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

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

From: "Sanjay Bedi"
To: "HIFA2015 - Healthcare Information For All by 2015"
Subject: [HIFA2015] Access to information for medical students (24) Low-cost medical books
Date: 6 Nov 2009 19:01:14 +0100

A lot of Medical books written by Indian authors especially can be ordered online at http://www.jaypeebrothers.com/ and they deliver anywhere in the world. Medical Books written by Indian authors are cheapest in the world and are second to none in content. They can solve the problem in Africa quite practically and legally.

Sanjay

HIFA2015 profile: Sanjay Bedi is a Professor at MM Institute of Medical Sciences, India. Professional interests: Pathology, Medical Education, Medical Informatics. drsanjaybedi AT gmail.com

posted 08 November 2009 by M Mathews  from email

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

----- Original Message -----

From: Sylvie Donna
To: HIFA2015 - Healthcare Information For All by 2015
Sent: Sunday, November 08, 2009 2:17 PM
Subject: [HIFA2015] Low-cost medical books (3) Books for midwives

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 09 November 2009 by stanfield.welcome from email

Paget Stanfield's suggestion is a good one as his always are but it does take time. Best wishes, Liz

Elizabeth S. Hillman
hillmane@iname.com

HIFA2015 profile: Elizabeth Hillman is a retired Professor of Paediatrics, Memorial University, Newfoundland, Canada. She has taught in several Canadian Universities and has worked in many countries overseas with her husband supporting innovative teaching of paediatrics/child health, most recently in Kenya and Uganda where she and her husband (Don Hillman, now deceased) spent several years at Universities promoting child health/community health teaching. The Hillmans took their five children aged 5 to 12 to Kenya where they attended Kenyan schools for 4 years. These experiences enriched all their lives. hillmane AT iname.com

----- 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 hillmane from email

Hello Sylvie,

I am trying very much to do exactly what you have intended, in bringing local content into medical teaching. It has been tough, the achievements in India are as a result of Government policies. However, I am trying to conduct a survey on textbooks liked by students in the sciences starting first with medics, maybe these may help in generating the needed impetus to start a coalition of local publishers. So far I haven't had much support.

Uchefe A.O.
President (2006-08)
African Medical Students Network
Nigeria
+2348054644975,+2348138024616

"SCIENTIA POTENTIA EST"

HIFA2015 profile: A O Uchefe is Acting President of the African Medical Students Network, Faculty of Basic Medical Science, Delta State University, Abraka, Nigeria. tuchefe AT yahoo.com

------------------------------------
From: stanfield.welcome stanfield.welcome AT talktalk.net
Subject: [HIFA2015] Low-cost medical books (4) Support for local authors
To: "HIFA2015 - Healthcare Information For All by 2015" HIFA2015@dgroups.org
Date: Monday, November 9, 2009, 6:04 AM

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

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

From: Sylvie Donna
To: HIFA2015 - Healthcare Information For All by 2015
Sent: Sunday, November 08, 2009 2:17 PM
Subject: [HIFA2015] Low-cost medical books (3) Books for midwives

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 22 March 2010 by tuchefe from email

Dear All,

I have been following this important discussion with a lot of interest. My observation as an experienced health information provider is that information providers have to balance their collections with relevant situational reference works. There would be a gap if we would be using certain reference works as the core texts without other supplementaries from other authors especially with local contents.

My experience is that it is always important to inform the clients (lecturers, clinical instructors and students) of other available authors including those in the developing countries. The selection of which work to use is however left to the clients. It is important that the information provider alert the clients on relevant reference works from which to choose as they give their information resource requests.

Publishers are usually very pleased if their publications are preferred from others. Some years ago, we got concerned on the high costs of the medical books that were available locally. We got all relevant publishers and local book distributors representing overseas publishers and invited them for an exhibition in our institution. The lecturers and students had the opportunity to talk face to face with the publishers or their representatives regarding the costs and the relevance of the contents to our local set up.

After much follow ups with the publishers' representatives, we all found ways of reducing the costs. This was specifically for our own students (whose population is quite large). There were conditions notwithstanding but the costs were students' pocket friendly. Our institution was also encouraged to take manuscripts to relevant publishers. Of course the work had to meet the standards. The essence here is to work closely with the publishers. We have to be close to each other, i.e. the publishers, librarians, lecturing staff, students and other health providers. It has so far proved worthwhile hence a balanced collection with relevant local contents.

We would appreciate having more authors who would specifically write for the developing countries.

Muthoni

HIFA2015 profile: Muthoni Gichohi works with Family Health Options Kenya and is the programme manager (Library and Information Services). Main interests: Administration, management and dissemination of multimedia health information to the medics, paramedics, patients, the aged, the disabled and other clients interested in health related information. mgichohi AT fhok.org

----- Original Message -----
From: tuchefe
To: HIFA2015 - Healthcare Information For All by 2015
Sent: Monday, March 22, 2010 3:44 PM
Subject: [HIFA2015] Support for local authors (5)

Hello Sylvie,

I am trying very much to do exactly what you have intended, in bringing local content into medical teaching. It has been tough, the achievements in India are as a result of Government policies. However, I am trying to conduct a survey on textbooks liked by students in the sciences starting first with medics, maybe these may help in generating the needed impetus to start a coalition of local publishers. So far I haven't had much support.

Uchefe A.O.
President (2006-08)
African Medical Students Network
Nigeria
+2348054644975,+2348138024616

"SCIENTIA POTENTIA EST"

HIFA2015 profile: A O Uchefe is Acting President of the African Medical Students Network, Faculty of Basic Medical Science, Delta State University, Abraka, Nigeria. tuchefe AT yahoo.com

posted 23 March 2010 by mgichohi from email