australasia, particularly for those with very close ties

    24                                               SMA UK & Ireland conference- Galway June 2012
                                            Migration of Sudanese Doctors: Dynamics & Opportunities
with their families at home. Other pull factors -which is not specific to Ireland- include: better
job opportunities, higher pay, better work environment, prospects for career development and
training opportunities, and the high living standards.




                     Dr. Sean Dinneen from NUIG addressing the conference




   Prof. Peter Cantillon from NUIG during one of the
                  conference sessions




     25                                                SMA UK & Ireland conference- Galway June 2012
                                              Migration of Sudanese Doctors: Dynamics & Opportunities
                 5. CONDUCTING RESEARCH IN A
               CHALLENGING IRISH HEALTH SYSTEM

The fifth session provided an opportunity to present and discuss examples of quality research
work conducted by Sudanese doctors in Irish medical institutions with a view to highlight the
skills and other requirements of research as well as the challenges facing clinical researchers.

Dr. Safaa Abdallah presented her research work on evaluating mortality rates and other
clinical and sociodemographic parameters among the Irish travelling community as a
disadvantaged group of the Irish population.

The figures presented by Dr. Safa showed very high mortality rates among male and female
members of the travelling community which are different from the rest of the Irish
population. These inequalities result from complex pathways that involve direct and indirect
effects of health determinants ranging from socioeconomic status, employment, living
conditions, environmental factors, education and behavioural factors such as smoking and
dietary habits. Dr. Safa concluded that these inequalities should be considered when planning
any prevention strategies in keeping with the holistic inter-sectorial approach.

Dr. Imad Brema presented his research investigating the role of novel adipocytokine visfatin
in insulin resistance. He provided a brief overview of the worldwide pandemic of obesity and
the parallel increase in the incidence of type 2 Diabetes Mellitus (T2DM) that increased from
151 to 221 million between 2000 to 2010. It is predicted to reach 300 million in 2025.

It is well documented that exercise improves insulin sensitivity in middle aged subjects with
T2DM. Plasma Visfatin levels have been found to drop significantly post-exercise among
obese controls and young subjects with T2DM. Dr. Brema concluded that Visfatin is a
promising marker or mediator of aerobic fitness and cardiometabolic risk; however; further
mechanistic large studies are needed to clarify this role.




          Dr. Ali Zaki, Prof. Ruairi Brugha and Dr. Narayanan Subramanian chairing one of the sessions


     26                                                       SMA UK & Ireland conference- Galway June 2012
                                                     Migration of Sudanese Doctors: Dynamics & Opportunities
Dr. Mohammed Bashir: presented his research investigating the effects of smoking on
glycaemic control, lipids, BP, albuminuria, GFR, and region-specific urinary biomarkers in
patients with type T2DM.

In his first retrospective case control study that compared 400 smokers with T2DM with 200
non-smokers matched for gender, age, Body Mass Index (BMI) and duration of DM, he
found statistically significant difference in control of glycaemic and lipid laboratory values as
expressed in higher readings of HbA1c, total cholesterol, triglycerides and LDL with lower
HDL among the smoker group.

In his second study, Dr. Bashir compared 279 smokers with 200 controls and showed a
statistically significant higher risk of micro-albuminuria and higher rate of renal function
deterioration as expressed in e-GFR estimates in the smoker group.

Dr. Safaa Abdallah, Dr. Imad Brema and Dr. Mohammed Bashir all agreed that conducting
research in a clinical setting requires good knowledge of research techniques and
methodology, basic understanding of statistics, availability of databases and assisting staff.

They also agreed that the main challenges facing doctors doing research in Ireland are the
huge clinical workload, short-staffed health services, lack of protected time, and the lack of
supportive research tools in most Irish hospitals.

The three doctors informed the conference that completing research allowed them to become
better clinicians with improved skills in utilising and applying evidence-based medicine.
They also agreed that with their research experience they became more competitive for
quality medical/clinical jobs.




                                  One of the conference sessions.



     27                                                SMA UK & Ireland conference- Galway June 2012
                                              Migration of Sudanese Doctors: Dynamics & Opportunities
                  POST CONFERENCE ACTIVITIES




Business meeting between the Sudan delegates, SMA executives and the conference organizing committee




                                   Sudan delegates at the RCSI


 28                                                    SMA UK & Ireland conference- Galway June 2012
                                              Migration of Sudanese Doctors: Dynamics & Opportunities
                                  The meeting at the RCSI




                                  The meeting at the RCSI




 From left to right: Dr. Khalifa Elmusharaf, Dr. Mohamed Ahmed and Dr. Abdulmoneim Khalifa



29                                                 SMA UK & Ireland conference- Galway June 2012
                                          Migration of Sudanese Doctors: Dynamics & Opportunities
      Sudan delegates at the Royal College of Surgeons Ireland (RCSI) Dublin




     Sudan delegates visiting St. James’s Hospital, the biggest hospital in Ireland




                   Sudan delegates at St James’s Hospital, Dublin


30                                               SMA UK & Ireland conference- Galway June 2012
                                        Migration of Sudanese Doctors: Dynamics & Opportunities
                        The meeting at St. James's Hospital Dublin




     From left to right: Prof. Zein Karrar, president of Sudan Medical Council, Prof. Kieran
         Murphy, president of the Medical Council Ireland and Dr. Abobakr Shadad.




