15 minutes with . . .
A pioneer in travel medicine
Authors: Samira Jane Green
Publication date: 13 Jul 2011
Samira Jane Green speaks to Ted Lankester, the co-founder of the charity InterHealth
Name: Ted Lankester
Position: GP and expert in travel medicine and global health
Biography: Ted Lankester trained and worked as a GP. In the 1980s he worked in the Himalayas, setting up health programmes in mountain villages and refugee camps. As well as practising at InterHealth, which he cofounded in 1989, he co-leads the Community Health Global Network (CHGN), is a regular speaker at international conferences on travel medicine and global health, and does consultancy work. He is a foundation fellow of the faculty of travel medicine at the Royal College of Physicians and Surgeons of Glasgow.
Tell me about the work you have done abroad
After being a house officer, I was offered the opportunity to travel overland across Asia and drive a Land Rover and bring medical equipment to a mission hospital in Nepal. It was an amazing four week trip with many adventures. I stayed on, working in a remote Himalayan village among several hundred world travellers and hippies, many of whom were seriously ill, malnourished, and abusing drugs but who were also very suspicious of orthodox medicine. I had recently got married, and before the end of the year we got ill, lost three stone [20 kg], and ended up in the Hospital for Tropical Diseases. For all of that, it was a fantastic year.
And what happened next?
After a stint at theological college—I wondered if I should become a vicar, but it was not for me—I spent seven contented years as a GP in Twickenham. Then we decided to head back to the Himalayas to work in community health. As on previous occasions most people thought us crazy—this time taking a wife and three children under 5 to a remote village in the mountains. The first night there, we caught 48 rats in the house we were staying in. Most days there was no electricity or running water. I worked with inspirational Indian colleagues on ways in which remote mountain villages could become more “self sufficient” in health by training community health workers and setting up local community groups. We stayed there for seven years.
What is InterHealth and how did it start?
When we came back from India, I was asked to take over a small outfit called the Missionaries and Volunteers Health Service in east London. At that time travel medicine was just evolving as a specialty, and we were enthused by this emerging and exciting area of medicine. Our initial team of three provided healthcare for those working long term overseas, as volunteers, missionaries, or aid workers. This enterprise became InterHealth, and after nearly 20 years we have a staff of nearly 60, look after almost 300 organisations, including many of the well known NGOs [non-governmental organisations], and provide travel medicine, psychological care, occupational health, and a travel clinic in the context of a relaxed, user friendly, and holistic model.
What kind of pathology do you see at InterHealth?
There are always exciting cases. Although a lot of our work is a particularly interesting form of general practice, we get handed roundworms in bottles, answer endless questions about rabies, see cases of leishmaniasis, loa loa, schistosomiasis, dengue, Chikingunya fever, malaria of course, and a variety of weird and wonderful skin problems.
What is the biggest challenge for health workers overseas?
Stress and work pressure are probably the biggest problems. This is often caused as much by poor team dynamics and faulty management as by the difficult and dangerous places where our patients work . . . Stress weakens people’s immune system so they are more susceptible to malaria, diarrhoea, and other infectious illnesses.
How do you think travel medicine and global health interact?
Most of our clients are involved in healthcare, or relief and development, both long term and in emergency situations. For us to better understand the issues our patients face, we need to be involved in global health ourselves. Travel medicine, with its emphasis on epidemiology, management of infectious disease, and the migration of people from one country to another, indicates that the health of outsiders working in a community and that of the community itself are closely interlinked. Travel medicine therefore needs to be seen as a distinct and yet integrated part of international health.
What is CHGN?
Community Health Global Network came out of an idea I had when working in the Himalayas. I was aware that in any given area there were many small, struggling health programmes, mostly funded by outsiders, each doing their own thing . . . They were often not linked with other charities or local government services and usually unaware that 10 miles down the track another group was doing almost exactly the same thing for the population they were serving. In areas of great need there was overlap, competition, and ineffective coordination of NGOs and other healthcare organisations . . . There was a need for coordination, resource sharing, and mutual encouragement. And that’s what CHGN is about: linking organisations working in the same area, establishing trust, encouragement, and learning and working together on joint projects . . . We now have clusters in India, Bangladesh, and Kenya as well as a website where people from all countries can gain information and find a means of relating to others involved in community based healthcare.
What advice would you give to medical students with an interest in global health?
We all need to continually ask ourselves, what is my interest or passion—and how can that best be fulfilled rather than be allowed to die or atrophy? You might have two options: staying in the “sausage machine,” but making sure that from time to time you make creative leaps to use your gifts and reinvigorate or rediscover your dreams; or, for some, taking a calculated risk and following that interest or dream, even if family, friends, and medical colleagues think you’re crazy. Many of us in the global health arena took this route, and few of us have been disappointed.
Personal view, BMJ 1984;288:1452, doi:10.1136/bmj.288.6428.1452.
Competing interests: None declared.
From Student BMJ.
Samira Jane Green third year medical student
Barts and the London