By Hemali Bedi

Travelling far afield for your elective? If so, we want to hear all about it. Write up your experiences into a Global Health case report and not only could you be the lucky winner of a £500 travel bursary, your article could also be included in the 2016 special edition print journal.

We’ve put together a quick guide to tell you everything you need to know.

What is a Global Health case report?

Global Health case reports should focus on:

• the causes of disease
• the social determinants of health
• access to healthcare services
• how Global Health issues affect individual lives

Global Health case reports require a comprehensive review of the relevant literature. This includes related publications published by governments and global organisations, not simply the medical literature. For more information, see our website.

What could I win?

• A £500 travel bursary to help you attend a medical conference or event related to Global Health.
• Your article will be published in our 2016 special edition print journal along with three runners-up.

How do I get started?

Before you begin, why not have a browse of our existing Global Health case reports collection? Be sure to check out our Instructions for Authors for guidance on patient consent, the submission process, and formatting issues such as the use of images. If you’ve never written a Global Health case report before, you may find our template useful to help get you writing.

The deadline for entries is 30th April 2016. For more information, visit our competition website or get in touch!

By Kristian Dye

Dhillon et al. present a case discussing the care of a patient with Ebola, which demonstrates in a microcosm some of the biggest issues facing healthcare providers in patients with palliative or terminal care needs – albeit in a particular extreme care environment.

In the case, the patient is declared palliative and restarted on active management, before being considered palliative once again and passing away.

These are issues which perplex physicians in all care settings.

1. When do we consider a patient for palliative
   care only?
2. How can we reconcile differing beliefs and values within the team to deliver the best care for patients?

Deciding a patient is palliative

This is an issue that continues to vex physicians the world over. Cardona-Morrell and Hillman identify no less than 18 different scales and assessment tools available to attempt to guide these decisions, none of which are perfect.

Rightly, much of this effort is focused on identifying those within the population who are entering the end of life, and for whom discussions and decisions surrounding palliative care can help them to avoid invasive and unpleasant interventions – in the UK the Gold Standard Framework is the current tool used in community settings.

The difficulty with many of these tools is that they are not well-suited to the kind of case presented here. The ‘normally fit but acutely unwell’ patient presents a real problem for prognostication – where patients in similar situations receive the same care, some will still die, others stage recoveries that would make Lazarus jealous. In these situations, how can we make clinical judgement without losing the patient in the interest of treating clinical indicators?

Team-based approaches in palliative care

Palliative care is one of the areas of medical practice where personal values can have the biggest impact on the judgements physicians make. We all bring with us a multiple of baggage – emotional, cultural and religious – that colour our views.

A helpful summary of religious views on palliative care, by Steinberg, demonstrates the breadth of both agreement and disagreement between major religions on this topic.

Alongside this, our practice has to be informed by the ethical principles underpinning medical care. Respect for autonomy, the duty to act in the patient’s best interest and the duty not to harm our patients are all critical to decisions around palliation of the dying patient – and all are open to interpretation by the practitioner.

What approaches can we take to ensure that judgement are taken by consensus, objectively, and within the context of the individual patient?

By Hemali Bedi

We are pleased to announce that BMJ Case Reports has published over 10,000 online cases. And what better way to celebrate this massive milestone than by sharing our second print edition – the 10,000 cases special edition booklet.

Seema Biswas, Editor in Chief of BMJ Case Reports, comments, “As we enter this new phase, we want to highlight Global Health: improvement in health and access to healthcare for all; and to make sure that all our case reports, clinical or Global Health, include the patient’s perspective.”

Our aim is to publish cases with valuable clinical lessons, with the advantage being that we learn from real cases. We hope that this special collection of case reports will serve as a useful educational resource that supports both learning and teaching. Why not have a look and let us know what you think? We’d love to hear your feedback.

We would like to thank all of our authors and contributors, and we look forward to welcoming many more cases in the days to come.

By Manasi Jiwrajka

The three cases presented by Nigam et al outline the malposition of an intra-uterine contraceptive device (IUCD) in young women who had given birth in the previous 1-2 years.

Some significant global health problems in this report are:

1. The importance of contraception and family planning in India
2. Contraceptive options available for women

Family planning and population control

India has an interesting history of government level family planning options including a mass sterilisation campaign initiated in the 1960s and more recently, one that received much media attention due to 12 women who died at a government-run tubectomy camp. (1)  The Indian government has advertised vasectomy, tubal ligation and other reversible and temporary contraceptive methods for population control. In fact, there are government incentives for those who undertake sterilisation surgery, a tradition held on since the 1970s emergency and poverty-stricken period in India. (2) More than sixty years later, India continues to struggle with its population, and it appears that the mass sterilisation attempts have failed to adequately control the booming population.

Contraceptive options available

My experience of working in resource-poor settings in India has been that many women do not want to give birth immediately after marriage, or immediately after having given birth to a baby, but face enormous pressure from their husbands and families to give birth again. One big factor in India is that of a son preference, which results in families trying to conceive until they have a son or more. (3) As such, many women prefer concealed approaches to birth control that they do not have to justify to their families – such as the depot or the IUCD. A recent study investigated the influence mother-in-laws have on contraception and family planning decisions because they found that “in casual discussions during the intervention project, rural women often mentioned that mothers-in-law were opposed to young women’s desire to limit family size.”(4)

Some real solutions or alternatives to sterilisation and these reversible contraceptive methods are fundamental. Some include: (i) Spacing out children, (ii) Delaying first pregnancy, and (iii) Education of both men and women.

What do you think? Are there other alternatives and solutions?

References

1. Burke J. India mass sterilisation: women were ‘forced’ into camps, say relatives. The Guardian. 2014.
2. Matthews Z, Zoë M, Sabu SP, Inge H, Juliet M. Does early childbearing and a sterilization-focused family planning programme in India fuel population growth? Demographic research. 2009;20:28.
3. Char A, Saavala M, Kulmala T. Influence of mothers-in-law on young couples’ family planning decisions in rural India. Reproductive health matters. 2010;18(35):154-62.
4. Pachauri S. Priority strategies for India’s family planning programme. The Indian Journal of Medical Research. 2014;140(Suppl 1):S137-S46.