WONCA Seoul

WONCA is the worldwide network of general practitioners and, yes, it is also the name of a famous chocolate-maker who handed out golden tickets hidden in chocolate bars. To give a little run down, the WONCA World conference happens every two years. Each WONCA region (Europe, North America, South America, Middle East, South Asia and Asia Pacific) has an annual conference – WONCA Asia Pacific is in Kyoto in May next year and WONCA Europe is in Bratislava in June. When I found out that WONCA World was going to be in Seoul for 2018, I cleared my diary as there was absolutely no way that I wasn’t going to go.

I’ve been dying to go to South Korea since I was 18 when I discovered Korean food, namely Bibimbap. Whenever I’m in Central London and looking for a solo lunch experience to fit around my day’s activities, I head to one of two Korean restaurants to indulge in my Bibimbap habit. There’s also my later obsession with Korean barbecue and kimchee hot pots and addiction to Maangchi on youtube. Not just that but there has been a real zetigeist about South Korea at the moment. Whether it’s from the”7-step skin regime” for Korean-perfect glass skin to the dance scene when Lia Kim popped down the catwalk at New York fashion week to Psy bringing Gangnam-style to our stereos, it’s hard not to miss the explosion of Korean culture onto the Western stage. And it is in this cultural context, that Stuart (our Vasco da Gama representative), Daniel (our Beyond Europe Lead) and I find ourselves at WONCA Seoul.

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From left to right Keita (Japan), me and Arnoupe (UK) after our workshop on how to manage difficult colleagues.

*For the record, WONCA World is not an event that the JIC are expected to attend. We just happened to all be there.

Korean primary care

Primary care in South Korea is, like Japan, still new, and a different landscape to what we know in the UK. Like Japan, it is a direct access system with no GP gatekeeper role with the service provided being delivered from hospital. I am still to really understand this complexity and I’m not really sure what role a family doctor can have when they take on a vertical rather than a horizontal role in the healthcare system. I guess what I’m trying to say here is how can family medicine compete with hospital specialties when our role is so different?

From what I know, a lot of a GP’s work in Korea is taken up by annual health checks. Home visits are not done and patients are expected to come to the hospitals for healthcare rather than care being provided in the community. Hospitals are large with only five hospitals covering the whole of Seoul, although 61% of their patients come from outside the capital city. Like everything in Seoul, the three main hospitals are epically large: the Asan Medical Centre has 2704 beds (2017); the Samsung Medical Centre has 1979 beds (2016); and the Severence hospital has 2625 beds (2017). I’m already thinking of the poor house officer’s legs on a busy on-call…

From
My other workshop on how cultures can affect how we deliver palliative care. From left to right Rob (Australia), Ai (Japan), me and Daniel (UK)

Challenges

Like most developed countries, South Korea is facing an aging population but not just that, with the increasing popularity of the nuclear family, more and more of the elderly are becoming isolated and a demographic prone to poverty (49.6% of over 65s live in relative poverty – OECD) with an obvious knock-on effect on health. A new phenomenon is the Silver Town where warden-controlled flats are sprung up next to hospitals to allow residents easy physical access to healthcare which is understandable when healthcare is delivered from hospitals rather than from the community.

The four commonest diagnoses are diabetes, hypertension, TB and, interestingly, hepatitis. So much so that I recall my Korean young GP friend, Seo Eun, interpreting hepatitis antibody and antigen blood test results from memory when we were working together in Japan whilst I was unsuccessfully trying to use google.

The Koreans are big drinkers and smokers (OECD) as evidenced on our evening excursions in the city. As my friend, Arnoupe, noted in disbelief “it’s only a Monday night” as we watched the businessmen at the table next to us downing shots of soju (a traditional Korean spirit) and soju-bombs (like Jager-bombs but with soju and beer). Long arduous hours at school or work coupled with the Eastern regard for stoicism, shrouded by an unhealthy stigma around mental health must lead to maladaptive ways of letting off steam. South Korea has overtaken Japan for rate of suicides and is the fourth commonest cause of death in the country and comes tenth in the world ranking.

And although not really healthcare related, let’s not forget that South Korea has the highest rates of plastic surgery per capita. It’s a common tourist destination for the Japanese to get nipped and tucked given it’s only a couple of hours away!!

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Young doctors pre-conference where you get to meet trainees or within first five years of qualifying from across the globe

The conference

With over 2000 delegates, the conference was of epic proportions. WONCA has a very inclusive vibe about it and is a great place to meet some fantastic people. It’s difficult not to remind myself that life is good when you meet such brilliant people from across the world with a shared vision and, for me, WONCA is about connection – connecting across cultures, connecting through laughter and connecting through a real passion for patient-centred care. If there is ever a moment that you have ever doubted becoming a GP, you need to attend one of these conferences. The next one is in two years time in U.A.E but the regional conferences will be happening next year. You honestly do not need to know anyone before you go in order to get welcomed into the fold!

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Some good old group international noraebang (Korean karaoke)

But after all the madness of the last three weeks, I am glad to be home. I have never been more glad to see my own bed and never felt more comforted, bizarrely, to do my weekly shop and, quite tellingly, never more excited to examine that snotty child at work.

References – (although, realistically, my knowledge comes from the hours of chat with my dear friend Seo Eun when we were in Japan and Sam Min, Australian GP born in Korea who helped me with some of my facts!
Big-5 hospitals dominate patient careKorea’s Healthcare System Overview ③ Big-Five hospitals http://www.koreabiomed.com/news/articleView.html?idxno=2778

https://www.channelnewsasia.com/news/asia/poor-and-on-their-own-south-korea-s-elderly-who-will–work-until-8577758

Click to access Korea-2016-OECD-economic-survey-overview.pdf

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Obligatory formal event photo! From left to right: me, Mike (RCGP Vice Chair), Stuart (VDGM rep looking photo-shopped but he’s not), Mr Smith (British Ambassador to South Korea), Steve (RCGP Treasurer), Julien (VDGM policy maker)

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