In London this November, during Gastro 2009, the joint meeting of the United European Gastroenterology Federation (UEGF), the World Gastroenterology Organization (WGO), the Organization Mondiale d’Endoscopie Digestive (OMED) and the British Society of Gastroenterology (BSG), the term of the current leadership of WGO, including my term as president, will come to an end. I take this opportunity both to reflect on what WGO has achieved in these past years and to identify the challenges that lie ahead.
WGO is, and derives its strength from being, an organization of organizations; its members are the national societies of gastroenterology and its activities are developed and enacted in collaboration with them.
WGO today is very different from the organization that it was 10
years ago. In the past, WGO (or OMGE as it was then known) was looked upon primarily as the organization that emerged every four years and participated in the organization of a World Congress; indeed, many came to regard WGO and the World Congress as synonymous and defined WGO exclusively in terms of this quadrennial event. Now, WGO, while still involved in a World Congress, is defined by its programs which run year round and have earned it a reputation as the global leader in gastroenterology. This shift in emphasis, made possible, in large part, by the financial success of past World Congresses, was driven by the recognition that WGO could play a vital role and one that would not conflict or compete with national societies or the ever more prominent regional societies. With regard to the latter, it has been a special pleasure for me to see the emergence and growth of the Africa Middle East Association of Gastroenterology (AMAGE) and the author acknowledges the efforts of all those in the Middle East and the Arab World who have contributed to its success.
Bearing all of the above factors in mind, WGO took stock of its position and developed objectives which are enshrined in its mission statement: to promote, to the general public and health care professionals alike, an awareness of the world wide prevalence and optimal care of digestive disorders through the provision of high quality, accessible and independent education and training. This signals the commitment of WGO to, firstly, provide the gastroenterologist of the future with an optimal training and, secondly, bring the benefits of digestive health care to those who currently struggle or, indeed, fail to achieve access to it. These objectives are achieved through distinctive, though closely inter-related, programs: Train-the-Trainers, Training Centers, Global Guidelines, the International Digestive Cancer Alliance (IDCA) and World Digestive Health Day.
Train-the-Trainers is uniquely devoted to bringing the very latest in educational techniques to those who will train the gastroenterologists of the future. Over the past several years, 12 programs have involved over 500 current and future leaders of our specialty in intensive, interactive workshops on modern educational methods. Such has been the success of this program that current and future leaders of our specialty from over 75 nations have attended to date and many more are signed up for future programs. Our Training Centres represent a direct collaboration between local experts, international faculty and several national and regional societies from Europe, Australia and North America to deliver regionally relevant training to those who have limited, or in some cases, no access to such opportunities [1], [2]. Within the Arab world, WGO has been proud to collaborate with our colleagues in the highly successful Rabat and Cairo centers. Our global guidelines are evidence based, prepared by international panels of experts and are unique in, firstly, addressing issues which afflict emerging nations, secondly, being available on our web site (www.worldgastroenterology.org) in translation into several of the world’s major languages and, finally, and most importantly, incorporating “cascades”, a range of options which accommodate the tremendous disparities in resources between various parts of the world [3], [4], [5]. IDCA seeks to promulgate information and education and promote research in digestive cancers; collectively, the most common cancers world wide, through educational programs, media events and support for local, or national, awareness campaigns and, especially, those devoted to the early detection of digestive cancer. IDCA has already spearheaded major statements on screening for colo-rectal and hepatocellular cancer. World Digestive Health Day (WDHD) was originally developed to mark the anniversary of the founding of WGO on May 29th 1958 and casts the spotlight, each year, on a disorder of the digestive system of global importance. Again representing a direct collaboration with national societies of gastroenterology, WDHD seeks to harness media attention, as well as traditional medical education approaches, towards events which increase public awareness of the prevention, diagnosis and appropriate therapy of common problems. Education is provided to the general public and healthcare workers alike and all are encouraged participate in activities which promote digestive health. Such has been the success of WDHD that an event which initially concentrated on one day now runs year long, generating print, radio and TV pieces in Europe, Asia, Africa and the Americas.