                               The conference organizing committee


31                                                  SMA UK & Ireland conference- Galway June 2012
                                           Migration of Sudanese Doctors: Dynamics & Opportunities
     Annex




32             SMA UK & Ireland conference- Galway June 2012
      Migration of Sudanese Doctors: Dynamics & Opportunities
      The conference organising committee




     Dr. Abobakr Shadad                   Dr. Khalifa Elmusharaf




     Mrs. Nuha Ibrahim                     Dr. Emam El-Higaya




     Dr. Mohamed Elshafi                      Dr. Zuhair Eissa




                     Dr. Mohamed Ali Ahmed



33                                      SMA UK & Ireland conference- Galway June 2012
                               Migration of Sudanese Doctors: Dynamics & Opportunities
                                          Conference Programme

  9:00 to 10:00                                                  Registration

                                              Session “1” 10:00 to 11:00 am
                                                     Opening Session
                                  Chair: Dr. Mahir Hamad Co Chair: Dr. Abobakr Shadad
      TIME                  Speaker        Title

  10:00 to 10:30        Mohamed Ahmed Welcome and Opening Remarks
                        Faisal Mihaimeed From Metropole London to Salthill Galway & beyond, the vision & mission
                        Mahir Hamad         SMA: The Present and The Future
                        Abobakr Shadad      From Khartoum to Galway
  10:30 to 10:45        Sudan FMOH         Health services in Sudan: Challenges and Future Plans
                        Mr. Bahar Abugarda
  10:45 to 11:00                                                   Discussion



11:00 to 11:30                                              TEA & COFFEE BREAK


                                                   Session “2” 11:30 to 13:00
                                               Dynamics of Doctors Migration
                                             Chair: Dr. Ali Zaki. Co Chair: Prof. Ruairi Brugha
 11:30to 12:30      Presenting Author       Title
                    Nuha Ibrahim            The Migration of Sudanese Doctors to Ireland: Push and Pull Factors
                    Emam El-Higaya          Historical and current trends of Sudanese medical migration to Ireland
                    Elsheikh Badr           Migration of health professionals in Sudan: issues, challenges and prospects
                    Ogennea Udumma          Human Resources for Health: Crisis in Africa
                    Narayanan
                                            Migration of doctors: An Irish perspective
                    Subramanian
                                            Trends in foreign trained doctors migrating to Ireland – ethical implications and
                    Prof. Ruairi Brugha
                                            responses
 12:30 to 13:00                            Discussion with invited comments from Prof. Osman Taha


 13:00 to 14:00                                                      Lunch




                   34                                                  SMA UK & Ireland conference- Galway June 2012
                                                              Migration of Sudanese Doctors: Dynamics & Opportunities
                                      Session “3” 14:00 to 15:30
                                      Models of Novel Initiatives
                        Chair: Dr. Sean Dinneen Co Chair: Dr. Faisal Mihaimeed
14:00 to 15:10 Presenting Author               Title
                                               Sudan Health Library: an innovative approach to support
                 Abobakr Shadad
                                               learning in health sciences
                 Helen Burke /
                                               Diabetes Care –Crossing Boundaries
                 Sean Dinneen
                 Arif Mutwali             Initiatives in Nephrology Services in Sudan
                                          Sudan Medical Council: Updates and Recent Initiatives
                 Prof. Zein Elabdeen Karrar
                 Mohamed Eltom            Maternal Health in Sudan: The Need for Initiatives
                                          Innovation in surgical Training in Africa: RCSI and COSECSA
               Eric O'Flynn
                                          project
15:10 to 15:30 Discussion with invited comments from Prof. Kathy Murphy (Maternal Health) and Prof.
                                               Osman Taha (COSECSA)




                                     Session “4” 15:30 to 17:15 pm
                                  Parallel Workshops and coffee break
                    Chair Dr. Diarmuid O’Donovan Co Chair: Dr. Mohamed Ahmed
15:30 to 15:35    Emam El-Higaya              Introduction and grouping
15:35 to 16:20    Workshop title              Description
                                              Sudanese doctors abroad have high intentions to return to
                  Return of migrant
                                              Sudan, however, this is not happening. Why do you think this is
                  doctors to Sudan
                                              the case?
                                              There have been many initiatives by individuals or small groups
                  Innovative health           to support health service and medical education in Sudan. How
                  service/ educational        can we move towards more innovative, group-based and
                  Initiatives                 sustainable health service delivery, educational/ training and
                                              research initiatives?
                                              In view of the current situation of the public health services in
                  The attractiveness of
                                              Sudan, is there any potential for the private health sector (private
                  Sudan Private Health
                                              hospitals or private practice) to attract migrant Sudanese
                  Sector
                                              doctors?
                                              Irish health system relies heavily on foreign doctors in delivering
                  Irish Perspective:          healthcare services. Is it fair for the Irish health system to invest
                  Training and retaining      in training foreign doctors who will eventually move to work
                                              elsewhere?
                  Ireland as a destination    Why did you choose Ireland for post-graduate training? Why
                  for migrant doctors         Ireland not elsewhere?



16:20 to 16:50                                 Groups Feedback in plenary session
16:50 to 17:15                                            Discussion




     35                                                   SMA UK & Ireland conference- Galway June 2012
                                                 Migration of Sudanese Doctors: Dynamics & Opportunities
                                         Session “5” 17:15 to 18:00 pm
                            Conducting Research in Challenging Irish Health System
                         Chair: Prof. Martin Cormican Co Chair: Dr. Mohamed Ahmed

17:15 to 17:50 Presenting Author          Title
               Safa I. A. Abdalla         Mortality among Irish Travellers; a population based study
               Imad Brema                 Early Onset Type 2 Diabetes: Does Exercise Help?
                                          Effects of smoking on metabolic control and novel urinary biomarker in
                  Mohammed Bashir
                                          patients with type 2 diabetes.
17:50 to 18: 00                                            Discussion



                                                    Closing Remarks
                                              Reception and Sudanese Music
18:00 to 20:00         The conference will bring to a close with Sudanese music and
                                           Mediterranean snacks




                  36                                          SMA UK & Ireland conference- Galway June 2012
                                                     Migration of Sudanese Doctors: Dynamics & Opportunities
     Speakers’ biographies
     His Excellency Mr. Bahar Idriss Abugarda
     Sudan Federal Minister of Health




     Prof. Gerry Loftus
     M.B.,B.CH.,B.A.O.,D.C.H.,M.R.C.P.I. He is the Dean of the College of
     Medicine, Nursing and Health Science at NUI Galway. Gerard Loftus has
     been Professor of Paediatrics at NUI Galway since 1988. He was an
     undergraduate at UCD and undertook postgraduate training in paediatrics
     in Dublin and London, including research in Paediatric respiratory disease.
     The topic of his MD thesis was Asthma in Pre-School Children. His areas of
     clinical and research interest are diabetes and respiratory disease,
     particularly Asthma. He has over 40 scientific articles published in peer
     reviewed journals, 70 abstracts, 1 book and several review articles. Current
     research interests include the influence of atmospheric pollution on acute
     asthma in children. Professor Loftus has served on Comhairle na nOspideal,
     The National Task Force on Medical Staffing, and as chair of the
     Postgraduate Medical and Dental Board, the Health Services Expert Advisory
     Group on Children, and the National Steering group on implementation of
     Newborn Screening for Cystic Fibrosis. He is a member of Governing
     Authority, and is serving his third term as Dean of the College of Medicine,
     Nursing and Health Science at NUI Galway.


