Dear All

The distribution issue could easily be resolved if publishers were to send PDF files for books to the relevant country. They could then be printed and distributed in the country where they were needed, perhaps with a licensing agreement to one printer-distributor in each country. This does, of course, already happen in many cases - for example when a publisher sells rights for a book (or other materials) to be translated for a particular market. I would guess, actually, that the reason these agreements are limited is because publishers need every bit of income they can get, and these licensing agreements disadvantage the original publisher. This is a problem simply because it is extremely difficult to make any profit when publishing. I realise that many members of the HIFA group will have difficulty believing this but I assure you, it’s true. It is also extremely difficult to make a living as a writer and payment in terms of one-off fees or royalties are much needed to compensate for the enormous investment of time involved in creating anything to be published. Perhaps the reason many publishers might be reluctant to participate in ‘free PDF distribution’ schemes is that they might feel that government money ought to be made available to fund distribution in any particular country. However, these arrangements do happen and I remember Cambridge University Press contacting me some years ago to ask if I would be prepared to accept very low or zero royalties for a book I wrote, so that a similar arrangement could be set up with India. (My answer was yes.) If publishers such as Elsevier, Churchill Livingstone, etc could be persuaded to set up similar agreements, there might be big cost advantages for poorer countries.

Having said all that, I remember talking to an Ethiopian midwife at the ICM (International Congress of Midwives) conference in Glasgow last year. She was just finishing a Master’s in Ethiopia and she told me that their main text book was Myles Textbook for Midwives. I have Myles (and Mayes) on my bookshelves, as well as many other books on midwifery and obstetrics, and I can understand why Myles and Mayes have become mainstays of midwifery courses... but I was horrified. Knowing a little bit about the situation in Ethiopia, I realised that perhaps 90% of the content would be either inappropriate or inapplicable in Ethiopia. The situation is different in terms of health, so the risk profile is very different in different situations - e.g. higher rates of anaemia mean that PPH is a bigger worry. Also, the lack of resources and problems with infrastructure generally mean that treatments recommended as ‘standard’ would not be able to be applied. I suspect that in Ethiopia the same is happening as I’ve observed elsewhere. Money is invested in ‘impressive-looking’ equipment, such as fetal monitors, which offer very little or zero benefit in most cases. Meanwhile, supplies of drugs which could make a dramatic difference in many common cases (e.g. magnesium sulphate to treat eclampsia, or uterotonics to treat PPH) are not usually available. Also, the cultural values are dramatically different and these different values would affect so much of the advice in Myles.

Anyway, my net conclusion is that midwives in Ethiopia need an altogether different textbook - one which will be really useful to them. At the risk of sounding politically incorrect, I would also dare to suggest that linguistically Myles - and similar books written for native speakers - might be inappropriate. During many years teaching working adults English, when my speciality was always advanced students of English, I noticed that subtleties in text would often get misinterpreted. Take, for example, the advice in Myles offered for hypertension: 'Women are advised to rest as much as possible and may be admitted to hospital to facilitate this; however, this has not been found to be cost-effective and can be disruptive to family life.' So would the non-native speaker of English conclude that bed rest is needed, either at home or at hospital or not? I would guess they would - and I’m sure many HIFA members know that this has been shown by Cochrane reviews to be unhelpful. Even if ‘bed rest’ isn’t interpreted from Myles difficult-to-interpret advice, would caregivers feel that women with hypertension need to ‘sit back and relax’? I would suggest they would. And then, as a result, there might be more posterior labours as a result. (A commonsense, rather than an RCT-based conclusion, based on a knowledge of physiology.) And what would the caregiver tell the woman if her husband has died of AIDS and she’s the sole breadwinner for the family? All in all, I think something more culturally appropriate could be written. Experts working in each country need to write or adapt books for their own countries. Of course, these would then be new books or new editions for very specific markets... and publishers would readily agree for PDFs to be available (for printing and distribution) in the locality where they are needed. In the case of a project, such as the one I envision, where ‘white people’ - perhaps inappropriately - write something for developing countries generally, so as to share knowledge, this would have to be done as a charity project. This is because it would be impossible for it to be profitable for any one publisher.

In summary, there seem to be three issues: 1) profit margins, or lack thereof, for publishers and writers, 2) distribution costs, and 3) appropriacy of distributing materials in specific countries.

