"Without racism there would be no geriatrics": South Asian overseas-trained doctors and the development of Geriatric Medicine in the United Kingdom', 1950-2000

The long history of medical migration to the united Kingdom is relatively well known. however, until recently the story of the contribu-tion of South Asian doctors to specific fields has been less discussed. in this chapter we address this gap by focusing on the contributions of migrant doctors to the geriatric specialty. We begin with a history of geriatrics in the united Kingdom and go on to outline our methodology before describing the process by which South asian doctors came to be working in geriatric medicine, what barriers they encountered, and how networks worked both for and against them, before conclud- ing with a consideration of how certain regional centres of excellence played a part in their professional development and careers as consult- ants in the specialty

The ‘Skills Drain’ of Health Professionals from the developing World:a Framework for Policy Formulation

This paper examines policy towards health professionals’ migration from economic and governance perspectives

Doing development and being Gurage : the embeddedness of development in Sebat Bet Gurage identities

This thesis aims to contribute towards an understanding of the relationship between ethnicity and development in Africa. I examine the complex relationship between ethnicity and communal action in the Gurage People's Self-help and Development and Organisation (GPSDO), a federation of ethnically based Development Associations in Ethiopia. I investigate the extent to which concepts such as participation and accountability, used by dominant development discourses to analyse the relationship between development agencies and their beneficiaries, are applicable to ethnically based indigenous development associations. These discourses are juxtaposed with the ways that the development associations, their stakeholders and beneficiaries conceptualise their relationships and the processes and purposes of development. In this thesis, I argue the trusteeship constructed between indigenous ethnically based development associations and their beneficiary communities is underpinned by indigenous perceptions of civic virtue, the rights and obligations inherent in notions of ethnic citizenship. Although concepts such as, participation and accountability are used in Gurage development discourses, their meanings are related to the values and practices embedded in Gurage notions of citizenship. I argue that to understand the relationship between indigenous ethnically based development associations and their beneficiaries, one must first analyse the complex web of rights and obligations that are embedded in their perceptions of what it means to be a good citizen. I argue that ethnicity can act as a resource to be harnessed for development purposes and that the contested values embedded in Gurage ethnic identities act as a point of reference in the construction of trusteeship between GPSDO and its beneficiaries. Furthermore, for Gurages, the processes of development are part of the formation of civic virtue and thus, central to the construction of their ethnic identities

”Without racism there would be no geriatrics’, in South Asian overseas-trained doctors and the development of geriatric medicine in the United Kingdom, 1950-2000”’

There has been a long history of migration of doctors from the colonies to the United Kingdom. Records of medical migration show that the practice of moving in order to study in the United Kingdom began at least in the 1840s and kept pace throughout the nineteenth and twentieth centuries, and South Asians accounted for a significant part of this migration. Those who taught medicine in India, Pakistan, Bangladesh, and Sri Lanka had often trained in the United Kingdom for some time. As a result, many doctors in South Asia felt that they were part of a community of medical practitioners for whom some markers of participation in the U.K. labour market were central to career progression. They had often been advised by their teachers to get training in the United Kingdom. Upgrading and validating skills through training at one of the U.K. royal colleges was therefore seen as crucial to being recognized as a good doctor and was embedded in South Asian doctors’ professional cultures. Organizations like the royal colleges implicitly shaped migration (and indeed directly benefit financially from it) through their ability to award internationally accredited professional qualifications that were prestigious across the Commonwealth. As a result, many doctors in South Asia were already in some way part of a professional community where migration to the United Kingdom was seen as part of career progression. The South Asian doctors were not alone, of course. The history of colonialism and postcolonialism meant that doctors from other parts of the British Empire and Commonwealth were similarly leaving home to gain qualifications in the United Kingdom’s medical system, though with different experiences and outcomes, as Armstrong’s research shows

Difference and distinction? Non-migrant and migrant networks

In recent years the role of social networks, and of social capital, in shaping migrants' lived experiences and particularly, their employment opportunity has increasingly come to be recognised. However, very little of this research has adopted a relational understanding of the migrant experience, taking the influence of non-migrants' own networks on migrants as an important factor in influencing their labour market outcomes. This paper critiques the alterity and marginality automatically ascribed to migrants that is implicit in existing ways of thinking about migrant networks. The paper draws on oral history interviews with geriatricians who played an important role in the establishment of the discipline during the second half of the twentieth century to explore the importance and power of non-migrant networks in influencing migrant labour market opportunities in the UK medical labour market

Networks as transnational agents of development

The term network has become a hallmark of the development industry. In principle networks have the potential to provide a more flexible and non-hierarchical means of exchange and interaction that is also more innovative, responsive and dynamic whilst overcoming spatial separation and providing scale economies. Although the label networks currently pervades discourses about the relationships between organisations in development, there has been surprisingly little research or theorisation of them. This article is a critical evaluation of the claims of developmental networks from a theoretical perspective. While networks are regarded as a counter hegemonic force we argue that networks are not static entities but must be seen as an ongoing and emergent process. Moreover theory overlooks power relationships within networks and is unable to conceptualise the relationship between power and values. These observations open up a research agenda that the authors are exploring empirically in forthcoming publications

Oral history voicing differences: South Asian doctors and migration narratives

Oral history's narration of its origins as a method lies in a commitment to challenge, reveal and give voice to those who are disempowered, misrepresented or simply missed out of official, documentary and dominant accounts of the past. People who are marginalised through discriminations based in race and ethnicity, reasons of class and status, gender, age or simply because they have moved location have been at the centre of oral history's achievements. The case of doctors from the Indian sub-continent who travelled to the UK during the twentieth century and who found employment in those parts of the National Health Service where UK graduate doctors were unwilling to work presents us an opportunity to give these assumptions a different twist. In this article we link the memories of a group of South Asian overseas doctors, working in an elite profession with a distinctly non elite group of patients (older, unwell and predominantly working class) to an earlier set of archived interviews with the founders of the geriatric specialty. Used separately and then together, our analysis of these two sets of interviews identifies muted voices, generates recognition and acknowledges ways of understanding and using the polyphony of difference. From this, we argue that the value of re-using archived oral history data lies in the possibility this brings for multiple interpretations of both old and new data and with this new ways of hearing and listening to voices in interviews

Can the outcome of pelvic-floor rehabilitation in patients with fecal incontinence be predicted?