     Prof. Zein Elabdeen Karrar
     Prof. Karrar is the president of Sudan Medical Council (January 2009 – to
     date). He graduated from Medical school, University of Khartoum in 1971. He
     obtained DCH London, DTCH Liverpool, FRCP London in 1989, and
     F.R.C.P.C.H U.K in 1998. He is a professor of Paediatrics and Child Health at
     University of Khartoum since1995. He worked as the dean of Graduate
     College University of Khartoum from June 2000 to April 2008, and as the
     director of Educational Centre for Health Professions University of
     Khartoum from 1994 to 2000. He also was the head of Department of
     Paediatrics and Child Health University of Khartoum from April 1991 to
     February 1994. Prof. Karrar has more than 50 publications in international,
     regional and local journals, and published three booklets, and supervises
     many PhD and MD thesis




37                              SMA UK & Ireland conference- Galway June 2012
                       Migration of Sudanese Doctors: Dynamics & Opportunities
     Prof Ruairi Brugha
     MB, BCh, BAO, MD, FFPHMI, MSc, DCH, Dip Obs, Dip Humanities. He is
     the Head of Epidemiology and Public Health Medicine in the Royal College
     of Surgeons in Ireland (RCSI). He qualified as a doctor in 1980, spent six
     years working in Africa (Ghana and Zimbabwe) in the 1980s and 1990s, and
     10 years at the London School of Hygiene and Tropical Medicine. In 2005 he
     took up the post of first full time Head of the Department of Epidemiology
     and Public Health Medicine at the Royal College of Surgeons in Ireland. His
     research interests are in health systems and policy research, globally and in
     several sub-Saharan African countries. He has been researching and
     publishing on health worker (nurse and doctor) migration to Ireland since
     2006. He was a member of the Global Advisory Council that drafted the
     Global Code on the International Recruitment of Health Personnel.

     Prof. Osman Taha
     M.B.B.S, F.R.C.S.I., D.Sc. (H.C.), F.S.M.S.B. He is the President of Sudan
     Medical Specialisation Board, January 2009 till date. Prof. Taha graduated
     from the faculty of medicine, University of Khartoum in 1972. He completed
     his postgraduate training in general surgery in Ireland where he obtained
     FRCSI in 1978. He is currently a consultant in general and paediatric surgery,
     Khartoum Teaching Hospital. He was the Dean Faculty of Medicine
     University of Gazira1996 - 2005, and the Dean of Graduate Studies 2005 -
     2007. He worked as consultant paediatric surgeon, Medani Children
     Hospital. He has a large number of published papers in both national and
     international peer reviewed journals. He has co-authored two medical books
     and supervised many M.D thesis's . He is an external postgraduate examiner
     in many regional and international training programmes; Arab board, Saudi
     Board, Egyptian Board and College of Physicians and Surgeons of Pakistan
     (CPSP).



     Prof. Martin Cormican
     Professor of Medical Microbiology at the National University of Ireland
     Galway is a consultant at the Department of Medical Microbiology,
     University College Hospital Galway. Professor Cormican worked in general
     medicine in UK and obtained the MRCP examination in 1989. His MD
     awarded in 1992 for work on diagnosis of tuberculosis. He obtained his
     FRCPath in 1993. From 1994 to 1996 he trained as fellow at the University of
     Iowa Hospitals and Clinics in the USA. He was appointed to a Consultant
     Immunology post in Galway in 1996 and was appointed Professor of
     Bacteriology and Consultant Microbiologist in 1999. He is a former WHO
     Expert Advisor on Antimicrobial Susceptibility Testing providing training
     courses in China and has acted as external examiner in Ireland, UK and
     Sudan. He has published more than 100 papers including publications in
     many prestigious journals such as British Medical Journal, Lancet, Journal of
     Clinical Microbiology and Chemotherapy




38                              SMA UK & Ireland conference- Galway June 2012
                       Migration of Sudanese Doctors: Dynamics & Opportunities
     Prof. Kathy Murphy
     RGN,BA,MSc,PhD,RNT,Dip N ED. Prof. Murphy is the Head of the school of
     Nursing and Midwifery, National University of Ireland Galway. She
     completed nursing clinical training in UK and Ireland. She has a special
     interest in teaching topics related to Nursing Education, Nursing Research
     and Nursing of older age patients. Her clinical Interest is focused on older
     People, Chronic Disease and Dementia. She has research Interests with
     extensive publications covering a wide array of areas in nursing such as
     Quality of life of older people, Chronic Disease and Advanced Practice. Prof.
     Murphy is a member of the National Steering Group for Dementia and the
     HIQA Long-Stay Care Standards in Ireland.

     Dr. Mohamed Ali Ahmed

     Dr. Mohamed Ali Ahmed is a consultant psychiatrist at the Brothers of
     Charity Services, Galway and honorary research fellow at the department of
     psychiatry, National University of Ireland, Galway. He graduated from
     Jordan University in 1996 and completed his basic and higher specialist
     psychiatric training in Ireland. In addition to the membership (MRCPsych),
     he obtained master degree in medical sciences (NUIG), diploma in clinical
     psychiatry (RCSI), higher diploma in clinical teaching (NUIG), diploma in
     psychopharmacology (CINP) and diploma in health services management
     (University of Limerick). He is at the final stage of submitting thesis for MD
     in neuroimaging (NUIG). He has co-authored two MCQ books for the
     MRCPsych examinations and has published more than ten peer reviewed
     papers. His interests include medical education and training and his research
     interests include neuroimaging in schizophrenia and the impact of
     antipsychotics on regional brain volume and the association of mental
     illnesses/ psychotropic medications with the metabolic syndrome
     Dr. Faisal Mihaimeed

     MBBCh, MSc, FRCS (Glasg), FRCS (Eng), FRCS (Gen), CCST. He is a
     Consultant General Surgeon with Interest in Breast & Endocrine surgery
     Newham University Hospital – London & Honorary Consultant Surgeon St
     Bartholomew’s & Royal London Hospitals (Currently, Barts Health NHS).
     He graduated from Ain shams University (Egypt) in 1980. He has the
     following qualifications: FRCS: Royal College of Physicians & Surgeons
     Glasgow, FRCS Royal college of Surgeons, England; Master in Surgical
     science – Royal Postgraduate Medical School, University of London; FRCS
     (Gen): Intercollegiate Fellowship in Surgery of the four Royal Colleges of
     Surgeons in UK & Ireland, CCST (Certificate of Completion of Specialist
     Higher Surgical Training, UK. His research interest includes Breast cancer
     hormone therapy and biological markers & Thyroid / Parathyroid surgery.




