Interview with Dr Fergus Macbeth

Interview with Dr Fergus Macbeth from Bristol, UK, previously Director of the Guidelines Department at the National Institute of Health and Care (NICE), Coordinating Editor of the Cochrane Lung Cancer review group, and oncologist.

Fergus has been engaged as a facilitator for the last three workshops on Evidence Based Healthcare arranged by the Collaboration for Evidence Based Healthcare in Africa (CEBHA), in Rwanda, Burundi and Tanzania, a program sponsored by the Elsevier Foundation.

Interview by Frode Forland

How did you become part of this program?
I met with Dr Frode Forland, who is the Project leader for the Collaboration for Evidence Based Healthcare in Africa, through the Board of Guidelines International Network (GIN), and he asked if I would like to participate as a facilitator at the workshop in Kigali in December 2012. I found it very interesting, and have now been involved in three workshops.

What are your experiences after facilitating on three workshops on Evidence Based Healthcare in Africa?
First of all, it has been very rewarding. Through personal feedback and the formal evaluations I believe that the messages of Evidence Based Medicine (EBM) have been enthusiastically received. I have spent the last 15 years working in EBM myself, and it was surprising to find how few African doctors seemed to be familiar with these principles.

Secondly it has been a challenge to get the messages across in a teaching and language style to enable the participants to take home the messages and apply them in their clinical or public health setting. Especially in francophone countries, we have had to speak more slowly and to be very clear and concise in our teaching.

How is the payment for this work?
Well, my payment is the joy of doing it. I recently retired from active work at NICE, and I am happy to do this on a voluntary basis. My expenses are covered  - that is all I need.

Why do you engage in such activities in retirement?
Because I strongly believe in the principles of EBM. In health systems where the challenges are big in disease, lack of personnel and infrastructure, the need to use scarce resources effectively is most important. The workshop we had in Bujumbura, Burundi was the first ever EBM workshop in that country, one of the poorest countries of the world. The participants were senior doctors and policy makers from the University, the Public Health Institute and the Ministry of Health. I believe that the impact of this work will be substantial.

What is your impression, are the messages of EBHC taken?
The three courses I have participated in have been very different. I have seen some participants   accepting the core messages easily while others were struggling, either with the statistics, the language or the conceptual understanding. We have had a blend of health workers and librarians in the workshops. Some of the medical terms and research methodologies have been hard for librarians to follow. I have learnt to convey the key messages in simple language, which has helped me to understand some of the concepts better as well.

You have spoken to many doctors and health workers in Africa, what in your view would be the best strategies to improve health in Africa?
As a first priority I think it is important to ensure equity of access to healthcare even when resources are scarce. There are still huge challenges and unmet needs in many of the countries. Investing in public health, poverty reduction, infrastructure and health systems are also important priorities. But it has also been good to see many of these countries really working hard to improve living conditions and health for their populations.

How do you see the future for Africa?
After visiting Rwanda, Burundi and Tanzania, I am more optimistic than before. Provided that political and social stability can be guaranteed, I have seen that many African countries have started, and I am confident they will continue, to deliver better health and social care for their citizens. Delivering cost effective and evidence-based services will enhance this process.

What have you learnt yourself from teaching others?
When teaching others you really have to learn the topic yourself! I have gained a huge amount by meeting and talking to these bright and enthusiastic colleagues working under sometimes much more constrained health systems and difficult conditions than I have been used to. In Burundi for instance, for a population of approximately ten million people there are only two pathologists. One is now trained in Evidence Based Health Care!