That’s how I see it, anyway. I’m still learning about publishing (and will be for the rest of my life)... I very much hope I’m completely wrong on these issues.

Best regards

Sylvie

Sylvie Donna
Fresh Heart Publishing
PO Box 225
Chester le Street
DH3 9BQ
United Kingdom
Email: sylvie AT freshheartpublishing.co.uk
www.freshheartpublishing.co.uk
www.freshheartpublishing.com

HIFA2015 profile: Sylvie Donna is researching safety in maternity and newborn health with a view to producing a useful manual for countries where the infrastructure or financing of health services is not yet sufficiently well-developed to mean that full, effective expertise and care are available for all women, men and children. The manual will be produced in collaboration with various key figures in the field of midwifery and obstetrics, many of whom have already agreed to participate as contributors, readers, reviewers or editors. Any interested parties on the DGroups mailing list who would like to support this project in some way can contact Sylvie either by responding directly to this email or by clicking on ‘Contact us’ on the Fresh Heart website. Sylvie Donna is also the author of two other books on birth, one for pregnant women and another for midwives working in the UK. (Fresh Heart Publishing was set up in order to publish these and other health-related titles which focus on ‘new beginnings’. Other authors are currently being commissioned to write books in the near future and the first two of these - about sight impairment - are due to be published in a few weeks’ time.) Both of the initial books on birth are now almost sold out and new editions (with new titles) are now in preparation, along with an American edition. These and the more international project are non-profitmaking as yet and Sylvie is investigating the possibility of setting up a charity in order to develop this work further. (More information is provided on each project on an ongoing basis on the Fresh Heart website.) Sylvie’s aim is to collaborate with professionals working in the field of childbirth in order to help improve maternity and infant mortality and morbidity statistics worldwide, while also taking into account experiential factors associated with pregnancy and birth, so as to optimise the process of childbearing for everybody concerned. info@freshheartpublishing.co.uk

-------------------------------

From: "M Mathews " mathews AT doctor.com
To: "HIFA2015 - Healthcare...snip... 2015" HIFA2015@dgroups.org
Subject: [HIFA2015] Access to information for medical students (25) Low-cost medical books (2)


Dear Dr Sanjay,

It is not only the cost of textbooks that is the issue, it is the cost of transportation to resource limited settings, of course, no one doubts the contents of Indian textbooks.

We have to think of a methodology to get books across the globe and this is where HIFA members need to suggest some cheap, appropriate and sustainable process.

mathews

M Mathews is a doctor and professor at Southern Medical University, China. mathews AT doctor.com

posted 08 November 2009 by Sylvie Donna from email

Dear Dr Stanfield

Reading your note about African authors of medical books I thought of a good friend in Addis Dr Damte who has recently completed a manual on the diagnosis and management of pediatric kidney diseases in Africa.

Dr Damte trained in Israel in Pediatric Nephrology and is currently the only pediatric nephrologist in Ethiopia. He wrote the book with Prof Dani Landau our Pediatric Nephrologist.
Damte was hoping to publish to manual through AAU [*] but I do not know if this is making any progress.

It would be very nice if you could think of a way the manual could be published.

With best regards

Miki Karplus MD
Emeritus Professor of Pediatrics
Faculty of Health Sciences
Ben Gurion University

HIFA2015 profile: Miki Karplus is Professor of Pediatrics at the Medical School for International Health, Ben Gurion University, Beer Sheva, Israel. Since his retirement from the position as chief of Neonatology several years ago he has become involved in the promotion of newborn care in the developing world mainly in east Africa. He is interested in the training of nurses and doctors in district hospitals to provide effective resuscitation and level II neonatal care using affordable solutions/equipment such as warm rooms and Kangaroo Mother Care. karplus AT bgu.ac.il

[*Note from HIFA2015 moderator:
AAU = Association of African Universities
Thanks, Neil PW]

----- Original Message -----
From: stanfield.welcome
To: HIFA2015 - Healthcare Information For All by 2015
Sent: Monday, November 09, 2009 10:34 AM
Subject: [HIFA2015] Low-cost medical books (4) Support for local authors

Dear Sylvie,

It seems to me the answer to at least the second and third issues of your conclusions is to encourage and assist local authors to write textbooks such as has happened in India. A good few of the chapters in the last edition of Diseases of Children in the Subtropics and Tropics were written by authors from the developing world of whom there are many who have such a capacity and would address local problems appropriately.