39                              SMA UK & Ireland conference- Galway June 2012
                       Migration of Sudanese Doctors: Dynamics & Opportunities
     Dr. Mahir Hamad

     FRCP (London), FRCP (Glasgow), FRCPI. He is a Consultant Physician and
     Clinical Director for Acute Medicine, James Cook University Hospital, and
     Middlesbrough. He is the President of the Sudanese Medical Association UK
     & Ireland. Dr Hamad graduated from Ain Shams University (Egypt), worked
     as junior doctor in Atbara, Saudi Arabia then moved to UK. At the moment
     he is the clinical director for acute medicine services at James Cook
     University Hospital. He has written extensive evidenced based guidelines on
     the management of acute medical emergencies for the trust as well as played
     a leading role in establishing MRCP teaching (part 1 & part 2) for trainees in
     the region. His area of interest is thromboembolic disorders, outpatient
     management of pulmonary embolism and ambulatory care pathways, in
     which he has numerous publications. He is OSCE and MOSLER Examiner to
     Newcastle medical school and MRCP Paces Host examiner.


     Dr. Abobakr Shadad

     Dr Abobakr Shadad MBBS, MRCPI, MSc, MD. He is a clinical lecturer in
     Medicine, National University of Ireland, Galway. He is the deputy president
     of SMA (UK& Ireland). Dr Shadad obtained the Membership of the Royal
     College of Physicians of Ireland in 2006 and a Master degree in Medical
     Sciences from the National University of Ireland in 2008. Currently, he
     works as a lecturer in medicine and senior registrar in endoscopy while
     writing up MD degree in translational research. His research is focus on
     exploring the complex nature of intestinal immune system. The research is
     expected to generate a new knowledge and to provide therapeutics insights
     for the problem of intestinal radiation injury. Dr Shadad continued to
     strengthen his academic role by pursuing a higher diploma in Learning
     &Teaching in third level education with interest in learning technologies
     and postgraduate student supervision. Dr Shadad was a co-founder of the
     SMA UK & Ireland. He is current deputy president for SMA UK& Ireland
     and lead of the academic office and research.
     Mrs. Nuha Ibrahim

     Nuha Ibrahim holds a BA in Biology from University of Khartoum, Sudan
     (2004) and master of Global Health from Centre for Global Health, Trinity
     College Dublin (2010). She is currently undertaking a PhD in Global Health
     at Trinity College Dublin. Her research area is the impact of work
     environment on the performance of health workers in public hospitals in
     Sudan. Nuha’s academic areas of interest include Health System
     Strengthening, Nutritional challenges & Food security




40                              SMA UK & Ireland conference- Galway June 2012
                       Migration of Sudanese Doctors: Dynamics & Opportunities
     Dr. Emam El-Higaya

     MBBS, DCPsych, MPH. Dr. El-Higaya is a graduate of Gezira Medical School
     in Sudan. He has been interested since his undergraduate years in mental
     health, medical education, and public health. Following qualification in
     medicine and working experience in rural Eastern Sudan, he worked as a
     PBL tutor in the International University of Africa's School of Medicine.
     Then he joined the Federal Ministry of Health in Sudan and worked as
     Director of Planning & Monitoring at the Department of International
     Health, before moving to UK and Sweden for further studies in health policy,
     health economics, and international health & development. He is currently a
     Specialist Trainee Registrar in the Western Postgraduate Rotational
     Training Scheme in Psychiatry. Dr. El-Higaya’s recent interests include
     evidence-based health policy, financing mental health services in-low income
     countries and training of under- and postgraduates in psychiatry and mental
     health.

     Dr. Elsheikh Badr

     Dr Elsheikh Badr is a consultant public health physician qualified in Sudan
     and the UK. He is currently the President of the Academy of Health Sciences,
     Federal Ministry of Health (FMOH)/Sudan and as well the Focal Person for
     the National Human Resources for Health Observatory (NHRHO). Previous
     and current work involvement include participation in national health
     policies and strategic planning in Sudan, preparation of a national HRH
     strategy for Sudan, strengthening human resource information system
     (HRIS) and work on health professions education systems and stakeholder
     coordination for health. Research work and projects include health worker
     migration, retention and HRH gender issues. Dr Badr is involved in the
     regional and global health workforce movement and serves as member of the
     Health Worker Migration Global Policy Council under the auspices of the
     Global Health Workforce Alliance (GHWA) and ASPEN Health and
     Development, USA. Dr Badr is designated an Arab Migration and Population
     Expert by the Arab League and contributed to development of a regional
     HRH strategy for the WHO Eastern Mediterranean Region.

     Dr. Ogenna Uduma

     Ogenna Uduma is the Coordinator of the International Doctoral School in
     Global Health, and the Doctoral Training Officer of the Trinity International
     Development Initiative (TIDI), Trinity College Dublin. She received her PhD
     in Parasitology and her Master’s in Public Health from the University of
     Ibadan and University of Pretoria respectively. She has spent the last 12 years
     as a research scientist and project manager working with health ministries
     and UNICEF, UNDP, World Bank, WHO Special Programme for Research
     and Training in Topical Diseases (TDR). She has managed a human resource
     for health project in Africa for the Centre for Global Health and took up the
     position of Doctoral Programme Officer with the Trinity International
     Development Initiative (TIDI) and Coordinator of the International Doctoral
     School in Global Health at the Centre for Global Health, Trinity College
     Dublin in 2009. Dr Uduma has published widely on tropical parasitic
     diseases and human resources for health in sub Saharan Africa and is
     currently involved in capacity building partnerships in Africa with TDR and
     EDCTP.


