LAUSR

Migration is rapidly becoming one of the defining issues of the 21st century. Its impact on health care delivery affects professionals and patients alike; worryingly as health inequalities increase. The global reaction is equally disconcerting. We hear demands to ‘close borders’; often under the misassumption that migrants drain rather than contribute to resources; totally dismissing any positive impact they offer to the workforce. It is timely to revisit Nigel Crisp’s book, now 10 year’s old, Turning the World Upside Down [1]. He argues so cogently against the distressing misconception that migration impacts negatively on society. Instead he champions the ‘upside down view’ stressing that we havemuch to learn from the developing world and the remarkable achievements made in these relatively resource poor societies. There is indeed much for us to learn in the Western World. This brought to mind Anne Fadiman’s book ‘The Spirit Catches You and You Fall Down’; [2]which had a great impact on me. ‘Our (Western) view of reality is only a view. Not reality itself.’ [2] The account of the journey of the American paediatricians struggling to care for a Hmong child and her parents and how the two cultures ‘collided’ was life changing both for me personally and my approach to practice. It is therefore timely to bring to our readers this issue’s reflective account from Ramsay et al on integrating Japanese and UK views of social accountability, a dialogue which arose from a joint workshop at the World Organisation of Family Doctors (WONCA) Asia Pacific conference in Kyoto last year. The article explores understanding ‘social accountability’ across healthcare with specific reference to Japanese and UK Primary Care. Different linguistic interpretation and contextualisation within the contrasting delivery structures impacted significantly. There was much shared learning. This article is exemplary in revealing how cross-country collaboration can support the integration of a topic such as social accountability into different healthcare and education systems. Similarly Alameddine et al report on a collaboration between relatively junior family physicians in the Middle East and the Irish Non-Government Organisation (NGO) IHEED. As the Middle East faces one of the biggest humanitarian crises of all times and strives to deal with Syrian refugees, these young family doctors offer us insight into how advocacy can enhance postgraduate training.We gain valuable understanding of how working with, and advocating for, these patients can have a major impact on trainees’ learning. Experiences from which we can learn and bring to our own training schemes. In contrast, Moore at al in Chile write looking to the West to support training their postgraduate teachers – an understandable request; although judging from their experiences one suspects we can learn from them too. The recent publication of the UK Marmot review on Health Equity in England [3] further strengthens my increasing opinion that medical education must embrace concepts such as social accountability, advocacy, social determinants of health, sustainability and globalisation. We face increasing evidence of the importance of learning in Primary Care at the ‘Deep End’ [4] and, as this journal continues to advocate, sharing our global experiences.