When Doctors strike: Making Sense of Professional Organizing in Kenya.

Little is known about how the health professions organize in low- and middle-income countries (LMICs). This is particularly troubling as health worker strikes in LMICs appear to be growing more frequent and severe. While some research has been conducted on the impact of strikes, little has explored their social etiology. This article draws on theory from organization and management studies to situate strike behavior in a historical process of sensemaking in Kenya. In this way, doctors seek to expand pragmatic, moral, and cognitive forms of legitimacy in response to sociopolitical change. During the first period (1963-2000), the legacy of colonial biomedicine shaped medical professionalism and tensions with a changing state following independence. The next period (2000-2010) was marked by the rise of corporate medicine as an organized form of resistance to state control. The most recent period (2010-2015) saw a new constitution and devolution of health services cause a fractured medical community to strike as a form of symbolic resistance in its quest for legitimacy. In this way, strike behavior is positioned as a form of legitimation among doctors competing over the identity of medicine in Kenya and is complicating the path to universal health coverage.

A Piece of History: The Legacy of George W. Counts and Underrepresented Populations.

The fight for social justice and diversity in medicine stems from racial inequalities and discrimination that have permeated our society for centuries. As America has become more diverse in recent years, African American physicians remain largely underrepresented in the healthcare workforce and academic medicine. In the field of infectious diseases, one man, George W. Counts, has shouldered the struggle to end disparities in education, training, research, and academic advancement. This article celebrates his legacy and rekindles the discussion about inclusion, diversity, access, and equity in infectious diseases.

Beyond the Bifurcated Myth: The Medical Migration of Female Korean Nurses to West Germany in the 1970s.

This study investigates beyond the bifurcated myth of the medical migration of Korean women to Germany in the 1970s, which is known as the "German dispatchment" myth from the Korean perspective and the "development aid" discourse from that of the Germans, by focusing on the newly-released documents from the German Hospital Federation (Deutsche Krankenhausgesellschaft, DKG). The migration was essentially a transfer of labor from a weak to a strong state, and the disparity of state strength characterized the nature of the recruitment mechanism. Both Korea and Germany have romanticized the labor transfer and appropriated the collective experiences of migrants for their own political purposes. In this transnational business, the Korean Overseas Development Corporation (KODCO) and the DKG maintained exclusivity in the labor migration channel and were faithful to their own interests. The DKG, as a representative of the German healthcare industry, was concerned about being criticized for destroying the healthcare system of developing countries by stealing their skilled workforce. They, therefore, tried to influence publicity in Korea and Germany to persuade the people that the recruitment benefited both countries. However, the DKG was aware of the deceitfulness of its "development aid" discourse. The Korean government, which advanced the labor export for the sake of obtaining foreign currency, romanticized it as patriotism and used the term "German dispatchment." However, the incapacity and corruption of KODCO as an agency from the Korean perspective resulted in criticism regarding its recruitment program. The DKG complained that the selection of incapable personnel coupled with corruption was causing unforeseen financial damage to its member hospitals. Nevertheless, it officially defended its partner for the sake of its own interests, such as avoiding bad publicity and securing the sustainability of the recruitment program. The conflicts regarding nursing tasks and working conditions between Korean nurses and their German colleagues and employers captured in the documents of the DKG trace the origin of the issues in relation to cultural misunderstanding and pervasive racism. The disparity of state strength between the two countries resulted in the subaltern position of Korean female healthcare workers in the global labor market, and they tried to bring forth the best possible outcome while working in a foreign country in unfamiliar circumstances. However, the difficulties with female guest workers from Asia were generally credited to their inability to adhere to the German working style. This study contributes to the existing scholarship on this topic by filling the gaps. Historical research on the medical migration of Korean nurses and nurse-aides to West Germany has relied on limited historical sources. In 2013, the National Archives of Korea transferred official documents regarding these workers that were produced and archived by the DKG, which represented the interests of German healthcare institutions. Its documents on Korean nursing personnel provide supplementary information and display findings in different perspectives. They do not bring forth completely new findings that have never been researched before but are still valuable for delivering concrete evidence on the circumstances of that time, which were previously merely inferred.

The impact after 50 years of a new medical education programme with a regional workforce mission.

