Medical Studies & Training: Challenges and Opportunities

1. Medical Studies & Training:Challenges and Opportunities Libya Higher Education Forum 2014, London Dr Fatima Hamroush Minister Of Health in the Transitional Libyan Government

2. Current Status in Libyan Primary Healthcare System (End of 2012) • Total Number of Medical Doctors: 8280 • Dental: 124 • 20 Doctors per 10,000 population. • 6 dental doctors per 10,000 population. • Primary medical care centres: Total number: medical centres 535, dispensaries: 37, central dental clinics: 15, primary medical care units: 820 Average of 2.6 centre x 10,000 population

3. Current status in Libyan Hospital Care: • Special Centres (Specialized Hospitals: cardiology, Paediatrics, Gynae&Obstetrics, Ophthalmology, Plastic Surgery, Psychiatry): 26 • Hospital Centres: 18 • General Hospitals: 21 • Rural Hospitals: 32 • Total: 97 • Total Number of Beds: 20689 • 38 beds per 10,000 Population.

4. Total Number of Medical and dental Students (2012) • Medical: 25000 • Dental: 9000 • Nursing: 2500 To quote Dr Naeem:Too many students, poor equipment, no staff appraisal system, no student exchange programmes, international exposure. • Planning/Management. • Required number of Medical Care Specialists vs. Population. • General Practitioners scheme. • Nursing and Paramedical Training.

5. In 2012: A total number of 1000 Doctors, in different specialties, were granted postgraduate education on government grants, and a total of 100 were Granted postgrad GP Education. There are 12 universities in Libya with more than 500.000 students each year in a population of 5.5 million. 

6. In May 2012, a memorandum of understanding was signed between Libya and UK&NI Ministers of Health, where an agreement was made between the two countries to collaborate in Medical care and medical training and education. • Similar MOUs are required with ROI. • However, MOU implementation…?

7. Opportunities/challenges for Libyans for Higher Medical Education • Language (English/Arabic)- require language course. • As mentioned by Mr Salah Meto: 10 Libyan universities are already in agreement with UK for teaching english, and yet, Libyan students are still arriving to UK and ROI for English language courses and no other arrangements. This reflects lack of communication between different institutions, and thus: saving effort, money and time. • Government Education Grants / local training schemes. • Observer (sClinicalskills?). • Clinical Attachment (require an GMC number). • Academic: Masters, PhD. (No Clinical skills) • Best: Training cycle: SHO, Registrar, SR, SpR, Consultant.

8. Medical Colleges In ROI • NUI, Galway. • RCSI. • Trinity College. • UCC (Cork). • UCD. • University of Limerick. • Entry requirements are obtained at each college individually. • Application for a place in the training programme is competitive. • Each training authority is able to clarify the work visa requirements to EU applicants.

9. Available Medical Education Programmes for Libyan nationals In Ireland: Registration to the Medical Council is mandatory. • Newly Graduates: Postgraduate Cycle: 4 Years. • Senior Graduates: 2 years Fellowship in the appropriate specialty. Registration to medical council is not required in: PhD Masters

10. Difficulties: • No agreement with Irish authorities re: Training Programmes, such as with Sudan, Oman, Kuwait, Saudi Arabia, Emirates, India, Pakistan. • Libyan Medical students arrive unprepared, re: Medical Council exams and registration. • Visa issues (arrival of students with study visas for language courses). • Education grants? (below minimal Wage). • Fairness of paid jobs?

11. The current turbulence in Libyan politics and the rapid changes of the governments, hinders the continuity of many decisions made by the previous authorities. • Any fees should be for undergraduates or non-clinical PostGrad studies, • Clinical PGs are expected to earn their living while learning and studying for PG.  • In this forum, we are not discussing undergraduate educations, and we should differentiate that from the scope of the arrival of the Libyan PG trainees. 

12. In Libya 16,000 medical students with free tuition fees, • While almost the same number is sent for PG with further governmental grants. • Therefore: • a massive loss on both sides in resources due to inappropriate expenditure, in addition to low standard of undergraduate education due to overcrowding • poorly planned PG education courses, • Lack of implementation of regulations etc, and • further loss (financial and human resources)!

13. Suggestions: • Government to Government agreement re: education programmes. • Role of Libyan Embassy, Culture Attaché to contact Irish Medical Council for Agreement. • Application to the training scheme, or Fellowship Programme. • For the current students: urgent solution from Libyan embassy to contact Ministry of Justice for extension of visas, provided proof of continuing education is granted.

14. I reiterate Mr John Law’s points: • one major cause of the difficulties encountered is the Loss of key international links. • Partnership. • Prepare the next generation of graduates. • Telemedicine, research training, etc... • Research collaboration. • Government to government agreements. • University to university. • System to system • Mobility. 

15. Special Notes: • Due to the downturn of the economy in Ireland, many Irish trainees opt to emigrate outside Ireland, leaving posts vacantandtherefore, window for training opportunity for Libyan Doctors. • Concept re: postgraduate medical training with/without government grant, pros & cons. • Causes of Decisions of Libyan trainees to emigrate: • Security issues. • Low income in Libya vs high income elsewhere (the need to improve income in Libya is crucial) • Social reasons. • Absence of contract between trainee and Libyan authorities re: return after completion of postgrad education.

16. Grants for PGs takes away the competition factor and encourages the lack of motivation for learning etc... • In Libya: Lack of CME accountability are all factors in the lack of innovation.  • This should be improved once the country recovers and professional ethical standards are reinstated.

17. Investment • Should be bilateral. • PG students for clinical Degrees should have paid jobs. • Only research PG degrees such as PhDs and Masters are fee-paid. • Also, PG exams are fee-paid. • Twinning between teaching hospitals, student exchange, fellowships, teaching staff collaboration.

18. Take Home Message “How to turn crisis into noble beginnings” The funds allocated for the high education, PG students are the future decision makers of the health care system.

19. The idea is not how to invest the funds that are allocated to the students, • it is in how to invest in the future: Invest in the students. • These PGs are our investment, they are the decision makers for the healthcare in the future in Libya and the bilateral collaboration.  • The programme needs rethinking and re arranging with a broader and longer sight for long term goals and gains.

20. The current political instability is detrimental to all decisions along with the lack of accountability and lack of security... • For us to achieve our goals, the country has to have peace: peace of the land and peace of mind.

21. Thank you