‘Setting learning goals’ seems to be one of the most important tasks of a trainee in International Health and Tropical Medicine. Ever since I started my education in this field, I have spent quite some time formulating and re-formulating the skills that in my opinion are valuable for working as a doctor in a low-resource setting – and I spent even more time looking for ways to master these skills in the wealthy Dutch health care system.

But as I am finding out along the way, the variety of skills that a doctor in International Health and Tropical Medicine must be competent in is enormous. For example, we are trained in planetary health, cultural sensitivity, refugee care, infectious diseases, and of course surgery, paediatrics, gynaecology, obstetrics, and so forth. Spending sufficient time and energy on all these topics can be a challenge for ‘jack of all trades’ doctors like me.

And in the meantime, clinical work continues – my regular job of patient care goes on. But especially during these busy days of clinical work, in which it sometimes feels like all my attention has drifted away from my learning goals, I learn the most – just from talking to my patients.

I discovered this a while ago when I was taking care of a Ukrainian refugee with unspecific neurological complaints and bilateral papillary oedema. He was put through a lot of diagnostic tests without any results – we simply could not find the cause of his problem. He was diagnosed with functional neurological disorder (FND), to which probably a lot of stress factors have contributed. He fled his homeland with his mum, leaving the rest of his family behind. The two now live in their second shelter in the Netherlands, after their first Dutch landlord put them out on the street.

He told me this in fluent Dutch, which he learned at a regular primary school where he will enter the final grade next year. Not just his language skills but above all his adaptability impressed me a lot, and I am sure that these capacities will enable him to combat his FND perfectly. By showing me his skills and telling me his story he taught me the following: I don’t always have to find the path to my learning goals myself – reality can already be a high road towards them.

Judith Polak is NVTG member, AOIS AIGT and currently working as a Resident Tropical Medicine at Rijnstate Hospital in Arnhem.

Global Health work excites me but also perplexes me often. When am I truly doing good? Am I not unintentionally hindering local efforts? Or neglecting long-term consequences? Or am I mostly feeding my latent saviour complex?

And it gets worse… is my ‘doing good’, good enough?

Recently, I have been reading books on effective altruism, such as ‘Doing Good Better’ by William Macaskill. Great read – I would highly recommend it. However, it spiralled me deeper into the ‘Dunning-Kruger valley of despair’.

Effective altruism is a philosophy that aims to maximise the impact of helping others. Some advocate for strategies such as ‘earning to give’. This means I should stop gallivanting, work as much as possible in a high-paying consultancy job (or something similar) and donate a proportion of my salary to the most effective charities. It was humbling to read, and frankly a bit depressing.

But it did make me question what is truly effective. Effective altruists argue that I should put my efforts into solving an issue that is big in scale, solvable and neglected. For most of my training, however, I primarily focus on technical skills as they might prove useful during clinical practice in low-resource settings. But when I consider impactful and QALY-effective interventions, I should perhaps focus my time on how to deworm as many children as I can, rather than how to perform a hysterectomy or a complex caesarean.

Granted, the heart wants what the heart wants. And most of us are clinicians, not public health workers. Still, I cannot help but wonder: are we, young global health professionals, prioritising effectiveness enough over what sounds and feels impressive? Perhaps a modern global health professional, with an honest intention of having a positive impact, should strive to be a bit more utilitarian? Doctors of low-hanging fruit! Too bad I am too late for the suggestion round for the renaming of NVTG.

Soon the Core Course in Public Health and Health Equity (CCPH-HE, formerly NTC) will start as a part of my training. Again, it is a fancy new name, which brings me excitement as perhaps someone will provide me with answers. Hopefully, I will soon find my big, solvable, and neglected issue.

Tip: via this website, it is possible to request a free book on this topic.

Sjoerd Verschoor is an NVTG member and currently working as resident Global Health & Tropical Medicine at IJselland Ziekenhuis in Capelle aan den IJssel.