Out of Africa

I was delighted to read the article about Dr Maskey’s experiences as a hospitalist in the May issue of Canadian Family Physician.1 I would like to draw attention to the fact that family physicians and general practitioners in sub-Saharan Africa are specifically trained for hospital work.

The concept of family medicine in some African nations is still underdeveloped. Most people are living in impoverished rural areas with little development and few or no medical personnel. The family physicians are still doing “everything”: surgery, gynecology, obstetrics, orthopedics, ophthalmology, etc.

In Nigeria, family medicine education is based on the concept of training “specialist GPs” to function in district or rural hospitals in case there are no general surgeons, gynecologists or obstetricians, orthopedic surgeons, or otolaryngologists available. At least 90% of the time, these specialists are not available in district hospitals.

Family practitioners practising in remote communities in Australia also have these “added” generalist skills. The Australian College of Remote and Rural Medicine has received accreditation to provide medical education, training, and professional development in the specialty of general practice. And the Royal Australian College of General Practitioners offers a Graduate Diploma in Rural and General Practice.

Family medicine in sub-Saharan Africa has yet to gain the respect it has in Canada and the United Kingdom. In Nigeria, in order to attract young doctors to family medicine, the government gave family physicians the status of hospital consultants to place them on par with their specialist colleagues. But the battle for optimal family medicine practices in Nigeria continues.

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