41                              SMA UK & Ireland conference- Galway June 2012
                       Migration of Sudanese Doctors: Dynamics & Opportunities
     Dr. Narayanan Subramanian

     MBBS, MRCPsych(Lon), MSc Addictions(Lon), Dip.H.Mgt, Dip.Cl.Psych.
     He is the Vice Chairman of Overseas Medics of Ireland, a pressure group for
     overseas doctors in Ireland and also a Senior Registrar in Psychiatry based in
     Nenagh, Co.Tipperary. Dr Subramanian was actively involved in talks with
     Irish Nationality & Immigration Service (INIS), a division of the Department
     of Justice in Ireland on Non EU doctors’ immigration issues, through the
     Irish Medical Organisation. He is known for his editorials and critical letters
     regarding NCHD matters on Medical newspapers such as Irish Medical
     Times and Medical Independent. He manages the blog for overseas medics of
     Ireland and advices overseas doctors on life, cultural and medical practices in
     Ireland through this blog. Dr Subramanian completed his medical school
     from India, was based in England before he moved to Ireland. He has done his
     Masters in Addiction from the renowned Institute of Psychiatry; King’s
     College London and has a special interest in Addiction and Psychiatry as
     Dual diagnostic conditions. Dr Subramanian has written book reviews on
     Addiction matters and written articles on same. He has also done his
     diploma in health services management from Dublin and also received his
     diploma in clinical psychiatry from the conjoint board of RCPI &RCSI.


     Ms. Helen Burke
     She is an advanced nurse practitioner in Diabetes. Ms Burke was certified in
     Diabetes Nursing in 1988 in Whittington Hospital London and proceeded for
     a degree in Health Services Management 1998 (Honors) University of
     Limerick she then obtained a master degree in diabetes nursing with honors
     level from Roehampton University Surrey United Kingdom. Following that
     she proceeded for a master in Health Science/Advanced Practice 2003 at the
     National University of Ireland Galway. Ms Burke obtained a certificate in
     nurse prescribing in 2008 from the Royal College of Surgeons in Ireland. She
     has keen interest in research and she was part of major trials undertaken at
     the Diabetes Day Centre, University Hospital Galway such as DAFNE,
     DESMOND and BRUCIE Educator. She is heavily involved in teaching
     undergraduate and post graduate nursing and medical students in diabetes.

     Dr. Seán F. Dinneen
     Dr Seán F. Dinneen, MD, MSc, FRCPI, FACP. Senior Lecturer in Medicine in
     the National University of Ireland, Galway. He is a Consultant in Diabetes
     and Endocrinology, Galway University Hospitals. He received his medical
     degree from University College Cork Medical School. He undertook
     postgraduate training in medicine in Ireland and then went to the United
     States where he trained in Diabetes and Endocrinology at the Mayo Clinic.
     After a period on staff at the Mayo Clinic he was appointed as a Community
     Diabetologist in Addenbrooke’s Hospital, Cambridge. He spent 5 years
     working in the NHS before returning to Ireland in 2005 to take up a Senior
     Lecturer post in Medicine in Galway University Hospitals. His professional
     interests are in delivering programmes of self-management education for
     people with diabetes, developing optimal models of community-based
     diabetes care and the diabetic foot.




42                              SMA UK & Ireland conference- Galway June 2012
                       Migration of Sudanese Doctors: Dynamics & Opportunities
     Ms. Lorna Hurley
     Lorna Hurley, RGN, BSc (Hon), MSc. Lorna is the Community Diabetes
     Facilitator for Co Galway. She graduated in General Nursing from Galway
     University Hospitals, obtained a BSc (Hon) Podiatry at Queens University of
     Belfast and an MSc Sports Medicine from the University of Glasgow. More
     recently she completed a diploma in Diabetes Management in Primary Care.
     In her current role, she aims to support integrated diabetes care delivery
     across hospital and primary care. She has a particular interest in patient
     education and is a DESMOND educator, assessor and trainer.




     Dr. Donal Reddan
     Dr Donal Reddan is the vice President of the Royal College of Physicians of
     Ireland. He is a Consultant Nephrologist, General Physician and clinical
     lecturer at University College Galway Hospitals in Ireland. Dr Reddan
     earned his medical degree from University College Dublin. After completing
     general internal medicine training in Dublin at St Vincent’s University
     Hospital, he completed a further residency in internal medicine at Allegheny
     General Hospital in Pittsburgh, and fellowship in the Division of Nephrology
     at Duke University Medical Centre Durham, North Carolina. After attaining
     American board certification in both internal medicine and nephrology, Dr
     Reddan went on to earn a Masters in Health Sciences from Duke University
     and joined the faculty at Duke and the Duke Clinical Research Institute. He
     currently retains an appointment as adjunct assistant professor at Duke
     University. Dr Reddan is a Fellow of the Royal College of Physicians of
     Ireland and is a currently serving Council member of the College. He has
     published extensively in the area of renal insufficiency and its accompanying
     cardiovascular risk and on issues relating to contrast nephropathy.



     Dr. Arif Mutwali
     Arif Mutwali MB MSc MPH MRCPI. He is Consultant Nephrologists &
     Physician at the Regional kidney Unit, Letterkenny & Sligo Hospitals HSE
     North West and Clinical lecturer, Donegal Academy, NUIG. He graduated
     from Faculty of Medicine, Gezira University, and obtained MSc in
     epidemiology from Jordan University of Science & Technology and a MSc of
     Medical Sciences from the National University of Ireland Galway. Dr
     Mutwali is a member of American society of nephrology and the Irish Society
     of Nephrology




43                              SMA UK & Ireland conference- Galway June 2012
                       Migration of Sudanese Doctors: Dynamics & Opportunities
     Dr. Mohamed Eltom
     Dr. Mohamed Abdelrahman Eltom, MBBS, MRCOG, MRCPI. He is a
     registrar in Obstetrics & Gynaecology, Portiuncula Hospital, Ireland. Dr.
     Eltom graduated from the University of Juba School of Medicine in 1994,
     before completing his basic training in obstetrics & Gynaecology in Ireland
     Dr. Eltom completed a fellowship programme in Cancer Epidemiology &
     Genetics at the National Institutes of Health (NIH), Bethesda, Maryland,
     USA in 2002. He completed two research projects in HIV related cancers in
     the USA and Nigeria both of which are published in peer-reviewed leading
     American journals (JNCI, AIDS), he also conducted clinical trials among
     pregnant women infected with HIV in Malawi in collaboration with the
     Johns Hopkins University School of Public health, Baltimore, USA. In
     addition to his membership, Dr. Eltom obtained a diploma in women health
     and a fellowship in Laparoscopic surgery; he is a member of the European
     Society of Laparoscopic Surgeons.

