Postgraduate training of Cameroonian medical doctors in Geneva
Von Fritz Baumann
In Cameroon, as in most sub-Saharian African countries, there is a severe lack of general practitioners and specialists, a situation that is progressively becoming worse considering the demographic evolution of the country. This shortage reflects, on one hand, the limited opportunities for medical training to be done locally but also, on the other hand, the exodus of newly qualified doctors and the fact that doctors pursuing postgraduate training in Europe or North America, often fail to return to their native country. In the case of Cameroon, it is estimated that 30% of new graduates emigrate each year and two thirds of doctors who departed for post graduate specialization do not return.
In the framework of a cooperation established in 1980 between the University of Geneva and the University of Yaoundé in Cameroon, the Faculty of Medicine of Geneva supports the former University Center for Health Sciences (UCHS), now Faculty of Medicine and Biological Sciences (FMBS), by providing access to urgently needed postgraduate training for its doctors.
72 Cameroonian doctors for training in Geneva
This project, which brings Cameroonian doctors to Geneva to specialize in diverse medical specialities, has been a success with almost 100% of the selected candidates returning home after completing their training. Since the beginning of the cooperation in 1980, seventy-two Cameroonian doctors have benefited from postgraduate training in Geneva. Some of these completed a full program for a medical specialty, weakly represented in Cameroon, whereas others came to Geneva for a few months as a supplement to a specialty training that they were pursuing in Cameroon. Of these seventy-two physicians, only one did not return after completion of training.
Applicants for the complete postgraduate program in Geneva are selected jointly by the FMBS in Yaoundé, the Faculty of Medicine and the University Hospital of Geneva (HUG). Their files are then sent to the Federal Commission for Scholarships for Foreign Students, which awards a fellowship to successful candidates. During their first year in Geneva candidates for a postgraduate training must go through a probationary period. On completion of their training (three to eight years, depending on the discipline), candidates obtain certification with a university diploma (or a certification of specialization equivalent to that conferred by the Federation of Swiss Physicians, FMH). Of the thirty-one doctors having completed their training as specialists in Geneva (in pediatrics, pathology, nephrology, rheumatology, neurosurgery, obstetrics and gynecology, psychiatry, neonatology, infectious diseases, as well as anatomy, physiology and medical informatics), twenty-eight are currently working in Cameroon, many of them as department heads in a major hospital and/or as teachers at the FMBS. Eleven Cameroonian doctors are at present in Geneva, pursuing their post graduate training.
Fellowship by the SDC
The second option, training in Geneva for a period of six to twelve months, is intended for physicians engaged in a specialty program in Cameroon. It allows them to acquire additional skills at the University Hospital of Geneva. The candidates are selected by the Dean of the FMBS and by the program coordinators of the concerned specialization, primarily on the basis of their medical school exam scores. Successful candidates are eligible for a fellowship awarded by the Swiss Agency for Development and Cooperation (Section for Education and Scholarships). After finishing their training in Geneva, they return to Cameroon to complete their formation, whereupon they are assigned by the Ministry of Public Health to a position within the public health system (generally in one of the major hospitals). Forty-one Cameroonian doctors have completed this training option, they all returned to Cameroon.
It should be mentioned that the interest of Geneva to work together with the UCHS (created in 1969 by the first Cameroonian government with the help of the WHO and the UNPD, the United Nations Program for Development) was strongly influenced by the fact that medical education as organized by the UCHS was focused on training general practitioners (GPs), community health workers, and physicians working in a team, an objective that was neglected in the Geneva curriculum.
Numerous collaborations in basic and clinical research projects
Ever since the signing of the convention between the University of Geneva and the University of Yaoundé in 1980 the cooperation between the two institutions has proceeded as a balanced partnership limited not only by the postgraduate training of Cameroonian doctors in Geneva but completed by the possibility for medical students from Geneva to benefit from internships in Cameroon in tropical medicine and in community health (to date about 300 students have completed this course), and a significant number of professors from Geneva have gone to Yaoundé to teach at the request of the UCHS, both in basic medical sciences and in clinical medicine (each year, an average of eight professors teach in Yaoundé for periods of about three weeks each). The early and intense exchange between Geneva and Yaoundé grew further and the links were strengthened when specialists who had just completed their training in Geneva returned to Cameroon. They often maintained close contacts with their mentors in Geneva, who in turn started to visit Cameroon to participate in clinical work, or invited them back to Geneva for further training or to attend scientific meetings. These interactions have led to numerous collaborations in basic and clinical research projects. It must of course be pointed out that the cooperative network between Geneva and Yaoundé does not maintain itself on its own but needs the commitment and dedication of leaders on both sides, who work tirelessly to ensure its continuity.
To summarize the conditions that have led to the success of the postgraduate training program in Geneva for Cameroonian doctors (both men and women), with an amazing rate of return close to 100%, the following three points can be emphasized: the areas for specialization and the criteria to select candidates were determined by a common agreement between the two partners; the newly-trained specialists are assured positions within the public health system of Cameroon, including the Faculty of Medicine; and last but not least the close professional ties maintained between mentors and their trainees generate a climate of reciprocal trust and respect, and often friendship, based on a mutual partnership and a belief in the common good. This last point is probably the most difficult to integrate in medical cooperation projects. It needs a broad and mutual commitment of trainees, teachers and health authorities. The cooperation between Geneva and Yaoundé, including the faculties of medicine and the hospital networks at the two sites, has been privileged to fulfill these conditions, which likely accounts to a significant extent for the return of Cameroonian doctors who train in Geneva to their country, thus avoiding the most damaging pitfall – a real scourge – of North-South cooperation: the brain drain.
Fritz Baumann is emeritus Professor of the University of Geneva. He studied medicine in Bern, Hamburg, Paris and Geneva. After graduation from the University of Geneva in 1956, he began a fruitful research and teaching career in the Department of physiology of the Faculty of medicine of Geneva. A postdoctoral fellowship from NIH allowed him to spend two years in Bethesda, USA, to study the electrical properties of photoreceptors of invertebrates, a research field he pursued on his return to Geneva and which led to numerous publications. Beside research, Baumann had a passion for teaching of neurophysiology from which many generations of medical students, psychologists, nurses, physiotherapists and allied professions greatly benefited. Full professor in 1971, chairman of the Departement of physiology in 1977, vice-dean of the Faculty from 1978 to 1982, Baumann was in charge of the pregraduate medical curriculum and became a leader in the implementation of the problem-based learning method in Geneva. 1983 was the year of his first contact with teaching in an African country, Cameroon, in the framework of a cooperation between the medical Faculties of Yaoundé and Geneva. His deep involment in this cooperation, as well as his role in the reform of the Geneva medical curriculum made him recipient of the Medal of the University of Geneva in 2003. The Republic of Cameroon also recognized the role of Baumann in the success of the cooperation by awarding him in 2009 the title of « Chevalier of the Order of Valour ». At present, Baumann is still involved in the the cooperation with Cameroon, especially in the programme which allows cameroonian doctors to come to Geneva for postgraduate training. Contact: Fritz.Baumann@unige.ch