BACKGROUND: Tasmania established its medical programme in 1965 to produce graduates to address medical workforce recruitment challenges. Many Tasmanian graduates work in Tasmania, but workforce problems continue. This paper reports the workforce outcomes of the first 42 graduating cohorts. METHODS: A database for all University of Tasmania medical graduates from the years 1970 to 2011 was developed by combining information from university, registration and local workforce survey databases. RESULTS: A total of 2012 doctors graduated from 1971 to 2011 and 1707 (85%) were registered, most commonly in general practice (45.8%), medicine (13%), anaesthetics (7.9%), surgery (7.5%), psychiatry (4.3%), emergency medicine (35, 3.5%), paediatrics (3.4%) and pathology (3.3%). While 41.9% worked in Tasmania, they comprised 35.6% of the local workforce and were clustered around the two larger cities. The proportion entering general practice has fallen since 1980s. DISCUSSION: The contribution of the Tasmanian medical programme is substantial but appears less than other regional medical schools. Relatively few work in smaller communities, particularly in specialties other than general practice. Lifestyle choices and the availability of training opportunities and career positions might be contributing factors. The medical school has established clinical schools in rural communities, promoted admission of rural applicants and increased rural clinical placement opportunities, with some early signs of success. CONCLUSION: The Tasmanian medical programme is important in this regional, island economy, but the rural and remote communities have not benefited as much as the two larger cities. Sustaining a regional workforce mission over time might require frequent adjustments to admissions and curriculum processes.

[Medical support of the 65th Army during the East Prussian offensive operation performed by the 2nd Belorussian Front].

Prussian offensive operation performed by the 2nd Belorussian Front. An activity of the medical An activity of the medical service of the 65th Army during the East Prussian offensive operation performed by the 2nd Belorussian Front is a typical example of the medical support of troops during the final stages of World War II. Forms and methods of medical support management, which were developed during the war, haven't lost their importance in modern conditions. These methods include the establishment of specialized surgical and therapeutic field hospital, establishment of medical institutions in the Army, which worked on the evacuation directions and reserve of mobile hospitals and transport, timely extension of the first echelons of the hospital base front to change institutions hospital deployed the army base. A research of experience in organizing medical support of the offensive operations performed during the last year of World War II provides the material for the development of the theory of modern medical support operations and ability to provide on this basis, the continuity of the hospitals, the continuity of qualified and specialized medical care, improve the performance of diagnostic and treatment work.

[Public health services and healthcare workforce in Bakar of the 18th and 19th century]. / Javnozdravstvena sluzba i zdravstveni djelatnici u Bakru tijekom XVIII. i XIX. stoljeca.

This review article draws on scarce and poorly studied archival information and several published articles to describe the development and organisation of public health services in the town of Bakar over the 18th and 19th century. For a short while at the turn of the 19th century, Bakar established a hospital run by two physicians and one surgeon to treat patients affected by the so called Skrljevo disease, an endemic type of syphilis. As the century went on, the number of healthcare providers increased by two more physicians, four surgeons, and three to six licensed midwives. There was also a town pharmacy, that worked all that time. As a busy port, the town also provided well-organised maritime sanitary services. As its economy changed over the two centuries to come to a halt after an initial boom, which resulted in a severe drop in population from 7600 to 2000 people, public services deteriorated, including public health. Maritime services suffered the hardest blow, while the workforce gradually came down to one or two physicians and surgeons and several midwives.

[The becoming of public medicine in the second half of XVIII-first half of XIX centuries. Report II. The development of public systems of training of medical manpower and charity provision to socially unprotected groups of population].

The present report considers the history of becoming of concept of medical police in second half of XVIII century. This concept became one of the most important instruments of public management in Austria, France, Prussia and Russia. Two directions of activity of public authorities in the area of implementation of medical police are discussed i.e. control of frauds and development of public systems of training of medical manpower and charity provision to socially unprotected groups of population. The historiographical data is presented concerning the development of public systems of training of medical manpower, reform of university medical education, implementation of hospital reform.

Status of the anesthesia workforce in 2011: evolution during the last decade and future outlook.