     Mr. Eric O’Flynn

     Eric O’Flynn is the assistant programme director of the RCSI/COSECSA
     collaboration programme and divides his time between Dublin and east,
     central and southern Africa. He previously worked in teacher training and
     worked as a consultant, education manager and director of an education
     charity in Rwanda.




     Dr. Diarmuid O'Donovan
     Dr O`Donovan is a senior lecturer in Social & Preventive Medicine at NUI
     Galway and Director of Public Health in the Health Service Executive (HSE
     West, Galway). He is a Project Leader in the Health Promotion Research
     Centre. He qualified in medicine in NUI Galway and in Public Health at the
     London School of Hygiene & Tropical Medicine. He trained in General
     Practice and Public Health Medicine in England. He lived and worked in
     Africa for seven years. His research interests include: Equity in health, Health
     Policy, Communicable Disease Control and Environmental Health,
     Reproductive, maternal and child health, Sexually Transmitted Infections
     and HIV/AIDS, Health and Human Rights, Global Health and Development.
     He is a member of: Irish Aid Technical Advisory Group on HIV/AIDS and
     Global Communicable Diseases (member), Irish Forum for Global Health
     (member, previous chair), European Malaria Vaccine Initiative (member of
     the Board, current vice-chair Public Health Alliance Ireland (Board member).



44                              SMA UK & Ireland conference- Galway June 2012
                       Migration of Sudanese Doctors: Dynamics & Opportunities
     Dr. Safa I A Abdalla
     She graduated from University of Khartoum with MBBS in 1999, and MD in
     Community Medicine in 2007. She acquired membership of the Faculty of
     Public Health Medicine of Ireland, RCPI, 2012. She worked as Teaching
     Assistant and then Assistant Professor in University of Khartoum,
     Department of Community Medicine. After moving to Ireland took up
     academic and research positions at UCD School of Public Health and
     Population Science, and the Institute of Public Health jointly with
     University College Cork. She Conducted research in Burden of Disease in
     Sudan, ethnic and socio-economic inequalities in life expectancy and healthy
     life expectancy in Ireland and injury epidemiology in Sudan and Ireland.
     Member of the Sudan Public Health Consultancy Group, a partner of the
     Federal Ministry of Health in Sudan and the Faculty of Public Health UK


     Dr. Imad Brema
     Dr Brema graduated from the University of Khartoum in 1998. He started his
     training in Ireland in July 2003 and obtained his MRCPI in 2005. He worked
     as a Clinical Research Fellow in Diabetes, Obesity and Insulin Resistance
     (2005-2007). He then worked in Tallaght Hospital where he was appointed
     as a clinical tutor for TCD undergraduate medical students and was also
     appointed as a part-time lecturer to TCD postgraduate MSc students in
     Clinical Chemistry. Dr Brema presented his research at national and
     international meetings such as the Irish Endocrine Society (IES) and the
     American Diabetes Association and has been invited to present at the
     American Endocrine Society meeting in June 2012. Dr Brema has published in
     peer-reviewed leading journals such as Diabetes Care, Diabetes, Obesity and
     Metabolism, QJM and IMJ. He has finished and submitted an MD thesis to
     TCD, University of Dublin. He is also a member of the Royal College of
     Physicians and Surgeons in Glasgow, IES and EASD. Dr Brema is currently a
     senior registrar in endocrinology in St.Vincent’s University Hospital (UCD).
     His main research interests are in the areas of type 2 diabetes and insulin
     resistance.

     Dr. Mohammed Bashir
     Dr.Mohammed Bashir, MBBS, MRCPI, MD. He is a Registrar in
     Endocrinology in Beaumont Hospital, Dublin. He graduated from University
     Of Khartoum in1999. He completed his general medical training in Ireland,
     and obtained the membership (MRCPI) in 2006. He obtained his special
     training in Endocrinology and Diabetes, and completed MD degree at the
     University College of Dublin in 2011. Dr Bashir's main research interests
     include insulin resistance, type 2 diabetes mellitus, and diabetic
     nephropathy. He is currently a Registrar in Endocrinology




45                             SMA UK & Ireland conference- Galway June 2012
                      Migration of Sudanese Doctors: Dynamics & Opportunities
     Dr. Mohamed Elshafi
     Dr. Mohamed Elshafi, MBBS, MRCPI. He graduated from University of
     Khartoum, Sudan in 2003. He gained the membership of The Royal College of
     Physicians of Ireland in 2010. He completed his general professional training
     in General Medicine (CCBST) in University Hospital Galway in 2010. He is
     currently appointed as a Registrar in the Department of Respiratory
     medicine in University Hospital Galway. He is currently working towards
     gaining an MSc degree in Clinical Research from The National University of
     Ireland Galway


     Dr. Zuhair Ali
     Dr. Zuhair Ali, MSc Clin. oncology, PG Dip Med EDu, DPH. Dr. Zuhair is
     currently working as a Radiology Registrar. He is a member of European
     society of Radiation Oncology ESTRO, and International Cancer Imaging
     Society ICIS. He has a special interest in Cancer imaging and Image guided
     Radiotherapy. He is also interested in medical education curriculum design,
     assessment and professional development aspects. He is involved in
     providing guidance for staff development and curriculum design for the
     Academy of Health Sciences AHS in Sudan.


