Editorial

A Welcome Addition

Bienvenida a una nueva revista

It is an honour to be given an inaugural editorial in an inaugural issue. The introduction of a medical education journal to represent the issues of medical schools in Latin America fills an important void, for both faculty and medical students.

As a frequent visitor to several countries in Latin America - Mexico, Guatemala, Brazil, and Peru, I have acquired a profound respect and admiration for the culture and people of these countries. To a North American or European, Latin America has about the most interesting and varied destinations on the globe, whether one's interest is natural beauty, history, culture, or modern attractions like fine dining and entertainment. The only challenge is to avoid the beaches that act as a magnet to North American tourists in the winter season.

It is all too easy to think of the countries of Latin America as "developing world" - whatever that means. Of course on economic indicators, their per capita income lags far behind those of the United States or the United Kingdom. But this does not imply that they lack sophistication in areas such as health care delivery. On my last trip to Mexico City, I was shown the new CT-PET facility at UNAM Faculty of Medicine. As a former physicist, this was like going into a candy shop. In one room were the co-annular CT and PET scanners, and right next door, the cyclotron where short half-life radioisotopes were produced. I was describing this facility to the Chair of Radiology on my return and, while he knew such facilities existed, he had never seen one and was certain that we have nothing similar in Canada. Last year, I saw the simulation lab at UNAM, where one "hospital" room contained six (count them - 6) METI simulators. We have none at McMaster; I do not think any Canadian school has one. So one wonders which country qualifies as "developing".

If Latin America is so "cutting edge" in some aspects of medical science and technology, why is it so under-represented in the scientific literature in general, and the medical education literature in particular? There are a number of reasons, I'm sure. One is simply the reimbursement system. Countries like Canada and most in Northern Europe have more socialized health care systems than many Latin American countries, which benefits both patients and doctors. Patients because all of them have equal access to care, and doctors, because they are fairly paid for their services within the public system and need not work two jobs (private and public) to maintain their standard of living. No doubt this is a sweeping generalization. Nevertheless, I think it is reasonable to presume that doctors in Latin America must work more hours in patient care than academic doctors in Europe or North America. Hence, less time is left for academic pursuits.

Another, and critical, issue is language. It is an English-speaking world in academe, particularly in medicine. English, not Esperanza, is the world's lingua franca.

This does not, I think, reflect any bias, overt or covert on the part of editors or publishers. After all, two of the largest medical publishers, Elsevier and Springer, are Dutch and German. It's just history, where the world's economic powerhouses post industrial revolution were the UK first, then the US. But it does make it even mo- re difficult for a Spanish-speaking academic to be successful in the "publish or perish" game. I sympathize; just the thought of the many hours I would have to put in to translate this brief essay into Spanish, brings home to me the magnitude of the problem. But people from non-English countries DO succeed; the most impressive example is the Netherlands. The University of Maastricht has the most publications in the 6 top English medical education journals - ahead of Harvard, Toronto, McMaster. Of course, nearly all Nederlanders are fluent in English from an early age, so the transition is easier (not easy, easier).

Hence, the appearance of a new journal is welcome. It permits Spanish-speaking academics an outlet for their efforts. It provides a venue for discussion of uniquely Latin American problems. And it should serve as an important source for communication with the rest of the community. I do not know what the future will bring, but it does seem to me that some forum, where the journal can bring cutting-edge ideas from the rest of the world to its unique audience, may be a valuable role served by the journal.

Mis mejores deseos. Buena suerte.

Su amigo,
Geoff Norman
McMaster University. Canada.

Correspondencia:
McMaster University.
Program for Educational Research and Development.
Room 3519, MDCL 1200 Main St. West Hamilton, ON L8N 3Z5.
Tel. 905-525-9140 ext. 23114.
Correo electrónico: norman@mcmaster.ca