The purpose of this review is to present a comprehensive assessment of the anesthesia workforce during the past decade and attempt forecasting the future based on present knowledge. The supply of anesthesiologists has gradually recovered from a deficit in the mid to late 1990 s. Current entry rates into our specialty are the highest in more than a decade, but are still below the level they were in 1993. These factors along with slower surgical growth and less capital available for expanding anesthetizing locations have resulted in greater availability of anesthesiologists in the labor market. Despite these recent events, the intermediate-term outlook of a rapidly aging population and greater access of previously uninsured patients portends the need to accommodate increasing medical and surgical procedures requiring anesthesia, barring disruptive industry innovations. Late in the decade, nationwide surveys found shortages of anesthesiologists and certified registered nurse anesthetists to persist. In response to increasing training program output with stagnant surgical growth, compensation increases for these allied health professionals have moderated in the present. Future projections anticipate increased personnel availability and, possibly, less compensation for this group. It is important to understand that many of the factors constraining current demand for anesthesia personnel are temporary. Anesthesiologist supply constrained by small graduation growth combined with generation- and gender-based decrements in workforce contribution is unlikely to keep pace with the substantial population and public policy-generated growth in demand for service, even in the face of productivity improvements and innovation.

Historical development of health professions' education in the Arab world.

This paper reviews the historical development of health professions' education in the Arab countries and highlights the role that the World Health Organization has played in the support of the health workforce. Challenges such as the migration of health professionals, the need for additional educational opportunities in public health and in the management of health services and the need to adapt education to address the needs of society are discussed. Efforts are needed to develop further the quality and relevance of education and to address the needs of the health systems and the welfare of communities. The production of research in cooperation with policy-makers to enhance decisions and policies based on evidence needs increased attention.

The emergence of physiotherapy in Germany from the mid-19th to the mid-20th centuries: A "female profession" concerned with movement in the health care arena.

Background: The history of physiotherapy in Germany dates back to the mid-nineteenth century, when German physicians discovered Swedish medical gymnastics as a therapeutic treatment modality. From the early 20th century onwards, physiotherapy slowly began to establish itself as a field of activity specifically for women of the middle classes who provided assistive services to medical doctors.Method: Extensive overview of published and unpublished research on the history of German physiotherapy as well as select primary sources from the 19th and 20th centuries. Additionally reference is made to historical research regarding the emergence of the physical culture and life reform movements, as well as on gender research regarding upper and middle class female employment opportunities in the social and health care sector. Findings: This study outlines the two leitmotifs of physiotherapy's incorporation into the medical sector (i.e. medicalisation) and its (self-)image as a "female profession" (i.e. feminisation) as two intertwined historical phenomena shaping the critical period when physiotherapy assumed its role as a health profession in Germany. These developments from the mid-19th to the mid-20th centuries resulted in the emergence of a "female profession" with a distinct focus on the role of movement as a treatment modality.Discussion: Critical engagement with a handed down professional self-image is needed. On the basis of my historiographical overview, I suggest a future research agenda which would result in a more appropriate understanding of early physiotherapists in Germany as historical agents.

The health and health system of South Africa: historical roots of current public health challenges.

The roots of a dysfunctional health system and the collision of the epidemics of communicable and non-communicable diseases in South Africa can be found in policies from periods of the country's history, from colonial subjugation, apartheid dispossession, to the post-apartheid period. Racial and gender discrimination, the migrant labour system, the destruction of family life, vast income inequalities, and extreme violence have all formed part of South Africa's troubled past, and all have inexorably affected health and health services. In 1994, when apartheid ended, the health system faced massive challenges, many of which still persist. Macroeconomic policies, fostering growth rather than redistribution, contributed to the persistence of economic disparities between races despite a large expansion in social grants. The public health system has been transformed into an integrated, comprehensive national service, but failures in leadership and stewardship and weak management have led to inadequate implementation of what are often good policies. Pivotal facets of primary health care are not in place and there is a substantial human resources crisis facing the health sector. The HIV epidemic has contributed to and accelerated these challenges. All of these factors need to be addressed by the new government if health is to be improved and the Millennium Development Goals achieved in South Africa.

The perils of not knowing the history of the nurse practitioner role.