     Dr. Khalifa Elmusharaf
     MBBS, PGDip, FRSPH, PhD(c). Dr. Khalifa Elmusharaf is a PhD researcher in
     Health System & Policy with focus on access and equity for maternal,
     newborn & child health in fragile states at National University of Ireland
     Galway. He is the Head of Reproductive & Child Health Research Unit
     ‘RCRU’ at University of Medical Sciences & Technology ‘UMST’; Khartoum
     - Sudan. He has ten years of experience as obstetrician, researcher, project
     manager, lecturer and health system specialist in academia, ministries of
     health, and International organisations. Dr. Elmusharaf is a Fellow of the
     Royal Society of Public Health (UK) (FRSPH) and a certified consultant in
     Reproductive health in crises, Quantitative and Innovative Qualitative
     Research, with experience in maternal, newborn & child health, human
     resource for health, community based initiatives, Participatory Ethnographic
     Evaluation & Research, Participatory Health Communications, Community
     Readiness Assessment, Critical incidents technique, reflective photography,
     and health system & policy research.




46                              SMA UK & Ireland conference- Galway June 2012
                       Migration of Sudanese Doctors: Dynamics & Opportunities
                                                                   Frederick House
                                                                   19 South Frederick Street, Dublin 2
                                                                   Telephone: +353 1 863 9700
                                                                   Facsimile: +353 1 672 4704
                                                                   Website: www.rcpi.ie
                                                                   Email: cme@rcpi.ie




Dr. Mohammed Ahmed
Brothers of Charity
Co. Galway




                                                                                 07 June 2012

Re: Application for Approval of an Educational Event for CPD Accreditation
Date:         09 June 2012                        REF: 3175
Meeting Title: Migration of Sudanese Doctors Dynamics and Opportunities
                                                  ID 3175




Dear Dr. Ahmed,
Further to your application for CPD accreditation for the above activity, please find
enclosed a CPD Meeting Approval Form indicating the number of credits your activity has
been awarded.

I have also enclosed for your convenience a template CPD certificate which can be
photocopied or pasted onto your headed paper and given to those who attended to record
their CPD credits, together with an attendance register template. Ideally, certificates
should be provided to attendees by email to facilitate recording in the e-Portfolio for
Professional Competence. You should retain the signed attendance register in a safe
place for a period of five years following the date of the activity.

Yours sincerely,




Dr Mary Holohan
Chair
Education Committee




                                                              Registered Charity in Ireland Ref. CHY1897
                                                                          Frederick House
                                                                          19 South Frederick Street, Dublin 2
                                                                          Telephone: +353 1 863 9700
                                                                          Facsimile: +353 1 672 4704
                                                                          Website: www.rcpi.ie
                                                                          Email: cme@rcpi.ie




                               CPD Event Approval

Title of Event                           Migration of Sudanese Doctors Dynamics and
                                         Opportunities

Event Date                               09 June 2012



Organiser                                Dr. Mohammed Ahmed

                                         Brothers of Charity
                                         Co. Galway




Approved for CPD                         07 June 2012


Please note that 1 hour = 1 credit and
fractions of credits are not recorded.
                                         Credit(s):              6
However, 1 credit is allowed if the
meeting runs over for betwen 30-60       Category:               External
minutes.




Assessor




                                         Dr Donal Reddan FRCPI
                                         Honorary Secretary
                                         Education Committee
                                                                                                     ID:3175




                                                                     Registered Charity in Ireland Ref. CHY1897
Sudanese doctors: opportunities in the face of
challenges
July 9, 2012
Submitted by Ashton
Also published on globalhealth.ie
Country Ireland
Filed under Resources
0 Comments


The achievements, challenges, and future direction of Sudan’s health system were outlined recently by the Federal
Minister of Health for Sudan, Bahar Abugarda.

Speaking at the recent Migration of Sudanese Doctors: Dynamics & Opportunities Conference in Galway, Ireland (9 June
2012), Abugarda did not shy away from discussing the difficulties Sudan faces, particularly in terms of Sudanese doctor
migration. However, Abugarda, like many other presenters, expressed similar sentiments to Dr Faisal Mihaimeed,
President of the Sudanese Medical Association UK and Ireland, that the conference “will mark the beginning of a new
dawn on the [Ireland-Sudan] relationship.”

Minister Abugarda discussed the double burden of communicable and non-communicable diseases that Sudan’s health
system now faces. He noted that coverage of primary healthcare and equitable access remain key challenges. Sudan’s
health workforce is concentrated in the large urban centres, creating problems of access in rural areas. There are still
weaknesses in the nursing, paramedic, and midwifery sectors in terms of training and capacity.

In particular, the minister stated a need to focus on investing in postgraduate education and training, reproductive health,
human resources for health, and health systems management. Spending on healthcare as a percentage of the national
budget has yet to reach its targets and needs to increase dramatically. While there has been a slight increase in
spending over the past few years, reduction of maternal mortality rates, reduction of child mortality, and improvements in
TB and malaria control, the figures are still cause for concern.

Nuha Ibrahim, researcher at Trinity College Dublin’s Centre for Global Health, presented the negative impact doctors
migrating from Sudan is having on its health delivery. She discussed the push and pull factors that lead many doctors
and medical students to emigrate from Sudan to Ireland. With this migration comes a loss of capacity, as well as
increased coordination and sustainability challenges. A retention strategy for healthcare professionals in Sudan and
migration management (a primary focus of the conference) remains a broad area that requires additional attention and
work.

Despite these daunting challenges, there are many opportunities for strengthening Sudan’s health system and tackling
issues of doctor migration. Minister Abugarda suggested several ways forward for Sudan. Interventions being considered
and implemented include scaling up postgraduate medical education, scaling up programmes in nursing, midwifery,
and paramedical training, focusing on quality assurance, and using and adhering to the World Health Organization’s
Glob al Code of Practice on the International Recruitment of Health Personnel. Notably, Minister Abugarda also
expressed the need to focus on collaborative efforts with Sudanese doctors abroad and research institutions (including
Irish institutions, such as the Royal College of Surgeons in Ireland). He suggested a mobilisation of expertise in host
countries.

In terms of doctor migration, Sudan is using the National Health Observatory to keep a database on emigrating health
workers. Collecting better data will be essential for improving migration and capacity-building policies. There is now a
greater political awareness surrounding migration issues, which will help in the coming years as Sudan, Ireland, and
many other countries seek to become self-sufficient in supplying their own healthcare workforce. While challenges
remain, the migration of Sudanese doctors conference also highlighted the progress that has been made in this area
and opportunities for the future.


