A farmer in his late forties winces as he pulls off his shoe, exposing the black and red colouring of a diabetic foot ulcer. The affliction has been plaguing him for months. He’s been to see a specialist several times, but to no avail. Instead of improving, the ulcer has only worsened.
It’s a situation Dr. Krystle Fraser-Barclay encounters often in her work at a clinic based in the urban centre of Georgetown, Guyana. Located along the northeastern coast of South America, Guyana is one of only three counties in the Americas that until 2015 did not offer any training for family medicine professionals. Primary care was delivered through a clinic-based system in which patients rarely met with the same doctor, and rarely for more than one health issue. A new mother, for example, would need one appointment for her postnatal care, another for her baby, another for other related sexual health testing, and so on. By comparison, more than 90% of primary health care delivered in Canada is done through family doctors.
That situation is one Dr. Fraser-Barclay is working to change.
“I’ve always wanted to do family medicine, to live in Guyana, and serve Guyana,” says Fraser-Barclay, who along with colleagues Tamica Daniels-Williamson, Indira Bhoj, and Kampta Prashad is part of Guyana’s first-ever cohort of domestically trained family physicians.
Learn more about an exciting conference that will take place this November in Montreal and will showcase the crucial work of Canadian postsecondary institutions and international partners like Dr. Fraser-Barclay.
“I like being able to follow through with a patient, build a relationship, treat them and see how they progress,” adds Fraser-Barclay. “That’s quite satisfying for me, being able to see firsthand how other things can influence the patient’s health, stuff that happens at home, at school, in the community. In a lot of cases, there are many little things that can be done to influence a positive outcome.”
In the case of the farmer with the diabetic foot ulcer, Fraser-Barclay notes that treating the patient requires a continuity of care and a holistic approach to medicine that can’t be achieved with one-off clinic visits. “When you get down to it,” says Fraser-Barclay, “the patient works on a farm, has to wear long boots and can’t afford to stop working, so the foot can’t heal. He is the primary breadwinner in his house. You have to wrap your head around the situation that is creating or worsening the health problem, not just the health problem on its own. You have to find a way for him to make ends meet while also taking care of his health.”
Fraser-Barclay and her peers have worked since 2015 to ensure the success of the country’s new training program. Moving forward, they will be key figures in leading the training of new family physicians in the country. These efforts have been made possible through a partnership between the University of Guyana and the University of Ottawa and a project with Canada’s Academics Without Borders, an international non-profit that helps developing countries improve their universities and social institutions so that they can train their own experts and conduct research to assist in their countries’ development. AWB’s projects are involved in the full range of university activities, from expanding and improving existing institutions and programs to helping create new ones.
The University of Ottawa, working with the Northern Ontario School of Medicine (NOSM), became involved in the effort to build family physician capacity in Guyana after being approached by the country’s Institute of Health Sciences Education, part of the University of Guyana. Subsequently, Dr. David Ponka, a professor of Family Medicine at UOttawa, worked with NOSM’s Global Health Coordinator, Jacqueline (Basia) Siedlecki, to help the University of Guyana propose a project to Academics Without Borders to boost the research and leadership training of this new cadre of physicians.
When he heard about the initiative, Ponka was excited to volunteer his time and expertise to assist in the effort. Previously Dr. Ponka had spent nine months in the African country of Chad working with Doctors Without Borders at the peak of the violent conflict in the nearby Sudanese capital of Darfur.
“After that, my wife and I started a family together, and I needed to think about my safety in a different way, in terms of how it might affect my family if something happened to me,” says Ponka.
When asked about what inspired him to lend his support to the Guyanese project, Ponka says that he has always been interested in building primary care capacity around the world. However, he warns that looking at the project “too altruistically” can create an imbalance of esteem between the host country and those who might self-identify as altruistic experts.
“It’s more an exchange of expertise and information, a partnership,” says Ponka, “and it’s important to respect that. This stuff also impacts what’s happening in Canada, where we are seeing more tropical diseases, more migrant populations, and where we have to be more mindful of the appropriate use of resources. There’s a lot Canada can learn from working with a country to build a system of family physicians from scratch.”
Together with other program co-directors, namely Australian family doctor Ruth Derkenne, who first spearheaded the initiative, Ponka has worked to help the family physician program in Guyana create learning plans, design exams, and build out the logistics of accreditation practices. This year, the first cohort of students who joined the program in 2015 are set to graduate, which marks an exciting time for all involved.
“We started out with our residents at two health centres, and now have them working at six,” says Fraser-Barclay, who insists that this growing availability of family medicine professionals has already had a significant impact on patients. “They like seeing the same doctor each time they come. They like building that trust, those relationships where they feel like their doctor knows them and their lives, not just their symptoms. This also has a huge impact on doctors’ ability to feel fulfilled in their work and to improve patients’ quality of life.”
Ponka says that with dedicated professionals like Fraser-Barclay building capacity in Guyana, he is optimistic about the future of primary health care in the country. “Krystle is quickly becoming a leader of family medicine in Guyana,” he says, “and in turn, she will train more leaders like herself.”
Fraser-Barclay notes that while formal professional incentives have yet to reflect the expertise and social value of Guyana’s first family physicians, this early cohort is driven to pursue this medicine because of a passion for their work and for making people’s lives better.
“Some doctors might find it boring to deal with a cough, a cold, or a chronic disease like hypertension,” she says. “But at the end of the day, this is about quality of life. Besides, I’ve seen a lot of strange things in my work as a family physician, too. When you’re a family doctor, you never know what new challenge is going to come through your door, and what connections you’ll make.”
A conference to showcase and support this crucial work
It’s work like Fraser-Barclay and Ponka’s that speaks directly to the core mission of Academics Without Borders. It’s with this same mission in mind that AWB will host the global conference Reaching Across Borders, Building a Better World this November 5 to 7 in Montreal.
This first-of-its-kind event will gather academic experts from around the world together with representatives from government, post-secondary leadership, NGOs, and the private sector to explore how academics and their institutions can help developing countries care for their citizens and build their economies. This work will involve sharing case studies, successes and failures, and best practices, as well as working directly with representatives from institutions in developing countries to co-create new approaches to longstanding and emerging social and economic challenges.
To learn more about this exciting event, please visit Academics Without Borders’ conference website