Meeting the challenges - reflections on partnership working with doctors in Yemen

A perspective from Prof Amanda Howe, secretary of the Royal College of GPs. Amanda practises at the Bowthorpe Medical Centre in Norwich, England and has been Professor of Primary Care at the University of East Anglia since 2001. She is on the Executive of the WONCA Working Party on Women in Family Medicine.

My medical school in the UK is well known for its modern approach to consultation skills and its integrated learning methods. Over two years ago, one of the many emails in my intray came from a colleague in another institution – she had been approached by a group of doctors from Yemen who wanted to partner to improve their curriculum via undertaking a British Council ‘ DelPHE’ partnership (DelPHE stands for Development Partnerships in Higher Education, see She wanted to know if I would help. In fact, she needed more than that – her own institution was giving her problems, as there was no overhead attached and they were not interested in supporting it. She admitted what she really wanted was a host so that she could undertake the work.

I could have said no. We were extremely busy, I had not been approached in my own right, and I also knew that Yemen was deemed high risk by the UK Foreign Office, so the chance of doing partnership visits (one of the perks) was low. But I liked my colleague, trusted her judgement, and was coming from a position of wanting to help anyone who was seriously interested in improving medical education; especially in a country which was troubled and relatively isolated by its political issues.

I approached my Dean. He shared my values, and agreed to do the institutional side, so that both medical schools would then provide the UK end of the partnership.

From there we heard little – then a request for a week’s visit for five doctors came in, and latterly a second similar visit. These were not simple – the doctors had learning aims, they needed to join in a wide variety of learning activities to achieve these, this meant complex permission seeking and timetabling, and the grant had no budget for additional staff costs at the UK end. In addition, emails were scarce, visas a problem, and arrangements changed from day to day. When on site, there were additional responsibilities – to make the team welcome, ensure they could handle the transport and accommodation, avoid cultural ‘beartraps’, and also avoid any disruption of student learning and assessment by their presence.

We were hugely helped by a young English doctor who had been involved in the scheme’s development, and by the goodwill on both sides to try to make everything work well and be useful. But after they left, both times we heard little: time passed, and the work we had put in was forgotten in the other busyness of life.

Then, again at short notice, the lead colleague reminded us that the scheme was coming to a close and a site visit was due ‘before the end of March’. No one was easily available at such short notice: we could not go to Yemen (too risky): and the sense of obligation without reward was strong. But a colleague suggested we could meet in Jordan, which was mutually acceptable: we found a date: I put the time aside: and two of us went, unclear what would be needed.

The work was wonderful: the team (four women and three men) presented the curriculum they had evolved, the training approach they had taken to 106 (106!!!) faculty, the role plays and case scenarios, and discussed in detail the challenges they still face. In parallel, I used material from a flexible set of ‘Training the Trainers’ resources to support their own further development. We worked on professionalism: on dealing with difficult encounters (they certainly had quite a few, and we were amazed at their resilience and achievements); on creating change: and on evaluation research methods. They talked of the change that the partnership had made to their working lives – of inspiration, of growing self confidence, and of deep bonds between themselves as colleagues. We wrote a very positive report, and came home.

What did I learn?

It is worth taking a risk if an opportunity presents itself. Working as a ‘volunteer’ can have huge benefits, even if this involves some personal costs and additional commitment. The work one does may be having effects which are hidden from view. And that we really need to help each other to make new achievements possible. I was also reminded that my own expectations often look silly when set against the very challenging lives of doctors in other countries.

Not all opportunities are practical – some are too difficult or demanding. Sometimes people do not make use of our precious efforts, and that can be annoying and frustrating. But this work was a real privilege, and again made me so proud to be part of the worldwide community of doctors – working together for change.

So, I hope WONCA will continue to promote partnership working, and skill exchange, using whatever routes we can.

Prof Amanda Howe