Domhnall MacAuley on WONCA

Domhnall Macauley“When you look in their mouth you can tell their social class.” Jan de Maeseneer used this stark example of dental caries to highlight continuing health inequality in the developing world in his opening address on the UN 2015 Millennium Development Goals. He listed the many areas where primary care can make a difference but it was fascinating to hear him speak of the role of the family doctor in social cohesion, an aspect of general practice that is being gradually eroded in the UK. He also pointed out the folly of donor organisations funding vertical programmes of care and spoke about a campaign to encourage them to shift 15% of their funding to horizontal care as illness seldom presents as a single disease entity. But his most radical suggestion was in the context of medical education, describing “ the deadly carousel of the brain drain” and suggesting that developing countries should be reimbursed for training medical personnel who subsequently leave to work elsewhere.

WONCA (World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians) has changed and, for the better. English is the conference language but there is much greater variation in language and colour with delegates from many more countries than ever. There is a huge attendance of Spanish speakers, as might have been expected, with the biggest queue of the day for the simultaneous translation equipment. Wonca is now truly a world body. This presents considerable challenges: While there is little disagreement on the big issues such as social inequality and the importance of primary care in addressing population health needs, it is increasingly difficult to find a common research and teaching agenda. Nevertheless, this is a huge organisation with an important voice and this is the largest and most diverse Wonca meeting yet.

Gender issues continue to be a thread running through the conference. When we mention gender, most think of the role of women in society and there are clearly still major problems with gender stereotyping in the developing world. But, gender issues in medicine have changed greatly in the last 20 years and some of the changes have been most dramatic in family medicine where, in most European countries, women have achieved equal status, equal numbers, and will soon become the greater part of the workforce. I attended one of today’s sessions on the difficulties facing women in medicine and must confess that I felt a little uncomfortable with some of the messages. It is important to ensure that the term “gender” retains neutrality. The audience was predominantly female and I didn’t feel I could raise the issue publicly (which must be a problem in itself). Perhaps it is time to alter our vocabulary and focus more on equity and fairness in the workplace.

The sculpture of The Little Mermaid, immediately identifiable with Copenhagen, is currently in Shanghai at the Danish pavilion at the World Expo 2010. Per Kallestrup used this image to illustrate the benefits of the Hippokrates programme, part of the larger Vasco de Gama movement, an exchange scheme for young doctors wishing to travel and experience general practice in another country. It was refreshing to meet this enthusiastic and committed group of young doctors and share their belief in the future in family medicine. I know they felt energised by the meeting and will return home refreshed and with a new belief in the value of what we do. Isn’t that what conferences are for?

Domhnall MacAuley is primary care editor, BMJ