Long-term benefits of short North–South exchange visits
Authors: Karilyn J Collins, Richard J Collins, John B Wood
Journal: The Lancet Global Health (2015)

International links between health facilities usually involve the transfer of skills or technology through South–North partnerships.1Parry EHO Percy DB Anaesthesia and hospital links: strengthening healthcare through South-North hospital partnerships.Anaesthesia. 2007; 62: 15-20Crossref PubMed Scopus (9) Google Scholar For 30 years, the Hereford–Muheza Link Society has arranged unusually short visits of 4–6 weeks each way between staff of the County Hospital in Hereford, UK, and St Augustine's Hospital in Muheza District, Tanzania. The visits' aims are to foster friendship, contacts, interest, curiosity, and some learning.2Wood JB Hills EA Hands across the Equator: the Hereford/Muheza Link.BMJ. 1988; 297: 604-607Crossref PubMed Scopus (5) Google Scholar, 3Wood JB Hills EA Keto FJ Hands across the Equator: the Hereford-Muheza link eight years on.BMJ. 1994; 308: 1029-1032Crossref PubMed Scopus (5) Google Scholar, 4Hills EA Collins RJ Bradley I Wood JB Hands across the Equator. The Hereford-Muheza Link.R Coll Phys London Comm. 2004; May/June: 20-22Google Scholar St Augustine's Hospital is the Designated District Hospital in Muheza District, northeastern Tanzania. It serves a rural population of about 280 000 with 260 beds and an annual budget of around £1·5 million. The County Hospital in Hereford, UK, serves a slightly smaller rural population of about 220 000, has 290 beds, and had an income in 2013 of more than £173 million. All health workers are eligible for visits, and those from Tanzania receive airline tickets, free accommodation, a subsistence allowance, and reimbursement of costs for visas and passports. More than 200 individuals have made the trip since the Link's inception in 1985. We did a survey of those who had returned at least 8 years previously to explore the visit's lasting influence. Visitors were sent a brief questionnaire including four open questions about effects on their careers, and five open questions about effects on life beyond work, including attitudes and friendships. 149 Link travellers were identified as having undertaken visits at least 8 years ago. 49 responded to the questionnaire—a reply rate of 33%. 26 responses were from visitors to Muheza and 23 were from those who had visited Hereford. In response to the question “Are you pleased that you went?”, 44 of 49 replied “Absolutely”. 46 of 49 responded positively to the question “Would you recommend a visit to others?”, and 27 of 49 said “Yes” to the question “Would you go again?” (the response to the latter was influenced by retirements and changed circumstances). Responses to the open questions by visitors from Muheza were highly varied, but several key themes emerged. The predominant replies referred to cultural differences between the two districts and hospitals. Many visitors to Hereford were impressed by timekeeping, team work, and hard work. Also repeatedly mentioned were better documentation, the importance of communication with patients, and the relief of symptoms. Influences were most commonly expressed as changes of vision rather than acquisition of particular skills or knowledge. Also identified were changes and improved services in Muheza following visits to Hereford, included the opening of an eye service in Muheza; the pioneering of local bacterial cultures; improved surgery; setting up an intensive treatment unit; the start of a central sterilising services department; and improved electronic services, including internet use. Personal stories included that of one visitor who returned later to the University of Worcester, obtained her BSc in Applied Professional Studies while writing two nursing books, and now directs the Muheza School of Nursing. Responses of visitors from Hereford to Muheza were also varied. Prominent themes included personal changes in values and attitudes, admiration at what can be achieved with very few resources and little money, appreciation of very warm welcomes at Muheza, a determination to reduce waste in the UK, and a strengthened regard for the UK's National Health Service. Notably, of the 26 who replied, seven had made their way back to Muheza at their own expense, most more than once. Seven had also arranged visits for spouses or children to experience Muheza, and six have subsequently worked elsewhere abroad. The value of short visits, the core function of the Hereford–Muheza Link, is hard to quantify. Yet most visits were beneficial, with long-term benefits extending to patients and the health services for which the visitors worked. Some participants described the visits as life-changing.5Collins KJ Collins RJ Wood JB Hands across the Equator: the Hereford-Muheza Link—evaluation after 30 years.http://www.wyevalley.nhs.uk/media/214555/Hands-Across-the-Equator-270415.pdfGoogle Scholar The Hereford–Muheza Link Society intends to continue to arrange short visits of health professionals between the two hospitals. We thank all those in both countries who provided the warm welcomes and generous hospitality which have made the Link possible, the hospitals for accommodation, Colin Wood for help with the questionnaires and advice, David Sudlow for much useful assistance, and to those who completed the questionnaires. We declare no competing interests.