A neurologist abroad: the RCP METAF programme

Dr David Nicholl, consultant neurologist and honorary senior lecturer at City Hospital, Birmingham, shares his experiences of teaching in Kenya and Tanzania during the first year of the Royal College of Physicians (RCP) / British Council Medical Training and Fellowship (METAF) programme.

I saw the ad for the METAF programme in the RCP newsletter and was immediately attracted. I worked as a medical registrar in South Africa in 1993, so the idea of doing further teaching in Africa really appealed to me.

More than that though, I was particularly attracted to a project that was clearly not a one off but planned over 4 years. METAF is aimed at building capacity to manage cancer and neurological disorders across east Africa and is a collaboration between the RCP, the East African Development Bank (EADB) and the British Council.

So last September I took a week’s leave to spend teaching neurology in Nairobi, Kenya, and in April I spent a week in Moshi, Tanzania, doing much the same. It truly was a brilliant experience, but beforehand I was somewhat concerned: what would this mzungu (Swahili for European) have to offer the local physicians? More than I realised!

I ended up finding out just how much I shared with my African colleagues.

Dr David Nicholl

Over the period of 5 days, teaching in both Kenya and Tanzania, I ended up finding out just how much I shared with my African colleagues – first and foremost the value we place on the age-old skills of listening to and examining our patients, and solid clinical reasoning. As it happened, on both trips I was working alongside Professor Richard Walker – RCP associate international director for sub-Saharan Africa and a care of the elderly consultant in Northumbria. Richard and I combined with local faculty to deliver a 5-day course in neurology for 20 hospital physicians, many of whom had very limited exposure to neurology since graduation.

METAF course participants and training faculty in Moshi, Tanzania

We covered a diverse range of topics: epilepsy, movement disorders, paediatric disorders, infectious diseases, stroke, dementia and headache disorders. The course attendees included medical officers, paediatricians, psychiatrists and physicians from across both Tanzania and Kenya and they were a joy to teach. There is nothing better than hearing the excitement of someone yelping in Swahili when they’ve found the optic nerve (I brought a bunch of cheap ophthalmoscopes with me! [1]).

There are, though, big public health issues in the region that need addressing. For example, weaknesses in primary care often lead to poor hypertension management and traditional health beliefs in relation to epilepsy mean that many patients won’t seek help from a health professional. 

What did I learn? Perhaps when one realises that a hospital like Kilimanjaro Christian Medical Centre in Moshi has 130% bed occupancy, it puts our current NHS worries in a more global context. The best moment for me was seeing the course attendees applauding each other and taking photographs at the end of the week – I can’t say I’ve seen anyone in the UK getting quite so excited over their CPD certificate!

The experience was truly humbling, but also helped establish bonds with colleagues in Kenya and Tanzania which will last a lifetime.

Dr David Nicholl, consultant neurologist and honorary senior lecturer at City Hospital, Birmingham

The International Office is looking for additional trainers for METAF medical oncology courses. If you’d like to get involved please contact international@rcplondon.ac.uk. The RCP would like to thank the East African Development Bank (programme sponsor) for its ongoing support.

[1] Blaikie A et al. Arclight: a pocket ophthalmoscope for the 21st century BMJ. 2016 Dec 14;355:i6637. doi: 10.1136/bmj.i6637.