Standing in the historic entrance hall of Buckingham Palace, I waited nervously to meet the Queen. Next to me was the Liverpool and England midfielder Steven Gerrard.
He was there to receive an MBE for services to football.
I was there to receive an OBE for my services to orthopaedics in Africa; for the small part I had been privileged to play alongside many hard-working colleagues over the past ten years to improve medical services and training in Africa.
Eventually my name was called out. I entered the Grand Ballroom and walked slowly towards the Queen and she pinned the medal to my chest.
Nothing will take away the splendour of that day, but the ironic truth was that at the same time as I was being made an Officer of the Order of the British Empire by my Monarch, another part of her Government was preventing me from practising as a consultant in the NHS.
I was involved in a 15-month battle against bureaucracy and Kafkaesque red tape that had cost me a fortune and meant - despite my professorships from the Royal College of Surgeons and Oxford University - I wasn't even allowed to work in my local hospital.
Back in 1995 when I was a 36-year-old NHS consultant at University College Hospital in London, I had often thought of working in the needy parts of the world.
As committed Christians, my GP wife Vicky and I had often discussed the possibility. In June of that year, the catalyst arrived.
I received a letter, sent by the director of NHS human resources to all senior managers and NHS chief executives encouraging them to allow staff to assist in developing countries and, equally important, encouraging them to re-employ the staff on return, taking into account the experience they would bring to the NHS.
The support of my employer was stimulus enough, and in early 1996, I transferred my job to that of honorary consultant, so I was still within the NHS, and set off to Malawi with Vicky and our six-month-old son Jonathan.
It was an exciting, fulfilling and very rewarding decade. As the only orthopaedic surgeon among 12 million people, I carried out literally thousands of operations.
I also helped set up a training programme for orthopaedic paramedics, build an orthopaedic hospital for children and establish the College of Surgeons of East, Central and Southern Africa.
We had two more sons and after ten years we thought it time to return.
Although I'd been earning a fraction of what I used to earn in England (and although my income will never be what it might have been), I was confident I'd be able to work as a consultant.
We knew that in 1997, under pressure from the EU, the UK had established a "Register of Specialists".
When we heard of this, we didn't think much of it; after all, we also heard that if you were an NHS consultant - as I was - you would automatically be on it.
What we didn't know was that you had to respond to a letter.
Nor that if you did not, there would come a time when you would not be able to work. I now know there are others - I suspect at least a hundred consultants - who also missed the correspondence and are not on the register.
After all, letters do go astray. If you're a consultant near retirement, it's not too bad: you simply have to stay put.
If you're at the beginning of your career, it could be devastating: You can never take another consultant job.
In December 2005, we returned, to settle in Oxford. I applied to the university for a part-time post researching my passion - helping children with physical impairments walk in sub-Saharan Africa - and to the NHS for a part-time consultancy.
The university soon gave me an honorary position. But the response from the NHS astonished me: I was not on the register of specialists, and there was no record that I had applied. I could not work as a consultant.
Although it came as a shock, it never occurred to me that it wouldn't be sorted out within days. I'll apply now, I replied.
"Ah. You could have done," I was told, "any time between 1997 and six weeks ago." But on October 31, 2005, the law changed. The register was now run by a new Government-appointed board.
I could start at the beginning, and spend six years retraining (no thanks). Or I could apply on the same basis as non-EU trained specialists, and send a synopsis of all my training and expertise and a cheque for £750 to the PMETB.
Foolishly, I balked: £750 represents several life-changing operations in Malawi. So I tried to circumvent the procedure, writing to my MP, Health Secretary Patricia Hewitt and even the Prime Minister.
My first letter to the PM received no response, the second prompted a routine reply from his office, referring me to the PMETB website.
If I could have joined the register six weeks ago, I argued, why not now? Surely this could be cleared up without forms and cheques.
On this false hope, I wasted the first three months, before biting the bullet and applying formally.
From then on, I began to become acquainted with the brave new bureaucratic world that Britain had become in our absence.
Rule Number One: You are not allowed to meet the people you deal with - it is forbidden to visit the PMETB in person.