Purpose: Pelvic-floor rehabilitation does not provide the same degree of relief in all fecal incontinent patients. We aimed at studying prospectively the ability of tests to predict the outcome of pelvic-floor rehabilitation in patients with fecal incontinence. Materials and methods: Two hundred fifty consecutive patients (228 women) underwent medical history and a standardized series of tests, including physical examination, anal manometry, pudendal nerve latency testing, anal sensitivity testing, rectal capacity measurement, defecography, endoanal sonography, and endoanal magnetic resonance imaging. Subsequently, patients were referred for pelvic-floor rehabilitation. Outcome of pelvic-floor rehabilitation was quantified by the Vaizey incontinence score. Linear regression analyses were used to identify candidate predictors and to construct a multivariable prediction model for the posttreatment Vaizey score. Results: After pelvic-floor rehabilitation, the mean baseline Vaizey score (18, SD±3) was reduced with 3.2 points (p<0.001). In addition to the baseline Vaizey score, three elements from medical history were significantly associated with the posttreatment Vaizey score (presence of passive incontinence, thin stool consistency, primary repair of a rupture after vaginal delivery at childbed) (R2, 0.18). Th

Country Concepts and the Rational Actor Trap: Limitations to Strategic Management of International NGOs

Growing criticism of inefficient development aid demanded new planning instruments of donors, including international NGOs (INGOs). A reorientation from isolated project-planning towards holistic country concepts and the increasing rationality of a result-orientated planning process were seen as answer. However, whether these country concepts - newly introduced by major INGOs too - have increased the efficiency of development cooperation is open to question. Firstly, there have been counteracting external factors, like the globalization of the aid business, that demanded structural changes in the composition of INGO portfolios towards growing short-term humanitarian aid; this was hardly compatible with the requirements of medium-term country planning. Secondly, the underlying vision of rationality as a remedy for the major ills of development aid was in itself a fallacy. A major change in the methodology of planning, closely connected with a shift of emphasis in the approach to development cooperation, away from project planning and service delivery, towards supporting the socio-cultural and political environment of the recipient communities, demands a reorientation of aid management: The most urgent change needed is by donors, away from the blinkers of result-orientated planning towards participative organizational cultures of learning.Des critiques croissantes de l'aide au développement inefficace exigent de nouveaux instruments de planification des bailleurs de fonds, y compris les ONG internationales (ONGI). Une réorientation de la planification des projets isolés vers des concepts holistiques de la planification de l’aide par pays ainsi que la rationalité croissante d'un processus de planification orientée vers les résultats ont été considérés comme réponse. Toutefois, si ces concepts de pays - nouvellement introduites par les grandes OING eux aussi - ont augmenté l'efficacité de la coopération au développement est ouvert à la question. Tout d'abord, il y a eu l’impact des facteurs externes, comme la mondialisation de l'entreprise de l'aide, qui a exigé des changements structurels dans la composition des portefeuilles des OING vers la croissance de l'aide humanitaire à court terme. Cela était difficilement compatible avec les exigences de l'aménagement du territoire à moyen terme. Deuxièmement, la vision sous-jacente de la rationalité accrue de la planification, concentré sur les resultats, comme un remède pour les grands maux de l'aide au développement était en soi une erreur. Un changement majeur dans la méthodologie de la planification, étroitement liée à un changement d'orientation dans l'approche de la coopération au développement, qui n’est pas concentrer sur planification du projet et la prestation de services, mais qui soutienne l'environnement socio-culturel et politique des communautés bénéficiaires, exige une réorientation de la gestion de l’aide: Le changement le plus urgent est un changement par les donateurs eux-mêmes, qui devrait implanter des cultures de collaboration étroit avec les partenaires et la population locale

A Spatial Distribution Study of Faunal Remains from Two Lower Magdalenian Occupation Levels in El Mirón Cave, Cantabria, Spain

Abstract: Human behaviour can be reconstructed by analysing specific activities and campsite organization using spatial analysis. The dense occupation layers of the Lower Cantabrian Magdalenian in the Northern Spain reveal varied aspects of Upper Palaeolithic lifeways, including evidence of specific localized activities. The outer vestibule of El Mirón cave has a particularly rich and intact Lower Magdalenian occupation horizon, Levels 15–17. The excavations in the outer vestibule “Cabin” area of the site revealed excellent bone preservation. Artefacts and faunal remains were individually recorded and sediments water-screened to yield a large sample of archaeological finds and spatial data. Zooarchaeological analysis provided the taxonomic, anatomic and taphonomic determination of the faunal individual finds. Smaller animal remains were categorized and counted; special attention was given to the identification of anthropogenic modifications such as burnt bones or bone flakes. These small refuse items are considered to be useful, in situ indicators of localized activities. The spatial distribution analysis of this dense and complex palimpsest of El Mirón Lower Cantabrian Magdalenian layers required GIS based methods including density analysis, heatmaps and cluster analysis. Based on the spatial distribution of Level 15 and 16 faunal remains, different activity areas were identified comprising hearth, working and dropping zones. These results imply the deliberately segregated use of space within the Lower Cantabrian Magdalenian site area, in which bone-processing activities played a central rol