Outreach in the East

I also advised representatives from the Malaysian Ministry of Health regarding their plans to cope with the ageing population of Malaysia. This resulted in publications in Age and Ageing and the Medical Journal of Malaysia. Over the subsequent years I have lectured in Malaysia and neighbouring Singapore, making many friends from Pan-Asia Pacific countries. In 2016 I was invited to be external reviewer of the Malaysian Geriatric Society Delirium Guidelines, published in 2017. With my good friend Professor Chia, from Kuala Lumpur, I have pursued the development of a local Diploma in Geriatric Medicine and when Sunway University agreed to support us I was appointed Adjunct Professor in the School of Healthcare and Medical Sciences, Sunway University, Malaysia in January 2018.

I have worked with the Veterans Hospitals in Taiwan since 2006, delivering seven one week teaching courses (2006-2017) on their Postgraduate Fellowship Programme in Geriatric Medicine and hosting over 20 Fellows as observers in my department between 2007-18. It has been a privilege to teach our skills to enthusiastic trainees from all manner of specialties and then to see over time how they have embedded CGA back into their specialty and how some have gone on to develop Departments of Geriatric Medicine in their hospitals. How wonderful to have been part of this transformation!

From 2008 to 2012, whilst Associate Director in the International Office of the Royal College of Physicians (London), I have lectured on Geriatric Medicine in Shanghai, Singapore, Malaysia, Sri Lanka, Thailand and Myanmar and hosted ten Shanghainese doctors as observers in my department. I have published one collaborative paper in Journal of the Royal College of Physicians with one of these doctors. I remain in touch with some of the doctors and still offer advice on English language for their publications.

Since 2013 I have been working with Hunan Provincial People’s Hospital, Changsha, helping develop Geriatric Medicine in their hospital, including providing a three week observership for their newly appointed Professor of Geriatric Medicine in my department in 2013. I have visited Changsha four times, the last one being last month. 

I have also been facilitating nurse education by arranging teaching visits by two senior nurses (one from the RCN and one from Addenbrooke’s). I consider it a coup to have been able to get this hospital and the provincial government to recognise the importance of training nurses in geriatric medicine. 

Professor Ou and I are now exploring how we can arrange observerships for his doctors and nurses in my department.

I have been working with the Ceylon College of Physicians and Sri Lankan Medical Association since 2010 and the newly formed Sri Lankan Association of Geriatric Medicine since 2014 to develop the specialty of Geriatric Medicine in Sri Lanka and help design the postgraduate curriculum and examination in Geriatric Medicine. 

In 2016 I spent three-and-a-half weeks as the guest of the Sri Lankan Association of Geriatric Medicine teaching doctors, nurses and physiotherapists. This was an education for me, to see how wanderers would be restrained, fallers would be restrained and those with incontinence put closer to the toilet; there is a lot to do to change nursing practice but the nurses are eager to learn. 

In July 2018, I was guest lecturer at the 131st Anniversary International Medical Congress of the Sri Lankan Medical Association (equivalent to the BMA, so encompassing doctors from a wide array of medicine, surgery and general practice) disseminating wider knowledge of the medical care of older people (specifically delirium, frailty and Comprehensive Geriatric Assessment). I also acted as a resource person examining posters and platform presentations. I met with the past president of the Sri Lankan Association of Geriatric Medicine to discuss future training needs of postgraduate doctors wishing to specialise in Geriatric Medicine and how I can continue to help with this endeavour. There is now an established training programme for Geriatric Medicine and a Specialist Society in Sri Lanka. The next step is to see graduates from this programme and the specialty numbers growing. Alongside this, there will be a move to develop nurse training in Geriatric Medicine.

The countries I have been working with share a common theme of rapidly ageing populations and a decline in birth rates; a recognition and desire to change health and social care to manage demographic change; willingness to learn from us and see what aspects of our health and social care systems might transfer to their societies (with variable speeds of governmental response). I have learnt that we do not engage with families as much as we should in the UK, e.g. antiquated visiting times in our wards; slow uptake of John's Campaign.

There has been opportunity to educate professionals and public; and I have been immensely fortunate to see some beautiful parts of the world and make some excellent friends. Thirty two years ago when I started in Geriatric Medicine I would never have dreamt that it would provide a ticket to travel and to teach worldwide. 

I have had the pleasure of seeing my specialty develop in different countries and to know that I have played a part in this and that my contribution is appreciated by professionals and politicians in those countries. Some very good friendships have also been established.

For my hospital and department there has been, and continues to be potential for research collaboration, teaching links, attracting highly skilled overseas doctors to provide service and receive training that they would not gain in their own country. This is done under the auspices of the RCP Medical Training Initiative (MTI) under Tier 5 visa scheme.

If I have enthused you and you wish to get involved I'd be happy to discuss the prospects with you. Alternatively, contact the BGS office to register your interest in future outreach possibilities.

Duncan Forsyth 
Cambridge University Hospitals Foundation Trust
Addenbrooke’s Hospital