Rule Number Two: Lines of accountability are blurred. On their website, they claimed to acknowledge applications within 48 hours and, once deemed complete, to deal with them within three months.
At the time, three months seemed to me an age. Little did I know.
It took me two weeks' full-time work to fill in the form. It ended up as a 200-page dossier, a CV in which every sentence had to be verified with documents and legal statements.
Every academic publication I'd ever written had to be photocopied; every degree certificate copied by a solicitor.
Once the completed dossier was sent, it took the PMETB a month just to acknowledge it. So much for the hope of applications being dealt with within three months.
It turns out this is rather like a New Labour NHS waiting list: the three months doesn't start till they say so.
My application was sent off in March 2006. I then emailed regularly to track progress. After six months, it had still not been opened, because of the number of other applications.
I sympathise over the workload, but my employment depended on this decision.
What made this particularly ironic was that last September I gave the prestigious biannual lecture at the British Orthopaedic Association, probably one of the highest honours I will ever receive, but while I addressed several hundred orthopaedic surgeons, I myself was not allowed to work as a consultant.
At last my file was opened. But my application was nowhere near being ready to process.
I hadn't, for instance, provided them with my training log. But I trained in the Eighties and Nineties, when we didn't have log books.
Nor had I produced verification for the list of operations I'd performed in Malawi. This had to be signed by "the consultant in charge".
Since I was the main consultant in the country I had worked in, it was hard to see how I could get anyone more senior to verify my work.
In the end, I decided I would have to go back to Malawi to get my former colleagues to stamp and sign every bit of paper I could put under their noses.
Frustrating though the past year and a half have been, we've laughed too. I had to show in my application that I had "teaching experience".
Having built a teaching hospital, helped found a postgraduate training college, been chairman of the exam board for the whole of Eastern and Central Africa, raised £250,000 for medical training and written several textbooks, I thought I was in the clear on that one.
Not a bit of it.
What more could they want?
"Well," came the explanation, "have you ever taken part in a teaching afternoon in your hospital?"
The next time I ran a weekly seminar, I apologised to my students for wasting their time, and got them to sign a bit of paper to prove I'd been there.
Then I was also asked if I'd ever had any feedback from any patients; you know, letters of appreciation or thanks.
Since many of my recent patients were illiterate and few spoke English, I was wondering how I could help, when the clerk continued: All such letters must be anonymous, so the signature at the bottom should be eradicated. And to further protect identity, any contact address must be removed too.
"Just a minute," I clarified, "you want a number of letters testifying to my competence as a surgeon, with the name cut off and the address removed?"
"That's right, yes." Presumably in different coloured ink and varying handwriting...
After almost a year of this, my officer in the certification board (by now a good friend) kindly gave me a list of all the evidence that was needed. Oh, if only I had known that such a list existed a year beforehand!
They had presumably been measuring my application against it all this time. Suddenly it was straightforward: within a fortnight, I managed to send all the correct data to the board.
In the New Year 2007, I was honoured with the OBE. Automatically I added it to my dossier. And, quite by coincidence, the three-month countdown began.
But there was still no hurrying the process. I suggested they might cut out the step of submitting my application for review by the Royal College of Surgeons, since two presidents of the RCS were my referees - and was given short shrift.
Just before I went to Buckingham Palace in March, I couldn't resist pointing out the embarrassment if Her Majesty happened to ask where I was working and I had to tell her I wasn't yet deemed fit to do so in the UK.
But bureaucracy is as immune to irony as it is to a sense of humour.
A few days later, on March 24 - towards the end of the three-month period - I was registered.
Yes, it's cost me a fortune, mostly in lost earnings over 15 months, but also my fee to the PMETB, trips to London, legal copy fees, recorded delivery, flights to Malawi and numerous bottles of wine to all the friends who've had to help. But that's not the point.
What message does it give about overseas work? What is this Government saying to those who want to donate their time abroad? Places like Malawi still desperately need the expertise we can give.
The work is some of the most rewarding in the world, and the experience gained by working with colleagues there is invaluable.
But what responsible young consultant, hearing of my experience, as he would be bound to, will take his family abroad with no assurance of work on his return?