                      Posted by Ashton

                      I work with the Irish Forum for Global Health & I am a recent graduate of the MSc in Global Health
                      Programme at Trinity College Dublin. Originally from the U.S., I am passionate about advocacy
                      around the issues of gender & health, children’s well-being, & food security. Some of my previous
                      experiences includes work with the Irish Joint Consortium on Gender-Based Violence, European
                      Institute of Women’s Health, & the Massachusetts Domestic Violence Council.
Building castles: Sudanese-Irish collaboration on doctor
migration challenges
July 9, 2012
Submitted by Ashton
Also published on globalhealth.ie
Country Ireland
Filed under Resources
0 Comments


“Tri na cheile a Thogtar na Caisleain.” (We can only build a castle if we work together.)

These were the words that Dr Abobakr Shadad, lecturer in medicine at National University of Ireland, used to welcome
participants to the Migration of Sudanese Doctors: Dynamics & Opportunities Conference in Galway, Ireland last month (9
June, 2012).

The conference was the first Irish conference of the Sudanese Medication Association (of UK and Ireland), and took
place over the course of three days in both Galway and Dublin. Dr Shadad’s phrase set the tone of the event with many
speakers focusing on the theme of collaboration. In particular, Mr. Bahar Idriss Abugarda, Sudan’s Federal Minister of
Health (FMOH), echoed these sentiments, stating that he wanted to take the opportunity to “encourage and welcome
collaboration and bilateral agreements with Ireland.”

Why collaborate?

Why is collaboration essential to tackling doctor migration issues? Is there much value in such partnerships, or is it
simply all rhetoric? Currently there’s a large deficit of doctors in Sudan as many emigrate. As Dr Elsheikh Badr,
President of the Academy of Health Sciences at FMOH Sudan, reported, in 2005 approximately 60% of Sudanese-trained
doctors emigrated, and the trend appears to be increasing. The doctors tend to leave for the Gulf countries, the UK,
Ireland, and more recently Libya.

Ireland is a country that relies heavily on foreign-trained doctors; Sudanese-trained doctors are increasingly important for
the Irish health system. Collaborative efforts allow Ireland’s government and research institutes to develop a clearer
picture of current training needs in Sudan and act on these needs. Overall, partnerships between Sudan and Ireland –
through research as well as direct bilateral engagement – aim to help manage doctor migration in the hopes of
maximising benefits for both countries.

Methods of collaboration

Speakers at the conference suggested several ways Ireland and Sudan may collaborate on issues of Sudanese doctor
migration.

MOU/bilateral partnership

On 9 June conference proceedings were temporarily interrupted for the signing of a Memorandum of Understanding
(MOU). Sudan’s Federal Minister of Health (FMOH), the Academy of Health Sciences, the School of Nursing and
Midwifery at NUI Galway, and the Sudanese Medical Association took part in the signing – a significant step forward in
building a bilateral partnership between the two countries. Such collaboration aims to bring about mutual benefits and
protection for professionals against possible exploitation.

Training exchange/twinning

Several presenters focused on the need for training exchange and hospital/medical centre twinning. Ms Helen Burke, an
advanced nurse practitioner in diabetes, discussed the pairing of the Diabetes Day Centre, University Hospital Galway.
The centre ran a small training exchange programme that brought two diabetes nurses from Sudan to Ireland. She
reported a positive overall experience, with the nurses being able to take ideas back to their own centre. With a
strengthened skill-specific training curriculum, it may be possible to develop similar, larger-scale programmes in other
specialities.

Mr Eric O’Flynn, of the Royal College of Surgeons in Ireland (RCSI), reported on the RCSI collaboration with the College
of Surgeons of East, Central, and Southern Africa (COSECSA). A ‘college without walls’, COSECSA is currently in nine
countries. It is a growing and evolving training programme focused on e-learning and distance exam administration.
COSECSA is unique because it is Africa-centred. The Sudanese Association of Surgeons has applied to join. Mr O’Flynn
stated he is delighted to be working with Sudanese colleagues. He thinks “the future is very bright for this” and other
capacity-building initiatives.

Twinning of hospitals is another means of collaboration that received significant attention at the conference. In February
2012, Ireland joined the ESTHER Alliance – a network of governments working to tackle major diseases and healthcare
issues by twinning European hospitals to those in developing countries. At the conference Dr Mohamed Eltom, of
Portiuncula Hospital, Ireland gave a presentation on saving mothers’ lives in which he briefly shared the experience of
the Omdurman Maternity Hospital’s collaboration with Irish universities from 2000-2009. He stated that such
“collaborations…have proven to be effective in the past” and should similarly be pursued now and in the future.

Dr Ruairi Brugha, of RCSI, discussed practical training for Irish-trained medical students and doctors in Sudan. He and
several colleagues suggested that a programme for a short training in Sudan (perhaps a month or two) would allow
doctors trained in Ireland to give back to Sudan and also help them to gain practical training in certain areas such as
tropical medicine.

Continuing open dialogues

Several speakers noted the importance of the conference itself as a forum for engaging on challenging topics. Keeping
an open dialogue between medical professionals, academics, and policy makers in Sudan and Ireland is crucial for
moving forward on key issues. This will help encourage compliance with the World Health Organization’s Global Code of
Practice on the International Recruitment of Health Personnel, which is not only about ethical recruitment, but also
includes regulations for health system development, health system management, and fair treatment of health workers.
Continuing the dialogue on this topic between the two countries gives Ireland the opportunity to identify pressing training
needs in Sudan on which Ireland can collaborate. Given the volume of Sudanese doctors in Ireland, it is important to ask
what Ireland can be doing to build capacity that would “help meet the health needs of Sudan and help those doctors who
want to return to Sudan”, as stated by Dr Brugha.

It is an exciting time for Sudanese-Irish collaborations around the issues of doctor migration and training. These
initiatives must remain truly two-way in nature, as each country has experience and expertise to share with the other. It is
only through partnership and working together that they will build castles – or rather, policies and collaborative initiatives
that benefit both countries.




                                Posted by Ashton

                                I work with the Irish Forum for Global Health & I am a recent graduate of the MSc in Global Health
                                Programme at Trinity College Dublin. Originally from the U.S., I am passionate about advocacy
                                around the issues of gender & health, children’s well-being, & food security. Some of my previous
                                experiences includes work with the Irish Joint Consortium on Gender-Based Violence, European
                                Institute of Women’s Health, & the Massachusetts Domestic Violence Council.

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