Historians tell us there are perils to not knowing history and that studying history allows us to understand our past as well as our present. The how and why of our nurse practitioner (NP) role today lies in our history. The NP role was created in the 1960s by Dr. Loretta Ford and Dr. Henry Silver in Colorado out of need to increase patients' access to pediatric care. Today, Dr. Ford believes NPs providing high-quality primary care can solve what ails the country: access to care. To better understand how the NP role developed, what pushback was met from health care professionals and patients that hindered practice and how this was resolved, how NP practice has changed, and pearls of wisdom for contemporary NPs were questions asked of six pioneer NPs (female, n = 5; male, n = 1). Their collated responses illuminate myriad ways the role was established and how each one overcame restrictions and barriers to practice. These pioneer NP participants highlighted ways NP practice has changed since those early days. They imparted a variety of pearls of wisdom that can guide contemporary NPs to address scope of practice barriers and overcome patient's and other health professionals' objections to NP practice. Loretta Ford cautions us to remember the most important word in NP is "Nurse" and we need to be mindful of our professional roots. Many of these pioneer respondents noted the importance of collective voices when dealing with professional and practice issues; they urge all NPs to join and be active in professional organizations that are invested in promoting and protecting the NP role.

Development of medical education in Nepal.

The first institution for training health workers started 75 years ago. Further development of teaching/learning institutions, mainly governmental started from the middle of the 20th Century. It was however with the setting up of the Institute of Medicine (IoM) under TU that training programmes for different grades of health manpower were started. The last two decades has seen an explosion of institutions involved in the training of health personnel. This is possibly because of the huge demand of human resources of health (HRH) not only in Nepal, but worldwide. Various grades of HRH are going out of the country and seeking their livelihood elsewhere.

International medical graduates: lessons from the past and hopes for the future.

The high levels of unemployment among international medical graduates (IMGs) in the UK and the skewed career structure of the NHS may stem from the 1930 withdrawal of General Medical Council recognition for Indian degrees forcing Indian colleges to align more closely with Western medical practices. From 2001 emigration to the UK surged just when UK medical schools were increasing their output. The result was severe unemployment among IMGs. The visa restrictions put in place to correct this make it difficult for IMGs to come to the UK even for short periods of experience. However, the Medical Training Initiative visa category offers an alternative and allows them the opportunity to gain up to two years' UK experience. The NHS has been in debt to IMGs and the countries that trained them since its inception. We must look for new ways to maintain international links and for the NHS to play a positive role in the global health economy.

The ties that bind: what's in a title?

BACKGROUND: Many Australian and New Zealand surgeons use the title 'Mister' rather than 'Doctor', a practice dating back to traditions established over 600 years ago. The Royal Australasian College of Surgeons is currently undergoing a period of critical self-reflection, embodied by its 'Respect' campaign. Active measures to embrace diversity and encourage women into surgery are underway. METHODS: This paper reviews the historical basis to the use of gendered titles and their current use amongst fellows. De-identified demographic data from the college register of active fellows was searched by self-identified title, country or state, and gender. Data were further reviewed by surgical sub-specialty and year of fellowship. RESULTS: The college dataset suggests that there is significant variance in the preference for gendered titles, determined predominantly by geography rather than specialty. The highest use of gendered titles (by male and female surgeons) was in Victoria/Tasmania (58% male, 22% female) and New Zealand (81% male, 17% female). By contrast, only 2% of female surgeons in other states elected a gendered title (Miss/Mrs/Ms). CONCLUSION: Surgery is the only profession that continues to use gendered titles. As the College of Surgeons moves towards greater equity and diversity, consideration should be given to phasing out the use of gendered titles, which serve to divide rather than unite our profession.

[Legal regulation of participation of medical personnel in the international peacemaking action: genesis and trends of the development].

The article is devoted to the question on legal regulation of participation of medical personnel in an international peacemaking action.

Surgery: no profession for a lady.

There are currently over 700 active female Fellows of the Royal Australasian College of Surgeons, accounting for just less than 10% of the surgical workforce. The first female Fellow of the College was Lillian Violet Cooper, of Queensland, who was admitted to Fellowship on 17 June 1927. Over the following half century, 32 women obtained Fellowships, initially awarded on the basis of experience and clinical practice and then, from 1947, by passing the Fellowship examination. This paper will examine the contribution of some of these early pioneer women, not just as surgeons, but as role models, advocates of women in professional life and champions of equality.