I like to think mine were the teething problems of a new system - but it would be good to be reassured it could never happen again.
Chris Lavy worked for Christian Blind Mission International, www.cbmuk.org.uk. The hospital he helped set up is run by Cure International, www.cureinternational.org.uk.
Sunday, 3 June 2007
Portsmouth Area Community Briefs
Sunday concert to aid African children
ELIOT, Maine — The popular local musical group Salt River will give a concert at 2 p.m., Sunday, at Fellowship House to help raise awareness about the plight of children in Malawi, the poorest nation in Africa.
The group will join with other area residents in support of Educate These Children, a nonprofit organization founded on the belief that all children deserve an education.
When Rose Cabot, founder of Educate These Children, first visited Malawi, she was overwhelmed by the poverty she saw. Rose describes that “after a few days I felt overwhelmed with sadness of what I saw around me and decided then that I needed to do something that could make a difference, even if it was for just one child.”
During the next few trips back to Malawi, she brought medical supplies with her. However, after Sept. 11, that was no longer possible, so began the Malawi Project to provide funds for children to attend secondary school. Nine dollars a month is all it takes to educate and provide a meal for one child each day to attend school for one year. Nine dollars a month to break the cycle of poverty. Nine dollars a month to give hope to one child without hope.
“It is not possible to save every child in every country ,but it is possible to save one child, she said.
Please join Rose and friends and help support its mission. Handmade crafts from Malawi will be available for purchase. Fellowship House is located at Green Acre, Route 103, Main Street.
ELIOT, Maine — The popular local musical group Salt River will give a concert at 2 p.m., Sunday, at Fellowship House to help raise awareness about the plight of children in Malawi, the poorest nation in Africa.
The group will join with other area residents in support of Educate These Children, a nonprofit organization founded on the belief that all children deserve an education.
When Rose Cabot, founder of Educate These Children, first visited Malawi, she was overwhelmed by the poverty she saw. Rose describes that “after a few days I felt overwhelmed with sadness of what I saw around me and decided then that I needed to do something that could make a difference, even if it was for just one child.”
During the next few trips back to Malawi, she brought medical supplies with her. However, after Sept. 11, that was no longer possible, so began the Malawi Project to provide funds for children to attend secondary school. Nine dollars a month is all it takes to educate and provide a meal for one child each day to attend school for one year. Nine dollars a month to break the cycle of poverty. Nine dollars a month to give hope to one child without hope.
“It is not possible to save every child in every country ,but it is possible to save one child, she said.
Please join Rose and friends and help support its mission. Handmade crafts from Malawi will be available for purchase. Fellowship House is located at Green Acre, Route 103, Main Street.
LOOKING A GIFT HORSE IN THE MOUTH: THE BATTLE AGAINST STARVATION IN MALAWI
When Susan George, formerly of the World Bank, wrote her revolutionary book How the Other Half Dies (Penguin, 1976), it pricked the conscience of those concerned with humanitarian issues globally. Others however, were keen to dismiss the work as an overstatement of the problem of world hunger and the global regime to combat this. The fact is that although global food production has increased manifold and at a faster rate than global population growth, the problem of hunger persists. Some of this hunger is caused by temporary factors - a particularly bad year of drought or caused by the failure of a leading crop. At other times, as in Somalia, Zimbabwe and North Korea, the difficulties of scarce resources are compounded by exploitative political regimes that remain unconcerned with the production and distribution of food. It is clear that in such circumstances the relatively wealthy benefit more than others with ethnic, linguistic and other minorities often stranded at the bottom of the appropriately christened, ‘pecking’ order.
The international community has been concerned with this situation for some time, with agencies such as the Food and Agricultural Agency (FAO) and the World Food Programme (WFP), seeking out ways in which to relive such situations through a series of emergency measures, and better planning to avoid the descent into famine. Concomitant to these efforts, various governments have become involved in bilateral food aid. This aid is often directed at countries facing drought and famine with food packages providing inhabitants with the means for a basic survival that would be otherwise denied to them. By and large, this form of aid is motivated by humanitarian concerns and, has often significantly alleviated particularly acute shortages. Yet the issues are far more complicated than a simple and generous donation from those with plenty to those with little, as has begun to become starkly clear in Malawi.