Paget Stanfield.

HIFA2015 profile: Paget Stanfield is a retired paediatrician. He has many years experience in the developing world especially in Africa, including work with the Makerere University, Uganda, and with AMREF. He edits the publication, Diseases of Children in the Tropics. stanfield.welcome AT talktalk.net

posted 09 November 2009 by karplus from email

The problem of getting appropriate low-cost textbooks to low-income countries is one with which BookPower (a registered UK charity) is also concerned. We try to assist by subsidising the production of special editions of recognised titles which are either on reading lists in those countries or are recommended by academic advisers with experience of at least some of the countries included in the scheme (both provisos hopefully ensuring the books are appropriate to local situations). Our subsidies make viable the sale of books at otherwise uneconomic prices. Transport costs are not a problem to the end-purchaser as the books are sold via normal booktrade channels (i.e. discount granted to local booksellers allows them to sell the books at their BookPower cover price, which is typically between one fifth and one third of the cheapest UK standard edition and at least 10% lower than ISEs [*]. (For full details see www.Bookpower.org)

Several years ago I suggested to one of our participating publishers that instead of subsidising production we pay for reprint rights & send pdfs to approved publishers in participating countries. The main objection was lack of confidence that the reprint quantity specified in the licence would be adhered to in practice.

Another major problem we face, particularly with medical and veterinary medicine titles, is the unwillingness of the larger publishers who have acquired many of the major imprints (e.g. Elsevier owns Churchill Livingstone) to participate as they claim to provide their own low-priced editions.

If Sylvie Donna and Fresh Heart Publishing would be interested in co-operating with BookPower I should be happy to hear from them.

Valerie Teague
Chief Executive
BookPower

HIFA2015 profile: Valerie Teague is Chief Executive of BookPower, a UK-based charity which provides low-cost higher education textbooks to low-income countries, with a particular emphasis on medicine, nursing and health. www.BookPower.org BookPower AT mistral.co.uk

[*Note from HIFA2015 moderator:
ISEs = International Student Editions.
Thanks, Neil PW]

----------------------------

From: "Sylvie Donna" sylvie AT freshheartpublishing.co.uk
To: "HIFA2015 - Healthcare Information For All by 2015" <HIFA2015@dgroups.org>
Subject: [HIFA2015] Low-cost medical books (3) Books for midwives
Date: 8 Nov 2009 15:17:07 +0100

Dear All

The distribution issue could easily be resolved if publishers were to send PDF files for books to the relevant country. They could then be printed and distributed in the country where they were needed, perhaps with a licensing agreement to one printer-distributor in each country. This does, of course, already happen in many cases - for example when a publisher sells rights for a book (or other materials) to be translated for a particular market. I would guess, actually, that the reason these agreements are limited is because publishers need every bit of income they can get, and these licensing agreements disadvantage the original publisher. This is a problem simply because it is extremely difficult to make any profit when publishing. I realise that many members of the HIFA group will have difficulty believing this but I assure you, it's true. It is also extremely difficult to make a living as a writer and payment in terms of one-off fees or royalties are much needed to compensate for the enormous investment of time involved in creating anything to be published. Perhaps the reason many publishers might be reluctant to participate in 'free PDF distribution' schemes is that they might feel that government money ought to be made available to fund distribution in any particular country. However, these arrangements do happen and I remember Cambridge University Press contacting me some years ago to ask if I would be prepared to accept very low or zero royalties for a book I wrote, so that a similar arrangement could be set up with India. (My answer was yes.) If publishers such as Elsevier, Churchill Livingstone, etc could be persuaded to set up similar agreements, there might be big cost advantages for poorer countries.

Having said all that, I remember talking to an Ethiopian midwife at the ICM (International Congress of Midwives) conference in Glasgow last year. She was just finishing a Master's in Ethiopia and she told me that their main text book was Myles Textbook for Midwives. I have Myles (and Mayes) on my bookshelves, as well as many other books on midwifery and obstetrics, and I can understand why Myles and Mayes have become mainstays of midwifery courses... but I was horrified. Knowing a little bit about the situation in Ethiopia, I realised that perhaps 90% of the content would be either inappropriate or inapplicable in Ethiopia. The situation is different in terms of health, so the risk profile is very different in different situations - e.g. higher rates of anaemia mean that PPH is a bigger worry. Also, the lack of resources and problems with infrastructure generally mean that treatments recommended as 'standard' would not be able to be applied. I suspect that in Ethiopia the same is happening as I've observed elsewhere. Money is invested in 'impressive-looking' equipment, such as fetal monitors, which offer very little or zero benefit in most cases. Meanwhile, supplies of drugs which could make a dramatic difference in many common cases (e.g. magnesium sulphate to treat eclampsia, or uterotonics to treat PPH) are not usually available. Also, the cultural values are dramatically different and these different values would affect so much of the advice in Myles.

