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A Word from the President: Regaining My Perspective in Dar es Salaam

AAMC President and CEO, Darrell G. Kirch, M.D.

Recently, I was privileged to participate in what was, in effect, a "summit meeting" of medical schools in sub- Saharan Africa. Held in mid-April in Dar es Salaam, Tanzania, the African Medical Education Symposium brought together medical education leaders from several continents to discuss future directions for medical schools in that region.

Of great interest to the AAMC, the meeting focused on the potential benefits of forming an African association of medical schools. This effort built upon the important work by the sub-Saharan African Medical Schools Study (SAMSS), a medical school capacity-building project led by Dr. Fitzhugh Mullan and colleagues and funded by the Bill and Melinda Gates Foundation. I found it fascinating to learn about the "paired" relationships between several of our member medical schools and their partner institutions in the sub-Saharan region. ("Pairing," also known to some of you as "twinning," brings together a medical school from the United States or Europe with one in Africa in a mutually beneficial relationship.) It truly was a unique experience, and on the long trip home I began to realize how much the week's visit had made an impression on me.

For example, one of my most interesting encounters was with Professor Gottlieb Monokosso, a distinguished senior statesman who told me that the AAMC had participated in a similar conference more than 40 years ago! When I returned to Washington, D.C., I found our 1968 annual report and read about AAMC involvement in a meeting of 11 sub-Saharan schools in Lagos, Nigeria, to discuss teaching methods and the exchange of resources. Not only did I better appreciate how dramatically the African political context had advanced (with so many nations gaining independence since 1968), but I also saw firsthand the impact of U.S.- African school pairing on a continent that, according to SAMSS, carries a quarter of the global disease burden with only 3 percent of the world's health workforce. The on-the-ground efforts of several AAMC medical schools have been extraordinary, covering important areas such as maternal health, HIV/AIDS research, and health care quality.

As I learned more about these activities, it reinforced the notion that, while we sometimes become absorbed in our individual daily challenges, our community remains sensitive to the needs of developing nations—whether it is across the globe in Africa, or closer to home, as exemplified by our capacity-building efforts in Haiti. Further, the timing of this experience—prior to my delivering two commencement addresses—was ideal. It served to crystallize my thinking around the message I wanted to convey to graduating medical students about medicine's fundamental ethical principles and, in particular, the principle of seeking to ensure social justice.

On a more personal level, I had the opportunity to see directly the extraordinarily challenging circumstances under which African students, doctors, and hospital staff work. My visits to two medical schools and their hospitals were at once heart-warming and heartwrenching; the former because of the courage exhibited by students and faculty in such an environment and the latter because of the packed hallways of mothers with their very sick children waiting with the hope of obtaining much needed medical attention. Further, my visit to an anatomy lab reminded me of the conditions Abraham Flexner described of U.S. medical schools a century ago. The facilities I saw stood in stark contrast to the state-of-the-art, computer-assisted labs now prevalent in our own classrooms. It not only reminded me of how far U.S. medical schools have come since Flexner's time, but, on a global scale, how far we have to go.

But even in this instance, there was cause for optimism as I realized the degree to which technology already has begun to "leapfrog" Africa into the 21st century. Two years ago, the South African Institute for Distance Education, a nongovernmental organization based in Johannesburg, launched an open education resources (OER) website called "OER Africa" with the mission to "establish dynamic networks of African OER practitioners by connecting like-minded educators— teachers, academics, and trainers" to share and exchange resources. Over the last year, OER Africa users also have become heavy users of our own MedEdPORTAL®, with more than 65 health education institutions in Africa downloading an estimated 680 educational resources. (Later this month, OER Africa representatives will meet at the AAMC to discuss further collaboration between our respective websites and services.)

The convergence, and juxtaposition, of so many factors observed on my African visit constituted a teachable moment for me in many ways. First, I saw medical educators establishing real strength in their sub-Saharan medical schools despite the most challenged of health care environments. Second, while I observed conditions reminiscent of our own institutions a century ago (in the very year we mark the Flexner report centenary), I was impressed by the energetic commitment of so many of our medical schools to help these African partners rapidly move to a higher standard. Third, I was privileged to see firsthand shining examples of our faculty members and students seeking social justice and to do so just prior to talking about this enduring principle to graduating medical students here at home.

My experience in Dar es Salaam convinced me that the time is right to continue the dialogue we started with our African colleagues more than 40 years ago. Critical to our success will be identifying ways to leverage these paired relationships between the United States and Africa, providing technical assistance to resources such as OER, and imparting practical advice about continuing professional development. In this regard, a proverb of the Sukuma, Tanzania's largest ethnic group, seems especially appropriate: "That which is good is never finished."

Darrell G. Kirch, M.D., AAMC President and CEO