Faced with famines in 2002, 2003 and 2005, the State was particularly grateful when the international community stepped into the breach to provide for the population. The assistance, led by the World Food Programme, was timely, focussed initially at the provision of meals at schools throughout the State, and had the added benefit of attracting children to schools in a country struggling to educate its population. The -result of what amounted to a well thought-out idea, was an increase in school enrolment and a near guarantee that every child in the State would be fed at least once a day: a luxury in some cases that was beyond the imagination of many. So successful was the model that it had begun to attract the attention of other States struggling with similar problems.
The United States of America, attracted by the efficiency of the programme, expressed a desire to join in, with a donation of $20 million over three years. Yet the fine print of the deal is crucial: access to the grant is conditional upon the food being bought off American farmers, and transported by American ships to Malawi. The result is a discrepancy whereby the cost per tonne of food will be $812 instead of $320 that is paid when sources locally. While the actual cost of the food is the same, the transportation and distribution costs add almost two-thirds to the American figure. Now the immediate crisis has passed and the State has begun to come to its feet, a new problem has surfaced: the ‘aid’ package has not stopped. Just last month the US announced that it would send another $20 million worth of corn and maize to Malawi. This corn and maize is sourced from Kansas and Iowa where farmers produce to vast excesses, with an additional subsidy estimated to be in the range of between $5-10 billion of American tax-payers’ money.
The food entering Malawi is causing a glut in a potentially good harvest year, and squeezing out local farmers, who cannot find any market for their produce. The result is that many are likely to see their produce destroyed without an opportunity to get a fair price for it. The medium term ramification is that the farmers are unlikely to earn the necessary cash to buy seeds to plant for next year’s crop and thus a gradual cycle of dependence is being formed.
The imposed compulsion to spend the attractive food aid packages on American produce is ensuring handsome rewards for farmers in Iowa and Wyoming with an additional boon for American shipping: it has begun to spell doom for indigenous African farmers. In addition there is evidence that some of the ‘in kind’ donation being sent to many African countries, is being delivered for sale at market prices to US based NGOs like Save the Children and World Vision, to generate cash to support the work of the organisations themselves.
Of course the notion of subsidizing farm produce is not exclusively an American preserve. Europe, with its Brussels funded programme of subsidies ensures adequate ‘protection’ for its farmers through a series of regulations and tariffs that keep cheaper African farm produce out of the European Union. Thus despite the constant rhetoric of the importance of free trade and the oft-heard criticism of other States’ (i.e. non US and EU) protectionist measures, in this, the fulfilling of the most basic of human needs, the powerful ensure that they and theirs come off best. Sometimes, as in the case of situations of particularly acute shortfalls this largesse is well received, but at other times, it feels very much as if the rest of the world is required to sit captive at the feet of the wealthy States, waiting to pounce on unwanted or carelessly thrown morsels that may fall to the ground.
The international regime for human rights has for long been overtly concerned with the plight of the individual and her/his civil and political rights. Yet as we have seen in the more than five decades that have passed since the passage of the Universal Declaration for Human Rights (1948) to be able to truly address the human rights of every global citizen, we have to see their rights as being both indivisible and collective. While the human rights regime has begun to become more active on economic and social rights, it is still to take on unequal world trade regimes with any sustained rigour. As this important example in Malawi demonstrates, this is a vital necessity to prevent the escalation of global inequality. As for Gift Horses and Mouths – well food aid risks being one gift where the pleasure and subsequent rewards are truly, all in the Giving.
1st June 2007
For a more detailed look at the situation in Malawi see the Guardian Newspapers Food Monthly Magazine or join in the debate entitled ‘Does Food Aid Do More Harm than Good? On www.observer.co.uk/blog.
