The BMJ Today: The pitfalls of migration

I’ve been taking lots of travel histories lately. As a GP who sees lots of patients with fever, patients are even starting to pre-empt me (” . . . and I’ve never been to Africa”). This heightened awareness is unsurprising, given news that some countries are introducing airport screening for Ebola. But will this actually make much difference? Probably not, say editorialists Mabey et al. By their calculations, “an entrance screening policy will have no meaningful effect on the risk of importing Ebola into the UK.”

They argue that: “People who know they are at risk and develop symptoms will want to seek care immediately, as they will fear for their lives. The priority should be to provide information to all those who may be at risk on how and where to seek care. This would be as effective as screening at a fraction of the cost.” And even better, “immediately scale-up our presence in west Africa—building new treatment centres at a rate that outstrips the epidemic . . . we would not only help the people of these affected countries but also reduce the risk of importation to the UK.”

As this call appears, the first group of 150 British army medical and nursing staff head to Sierra Leone, as part of Operation Gritrock. They will set up and run a treatment centre for health workers infected with the Ebola virus, located next to a larger Ebola treatment centre to be run by the charity Save the Children.

Their tasks will probably include: “investigations in an on-site laboratory, treatment of coinfection with malaria and other diseases, and correction of electrolyte and fluid balance disturbances,” as well as electronic scanning of patient records, and data collection for rapid analysis and practice implementation. And wisely, even as this first group is being deployed, planning is in place to train their replacements, as “the epidemic seems likely to continue for many months.”

Migrating viruses are not the only challenges that greater mobility brings. In Richard Smith’s postoperative reflections (“The joy of a hernia repair“), he observes, “I’d come across staff from Ireland, the Philippines, South Asia, Eastern Europe, and the West Indies. I don’t know who is going to look after us ageing Londoners if the anti-immigration zealots have their way.” To counter this, Mihail Călin gives a sobering perspective from one of these other countries, as Romanian healthcare workers keep packing.

He mentions an oncologist who has returned to work a week after retiring, with “no other specialist to care for his 4000 patients.” He writes, “each country holds the key to recruiting foreign workers and retaining the ones it has trained.” Yet while countries such as Hungary have found innovative solutions to retain their staff and improve the health of their people, Călin is less optimistic that sufficient political will for such solutions exists in Romania.

And for a final (rather weak) segue: drains and lines that travel to the wrong cavity are the junior doctor’s nightmare. It helps to be able to tell on X-ray that they are where they’re meant to be—test yourself in this endgames quiz of a neonatal chest and abdominal radiograph.

Mabel Chew is practice editor, The BMJ.