By Thomas Stubley
Regional Lead for Birmingham Medical School
I spoke to Mr Trevor Crofts, a retired General Surgeon and Honorary Senior Lecturer at the Royal Infirmary of Edinburgh. He worked within general and upper gastrointestinal surgery, dealing mostly with stomach and oesophageal cancers. Mr Crofts has been extensively involved in global surgery throughout various stages of his career, first working abroad in Peru/Bolivia as a surgeon in 1971 with VSO, and continuing past his retirement in the U.K. as a trainer and teacher in Malawi as recently as 2017.
Could you please describe the work that you completed whilst in Malawi?
I was first involved in surgery in Malawi in 2008, before returning in 2011 and then again throughout 2015-17. I initially volunteered as a surgeon and tutor at the Queen Elizabeth Hospital, Blantyre working under the organisation ‘Physicians for Peace’. During this period I was involved in the teaching and training of surgeons in the hospital, as well as operating on patients in areas of the country that at that time had high levels of AIDS. This work was interesting due to the limited resources, issues relating to hygiene and constraints on available equipment. The following visits to the country I focused more on teaching, training and ensuring proper theatre technique was followed; therefore reducing the time I spent operating. Most recently I have been tutoring groups of surgical trainees in preparation for their College of Surgeons of East, Central and Southern Africa fellowship exams.
I know that you have previously worked abroad as a surgeon in Australia and New Zealand, I was wondering if you could compare the experiences in these countries with Malawi?
Working in New Zealand and Australia represented the pinnacle of medical and surgical practice, as I was placed in fantastic hospitals with the newest equipment. The colleagues that I worked with in these countries were very experienced, and the lifestyle whilst in these countries is superb. The pay I received whilst working in these countries was significant enough that it could subsidise my work in Malawi to a certain extent.
How were you first able to get involved in working in these countries?
I took early retirement from the NHS specifically to volunteer abroad. I had worked for 2 years as a volunteer immediately after qualifying throughout 1971-3 and I always wanted to spend 10% of my working life in a voluntary capacity. I was visiting a friend in Johannesburg for his daughter’s wedding and knew of Professor Borgstein in Malawi so flew up to chat with him and he offered me a year-long contract.
I can see that you have continued working abroad post-retirement from the NHS, did you find that working abroad post-retirement changed the nature of the work you were doing?
Work abroad meant that one had to be more open to different ways of working but also more disciplined in not being corrupted from one's proven training acquired over a lifetimes work. It is very easy to drift and compromise one's surgical principals in a foreign environment and to be tempted to do things that are not familiar to you which may compromise patient care.
Do you think that there is scope for improving the numbers of doctors who continue to work abroad post-retirement, and do you have any ideas for increasing this number?
Working post retirement is a fantastic contribution. There is no greater privilege than to teach and train and no more grateful person than a mentored pupil/trainee. Post-retirement hopefully financial concerns should not be a problem for many surgeons and any children will have left home. It is also a lot more rewarding than playing golf! I feel that the BMA could do more as well as the Royal Colleges but presently they only pay lip service to these things! The government could have a scheme of enhancement of retirement benefits if surgeons retired early in order to work abroad.
I was wondering if you had any advice for medical students and more junior doctors who are keen to get involved in global surgery?
I think that there is a great opportunity for individual teaching hospitals and institutions to develop working relationships with overseas hospitals, and swap staff at all levels for mutual benefit.