Hundreds of doctors from around the world attended the four-day event, which took place on the campus of the University of Limerick
Rural doctors from across the world gathered in the University of Limerick last month to discuss issues associated with rural health and medicine – and to enjoy some music and revelry each evening.
This was the first time the biannual WONCA World Rural Health Conference – which coincided with the annual ICGP meeting at the same venue – took place in person since the Covid-19 pandemic. It was organised by the University of Limerick, the ICGP, and the Rural, Island and Dispensing Doctors of Ireland (RIDDI).
Hundreds were in attendance for the occasion, which lasted for four days, culminating in the annual RIDDI Paddy Cosgrave Golf Competition.
Making a bid
Needless to say, things took quite a lot of planning. “We decided that we’d like to hold an international conference and we went to Albuquerque to bid for it” said Dr Jerry Cowley, of the Rural, Island, and Dispensing Doctors of Ireland, speaking with IMT about how the meeting came to Limerick.
“We recruited our partners in UL, as well as the ICGP to come along with us to make the presentation. That was in 2019 – little did we know that Covid would hit us and that we’d be in this situation a few years later.”
Keynote speakers included Dr Mike Ryan, Executive Director of WHO Health Emergencies Programme; Professor John Gillies, Honorary Professor of General Practice, University of Edinburgh Co-director, University of Edinburgh Global Compassion Initiative, Global Health Academy; and Dr Anna Stavdal, WONCA World President. Also present was Professor Roger Strasser, who gave a talk on how rural medical health education improves healthcare for all.
The conference additionally discussed issues around a shortage of rural doctors, as well as a ‘green agenda’. Also addressed were needs, challenges and opportunities for the rural health sector; how community systems can be strengthened and effect change; the healthcare needs of indigenous people, as well as community nursing and pre-hospital care.
Raising awareness about global rural health
Among the international visitors for the weekend were members of WONCA Rural Seeds, a group of young doctors and healthcare professionals who champion rural health around the world.
Dr Mercy Wanjala, a Rural Seeds ambassador, said that it’s important for healthcare professionals to be aware that rural patients have different needs to patients who live in urban areas.
“What people ignore in medical and health education is the fact that there is a population – 50 per cent globally, 70 to 80 per cent in some nations – that require healthcare but are often ignored because their healthcare needs, their challenges and their context is different from the urban settings, where a lot of medical schools are placed,” she explained, speaking with IMT.
Medical students in some parts of the world are often trained in hospitals, which means that they are sometimes not exposed to rural patients who access healthcare in a different way, and whose healthcare problems can different.
It might have happened by accident, but there is an overemphasis on treating patients in urban areas, says Dr Wanjala.
“For example, in an African context, where people are living rurally – their needs are around water and sanitation; it’s around nutrition; it’s around ‘how do I keep myself healthy?’ People do not understand that because they are not trained to – so it’s important that we voice the concerns of rural areas, as well as the challenges they face.”
Peer-led, small group learning in Ireland: a success story
Irish GPs have done well ensure that they are kept up to date on their patients’ needs. Peer-led, small group learning was set up by Dr Michael Boland, the former President of WONCA. It subsequently spread all over Ireland, and to other parts of the world, such as Scandinavia and the UK.
Dr Pat Harrold, a Tipperary GP and Adjunct Senior Clinical Lecturer in University of Limerick Medical School, says that stepping away from hospital learning has been integral to maintaining standards of care for rural GPs. He was present to give a talk titled ‘CME Network Delivery of Evidence-based Peer Centred Learning for Rurally Based GPs’, along with Dr Stephanie Dowling and Dr Finola Minihan.
“It’s a really invaluable tool for keeping up, because there are changes all the time,” he says, speaking to IMT.
“Learning specifically targeted at GPs is important. Before that, back in the 60s and 70s it was all hospitals-based, which wasn’t really that relevant. GPs didn’t really know if they were an outlier – were they doing the same as everybody else? There’s also the support that these groups offer.”
Doctors attending these meetings are sometimes a mixture of both rural and urban – meaning GPs can learn from each other. There’s also crossover in terms of healthcare issues – some problems that were previously associated with urban living are now associated with rural living. For example, drug use once confined to urban areas in Ireland is now rife in certain rural parts of Ireland.
These meetings took place remotely during much of the Covid period. Though this wasn’t ideal, remote meetings kept GPs in touch with each other. The ICGP’s weekly broadcasts about the pandemic were also of great utility.
“These kinds of meetings are particularly valuable for young doctors” Dr Harrold adds. “They learn what’s available, not available, that kind of thing. There are always nuggets of medical education – stories, stories, stories! We could cover therapeutics, case studies, purely medical things like prescribing. It’s an eclectic mix.”
L to r: Dr Liam Twomey, Honorary Treasurer and Chair of the Finance Committee; Dr Grainne Ní Ghairbh, Honorary Secretary, ICGP; Prof Tom O’Dowd, Outgoing President; Dr John Farrell, Chair, ICGP, Mr Fintan Foy, CEO, ICGP; Dr Diarmuid Quinlan, Medical Director; Dr Paul Armstrong, Incoming President, ICGP
Guaranteeing the future of rural health
The final day of the conference saw rural doctors calling for urgent action from the government to address the needs of rural patients.
Delegates present unanimously supported RIDDI’s call on government to ensure that Irish rural medicine is made sustainable into the future. This means guaranteeing that rural areas have a sufficient number of medical practitioners, and that all vacant and locum-run rural and remote area GP panels are filled as a matter of urgency.
This is necessary to ensure rural populations continue to obtain a proper standard of medical care, RIDDI says. The organisation also wants isolated solo practices to operate with a second GP appointed and be fully resourced by the HSE.
“Supporting the 15 per cent of older people who will end up needing full-time care in congregated settings is integral to the work of rural medical practitioners, as is the dispensing of medicines in areas where it is not economically feasible for a pharmacist to operate,” a statement release by the organisation stated. “Both the aforementioned need to be fully supported and developed further for the sake of rural-dwellers.”
RIDDI further called for the restoration of the distance codes system, the abolition of which, it says, has amounted to a massive disincentive to rural practice as a career choice for young medical practitioners.
“They accepted them both: the Limerick Declaration and our document,” said Dr Cowley. “It’s a comprehensive document that has been fully ratified by the conference.”
The Limerick Declaration on Rural Healthcare is a blueprint for policy makers, academics, and citizens with instructions on how to bring high-quality healthcare to rural areas. It offers a blueprint designed to help facilitate investment in rural healthcare infrastructure, co-created with our rural communities protecting and enhancing local environments while addressing the social determinants of health.
It also seeks to build a diverse and inclusive workforce that is representative of the communities we wish to serve, underpinned by the principles of social accountability while being committed to gender equality and social justice. 
More photos from the event can be found here.
All photos by David Coleman/Bobby Studio.