The international community has been concerned with this situation for some time, with agencies such as the Food and Agricultural Agency (FAO) and the World Food Programme (WFP), seeking out ways in which to relive such situations through a series of emergency measures, and better planning to avoid the descent into famine. Concomitant to these efforts, various governments have become involved in bilateral food aid. This aid is often directed at countries facing drought and famine with food packages providing inhabitants with the means for a basic survival that would be otherwise denied to them. By and large, this form of aid is motivated by humanitarian concerns and, has often significantly alleviated particularly acute shortages. Yet the issues are far more complicated than a simple and generous donation from those with plenty to those with little, as has begun to become starkly clear in Malawi.
Faced with famines in 2002, 2003 and 2005, the State was particularly grateful when the international community stepped into the breach to provide for the population. The assistance, led by the World Food Programme, was timely, focussed initially at the provision of meals at schools throughout the State, and had the added benefit of attracting children to schools in a country struggling to educate its population. The -result of what amounted to a well thought-out idea, was an increase in school enrolment and a near guarantee that every child in the State would be fed at least once a day: a luxury in some cases that was beyond the imagination of many. So successful was the model that it had begun to attract the attention of other States struggling with similar problems.
The United States of America, attracted by the efficiency of the programme, expressed a desire to join in, with a donation of $20 million over three years. Yet the fine print of the deal is crucial: access to the grant is conditional upon the food being bought off American farmers, and transported by American ships to Malawi. The result is a discrepancy whereby the cost per tonne of food will be $812 instead of $320 that is paid when sources locally. While the actual cost of the food is the same, the transportation and distribution costs add almost two-thirds to the American figure. Now the immediate crisis has passed and the State has begun to come to its feet, a new problem has surfaced: the ‘aid’ package has not stopped. Just last month the US announced that it would send another $20 million worth of corn and maize to Malawi. This corn and maize is sourced from Kansas and Iowa where farmers produce to vast excesses, with an additional subsidy estimated to be in the range of between $5-10 billion of American tax-payers’ money.
The food entering Malawi is causing a glut in a potentially good harvest year, and squeezing out local farmers, who cannot find any market for their produce. The result is that many are likely to see their produce destroyed without an opportunity to get a fair price for it. The medium term ramification is that the farmers are unlikely to earn the necessary cash to buy seeds to plant for next year’s crop and thus a gradual cycle of dependence is being formed.
The imposed compulsion to spend the attractive food aid packages on American produce is ensuring handsome rewards for farmers in Iowa and Wyoming with an additional boon for American shipping: it has begun to spell doom for indigenous African farmers. In addition there is evidence that some of the ‘in kind’ donation being sent to many African countries, is being delivered for sale at market prices to US based NGOs like Save the Children and World Vision, to generate cash to support the work of the organisations themselves.
Of course the notion of subsidizing farm produce is not exclusively an American preserve. Europe, with its Brussels funded programme of subsidies ensures adequate ‘protection’ for its farmers through a series of regulations and tariffs that keep cheaper African farm produce out of the European Union. Thus despite the constant rhetoric of the importance of free trade and the oft-heard criticism of other States’ (i.e. non US and EU) protectionist measures, in this, the fulfilling of the most basic of human needs, the powerful ensure that they and theirs come off best. Sometimes, as in the case of situations of particularly acute shortfalls this largesse is well received, but at other times, it feels very much as if the rest of the world is required to sit captive at the feet of the wealthy States, waiting to pounce on unwanted or carelessly thrown morsels that may fall to the ground.
The international regime for human rights has for long been overtly concerned with the plight of the individual and her/his civil and political rights. Yet as we have seen in the more than five decades that have passed since the passage of the Universal Declaration for Human Rights (1948) to be able to truly address the human rights of every global citizen, we have to see their rights as being both indivisible and collective. While the human rights regime has begun to become more active on economic and social rights, it is still to take on unequal world trade regimes with any sustained rigour. As this important example in Malawi demonstrates, this is a vital necessity to prevent the escalation of global inequality. As for Gift Horses and Mouths – well food aid risks being one gift where the pleasure and subsequent rewards are truly, all in the Giving.
1st June 2007
For a more detailed look at the situation in Malawi see the Guardian Newspapers Food Monthly Magazine or join in the debate entitled ‘Does Food Aid Do More Harm than Good? On www.observer.co.uk/blog.
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