Access to medical and health information in the developing world: an essential tool for change in medical education

Henry Haddad, MD; Stuart MacLeod, MD, PhD

CMAJ 1999;160:63-4

© 1999 Canadian Medical Association

• Sending CMAJ abroad: Letter 1, Letter 2
• Sending CMAJ to developing nations
• News and analysis: Ugandan health centre awarded subscriptions

Although physicians in developed countries may feel overwhelmed by the volume of available information that is relevant to their missions in education, research and service, most doctors in developing countries would not understand such a complaint. The concern in the developing world, where at least two-thirds of future physicians are being educated, is the lack of access to current scientific data to help in medical decision-making. Library resources in these settings are usually scarce, inconsistent, incompletely catalogued or nonexistent. How can neophyte health care professionals in developing countries learn to make choices in clinical practice without supporting information and resources? How can the advantages of evidence-based medicine be promoted when the relevant evidence is not available?

Some would argue that the Internet will soon make information available around the globe to support medical decision-making. In fact, a recent survey by the Canadian Medical Association (CMA)¹ showed that 51% of Canadian physicians use email and 47% have access to the Internet and are able to search bibliographic databases. These statistics are encouraging, but they also indicate the still-limited penetration of this technology even in a highly developed country where such services are readily available at relatively low cost. The situation in developing countries is vastly different, beginning with the remote likelihood that a physician will have access to a computer, even within his or her home institution.

For the foreseeable future, physicians in developing countries will continue to rely on print media to satisfy their medical information needs. For this reason the Canadian Medical Association Journal (CMAJ) recently asked Canadian physicians to suggest institutions in developing countries worthy of receiving CMAJ and the Canadian Journal of Surgery (CJS) (see, for example, CMAJ 159;4:328). The response was gratifying, and the supporting nomination for one of the subscription donations appears on page 13 of this issue.² Yet the nominations that were received probably represent only the tip of a very large iceberg.

The concepts embodied by this program should not stop with the delivery of medical journals to libraries. Canada has unparalleled experience in creating practice guidelines; in developing, refining and applying accreditation standards in education and clinical care; and in using information technology for distance education and in support of clinical decision-making. Canadian medical schools and the CMA have been world leaders in fostering the creation of frameworks for lifelong professional development and self-directed learning. We have a collective responsibility to explore the ways in which this established Canadian expertise can be used to benefit health care and the education of health care professionals internationally. Achievement of such an ideal is likely to depend heavily on the dissemination of information resources such as CMAJ and CJS and on the promotion of more comprehensive and effective use of information technology.^3,4

Similarly, the World Medical Association and its component medical associations in developed countries should undertake to deliver information resources to institutions in developing countries to improve medical education and professional development infrastructures. Such an initiative would include an ongoing commitment to deliver Internet resources such as CMA Online to a world where the information to support practice decisions and optimal continuing professional development is essential.

The program to deliver CMAJ and CJS to libraries in developing countries is an important first step. We urge all members of the CMA to consider the information needs of developing countries. The CMA Publications Committee would like to hear from you if you have views concerning the pilot project described on page 13. We would be happy to convey any calls for expanded support to the Canadian Medical Foundation and would be pleased to hear from advocates for greater World Medical Association involvement in this area.

In another age, Sir William Osler said "to study medicine without books is to sail an uncharted sea." To put this in a 21st century context, we could say that to offer health care without full access to the information required for clinical decisions is to be forever at sea.

Part of the responsibility of having a high standard of medical professionalism, as we do in Canada, is to share medical and scientific information, knowledge and skills in medical informatics with colleagues in the developing world. We hope that the initiative announced in this issue will enjoy widespread support.

Competing interests: None declared.

Send a letter to the editor Envoyez une lettre à la rédaction

1. Sullivan P, Buske L. Results from CMA's huge 1998 physician survey point to a dispirited profession. CMAJ 1998:159:525-8.
2. Sending CMAJ to developing nations. CMAJ 1999;160:13.
3. Faughnan JG, Elson R. Information technology and the clinical curriculum: some predictions and their implications for the class of 2003. Acad Med 1998;73:766-9.
4. Sebaldt RJ. Information technology and the future of medical education. Clin Invest Med 1997;20(6):419-21.