In Conversation with Clare

Dr Clare Leong is an Infectious Diseases Registrar in Cambridge, and a key member of the new Harare – Cambridge partnership.

Here she talks to us about her global health experiences, and involvement in the CGHP Zimbabwe partnership.

About Clare

Dr Clare Leong qualified as a doctor in 2014. After completing her foundation training in London, she took a year out of training to pursue her interest in global health, completing the Diploma in Tropical Medicine & Hygiene and spending 9 months volunteering in a small hospital in Zanzibar. She now works as an infectious diseases registrar in Cambridge, has returned to Tanzania as a faculty member on the East African Diploma of Tropical Medicine, and has been instrumental in developing a new Infectious Diseases partnership between clinicians in Cambridge and Harare. Alongside her clinical work, she is a Leadership Fellow in Foundation Education with Healthcare Education East of England, and is currently leading on the development of global health education and opportunities for foundation doctors in the region.

How did you first get involved in global health, and how has this influenced your career?

In 2005, I got involved in a campaign called ‘Make Poverty History’, which was my first experience of proactively engaging with global issues. This quickly sparked my interest in global health and the wider social aspect of medicine. I have been subsequently fortunate enough to spend time working in health services in Ghana, Tanzania and Zanzibar. Each time, I left the UK full of anticipation about the potential impact I could have, and each time returned home with improved knowledge and skills and clearer insight, acknowledging that the benefit for my own development had been much greater that what I was able to offer overseas health systems.

What are the key things you have learnt while working in global health?

In Zanzibar, I learnt a lot about the importance of recognising my limitations. Our hospital was small and often understaffed, making it hard to leave after my shifts as I was never sure that there would be enough clinicians to manage overnight. I remember very clearly an emergency diabetic patient who, in the UK would have been in intensive care with close monitoring. In our hospital, there was only one nurse caring for all the patients overnight. My colleagues and I wrote a detailed care plan for the patient and left the hospital feeling nervous, not knowing what level of care would be possible during the night. The next morning when we came in, the nurse had done a fantastic job, meticulously following the plan to the letter, and the patient was well enough to be discharged and go home. This was a case where, despite minimal resources, the patient had a really good outcome.

On the other hand, I found that there were sometimes very different attitudes to urgent cases. One morning there was a baby who had deteriorated overnight in the hospital. My colleagues and I spent the morning resuscitating the baby (particularly delighting in the moment when she proved that her kidneys were working by urinating all down my colleague’s scrubs), and finally managed to get her stable enough to be transferred in an ambulance to the local referral hospital. It was the first time in my career where I had led on a resuscitation and actually saved someone’s life. Very sadly, I heard a week later that she had died in the referral hospital. I found it very difficult to confront the knowledge that, had she been born in the UK, she would probably have survived.

What has been your experience of working with Cambridge Global Health Partnerships?

I have known about CGHP since they sponsored my elective in my 5th year of medical school with their medical elective grant scheme. It has been brilliant to come back to Cambridge as a specialist trainee, and to get involved with activities that CGHP support. CGHP is doing so much to support true partnership working, ensuring that the skills and knowledge gained are bi-directional, and fostering attitudes of mutual respect and support.

Currently, I am involved in a project between the University of Zimbabwe in Harare and the infectious diseases department at Cambridge University Hospitals. Since the beginning of the pandemic, the way that the partnerships have worked has obviously been very different. The move to online working has given us an opportunity to think about whether we need to travel as much as we did previously – a timely realisation as we consider the health of the planet, as well as its people. There is so much that we can do with technology – one example has been the regular conference call discussions between Addenbrooke’s and hospitals in Kenya and Uganda, discussing the management of complex COVID-19 cases, with benefits and learning on all sides. We have set up monthly Zoom calls with a team in Zimbabwe, in which the infectious diseases team in Cambridge and the general medical team in Harare each present a case for discussion and to illustrate particular learning points. We have gained a wealth of knowledge hearing about tropical medical conditions which we might only see once per career in the UK, but which the team in Zimbabwe see regularly. We are gaining a great deal from their wealth of experience, and the Zimbabwe team assure us that they find our cases and discussion equally beneficial. At the most basic level, it is an opportunity to learn and share experiences and to gain cross-cultural appreciation and learning.

In the longer term, we hope to set up an exchange programme and to support the team in Harare with redeveloping their infectious diseases diploma, which has a fantastic potential as an educational resource and means of accreditation for infectious diseases specialists internationally.

It has been great to feel that we are really progressing with our global health activities despite the challenges of COVID-19 and related travel restrictions – a testament to the possibilities provided by working in partnerships. We look forward to further developing our partnership, learning from each other, and improving outcomes for patients both in Zimbabwe and here in Cambridge.

CGHP is running an Urgent Appeal in order to fund partnerships such as this. Please consider donating today.