Anyway, my net conclusion is that midwives in Ethiopia need an altogether different textbook - one which will be really useful to them. At the risk of sounding politically incorrect, I would also dare to suggest that linguistically Myles - and similar books written for native speakers - might be inappropriate. During many years teaching working adults English, when my speciality was always advanced students of English, I noticed that subtleties in text would often get misinterpreted. Take, for example, the advice in Myles offered for hypertension: 'Women are advised to rest as much as possible and may be admitted to hospital to facilitate this; however, this has not been found to be cost-effective and can be disruptive to family life.' So would the non-native speaker of English conclude that bed rest is needed, either at home or at hospital or not? I would guess they would - and I'm sure many HIFA members know that this has been shown by Cochrane reviews to be unhelpful. Even if 'bed rest' isn't interpreted from Myles difficult-to-interpret advice, would caregivers feel that women with hypertension need to 'sit back and relax'? I would suggest they would. And then, as a result, there might be more posterior labours as a result. (A commonsense, rather than an RCT-based conclusion, based on a knowledge of physiology.) And what would the caregiver tell the woman if her husband has died of AIDS and she's the sole breadwinner for the family? All in all, I think something more culturally appropriate could be written. Experts working in each country need to write or adapt books for their own countries. Of course, these would then be new books or new editions for very specific markets... and publishers would readily agree for PDFs to be available (for printing and distribution) in the locality where they are needed. In the case of a project, such as the one I envision, where 'white people' - perhaps inappropriately - write something for developing countries generally, so as to share knowledge, this would have to be done as a charity project. This is because it would be impossible for it to be profitable for any one publisher.

In summary, there seem to be three issues: 1) profit margins, or lack thereof, for publishers and writers, 2) distribution costs, and 3) appropriacy of distributing materials in specific countries.

That's how I see it, anyway. I'm still learning about publishing (and will be for the rest of my life)... I very much hope I'm completely wrong on these issues.

Best regards

Sylvie

Sylvie Donna
Fresh Heart Publishing
PO Box 225
Chester le Street
DH3 9BQ
United Kingdom
Email: sylvie AT freshheartpublishing.co.uk
www.freshheartpublishing.co.uk
www.freshheartpublishing.com

HIFA2015 profile: Sylvie Donna is researching safety in maternity and newborn health with a view to producing a useful manual for countries where the infrastructure or financing of health services is not yet sufficiently well-developed to mean that full, effective expertise and care are available for all women, men and children. The manual will be produced in collaboration with various key figures in the field of midwifery and obstetrics, many of whom have already agreed to participate as contributors, readers, reviewers or editors. Any interested parties on the DGroups mailing list who would like to support this project in some way can contact Sylvie either by responding directly to this email or by clicking on ‘Contact us’ on the Fresh Heart website. Sylvie Donna is also the author of two other books on birth, one for pregnant women and another for midwives working in the UK. (Fresh Heart Publishing was set up in order to publish these and other health-related titles which focus on ‘new beginnings’. Other authors are currently being commissioned to write books in the near future and the first two of these - about sight impairment - are due to be published in a few weeks’ time.) Both of the initial books on birth are now almost sold out and new editions (with new titles) are now in preparation, along with an American edition. These and the more international project are non-profitmaking as yet and Sylvie is investigating the possibility of setting up a charity in order to develop this work further. (More information is provided on each project on an ongoing basis on the Fresh Heart website.) Sylvie’s aim is to collaborate with professionals working in the field of childbirth in order to help improve maternity and infant mortality and morbidity statistics worldwide, while also taking into account experiential factors associated with pregnancy and birth, so as to optimise the process of childbearing for everybody concerned. info AT freshheartpublishing.co.uk

posted 10 November 2009 by BookPower from email