WGO has an ambition to develop a global network of high quality gastroenterology education and training based on an interlinked system of Training Centres; our challenge is to make the case for the long-term benefits to all of the success of this mission: to patients, society and all who seek to develop gastroenterology as a field of medical practice, therapeutic progress and device innovation.
This is a time of great challenge and opportunity in our specialty. Endoscopy, an investigational tool that is now indispensable to gastroenterology practice, has emerged from a largely forgotten era of rigid or semi-flexible instruments to a time when fully flexible video-endoscopes and capsule endoscopy have become the norm and the ability to access any part of the digestive tract expected. Meanwhile, the advent of the molecular era has provided the gastroenterologist with a completely new approach to diagnosis and therapy. Fifty years ago the idea that peptic ulcer disease, gastric cancer and gastric lymphoma might have an infectious cause would have been laughed at; now the discovery of Helicobacter pylori and its role in these disorders wins a Nobel Prize. Advances in immunosuppression, surgery and intensive care allow patients with end-stage liver disease to receive transplants and to expect to enjoy, not only long-term survival, but also an excellent quality of life, progress with that most challenging of organ transplantation procedures, small intestinal transplantation, continues.
These and other advances may ultimately re-define the boundaries of this specialty; others may diminish or augment the primacy of certain areas within it. WGO is committed to represent and promote all aspects of gastroenterology and remains convinced that most digestive health care will continue to be delivered by physicians with a broad training in gastroenterology. Fragmentation of the specialty is not in the best interests of global gastroenterology.
Major demographic trends, such as the aging of our populations and the growing obesity epidemic, will also impact significantly on the workload and work practices of the gastroenterologist of the future [6]. Accordingly, he or she must have a sound grounding in medical science as well as internal medicine and be equipped to cope and embrace those changes that will inevitably come. Herein lies one of the major challenges that face gastroenterology today: ensuring that our future practitioners are appropriately trained to cope with a complex and ever-changing medical environment, yet one which must retain the patient and his or her illness at the center of our universe.
It must be stressed that these advances have not been evenly bestowed on the world’s population; some areas of our planet have barely felt the impact of advances in diagnostics and therapeutics and still struggle with the ravages of malnutrition and infectious disease; many of their children simply do not live long enough to develop the chronic diseases that so preoccupy us in the West [7]. Even as these countries develop they face a further impending disaster: as their health professionals leave their home countries in droves to seek better lives elsewhere they starve their nation’s health service of the knowledge and skills that they so desperately need. Vast areas of the world are devoid of gastroenterologists while many other areas do not have the wherewithal to train specialists in the care of digestive disease.
I believe that WGO has defined and honed its mission and has initiated and refined programs which can fulfill these goals; an immediate challenge is to continue to fund a burgeoning schedule of teaching activities. WGO faces several obstacles in achieving long-term sustainability: the global financial crisis, mergers in the pharmaceutical and device industries, our traditional benefactors, the poverty of the GI new drug pipeline coinciding with our “blockbusters”, the proton pump inhibitors, coming off patent and the difficulties inherent in attracting traditional pharma support for international medical organizations and one that focuses on emerging nations, in particular. These are formidable challenges and ones that WGO does not underestimate. WGO has, therefore, recently launched the WGO Foundation to provide a broad base of support for its activities (www.wgofoundation.org).
Throughout the world the media and the public are casting a jaundiced and often openly hostile eye on interactions between physicians and the biomedical industry; the very institutions that have funded so much of our education and research. We have earned some of the opprobrium: our all too eager willingness to accept all sorts of gifts and gratuities scarcely graced our profession! Our challenge in the coming years will be to re-fashion our relationship with industry into a productive, ethical and open relationship that will have but one goal: the health of our patients. If WGO and other major organizations do not grasp this nettle, others may impose more draconian strictures upon us [8].
These are some of the challenges that we must meet and convert to opportunities. I believe that WGO has the experience, expertise and resolve to prosper and to continue to serve the global community of gastroenterology. For me personally, this has been a wonderful journey with WGO, illuminated by the many devoted and wonderful people that I have met along the way; I will forever treasure the many opportunities I have had, during this time, to get to know gastroenterology and gastroenterologists in the Arab World. I hope that you will all join us in getting to our final destination.
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