A Personal Note from Mahmud Ahmad Rajabalee

I have been exposed to healthcare systems in many different countries, including Mauritius. I started my studies in Egypt and moved to France for my residency in Internal Medicine. Whilst finishing up my residency, I was involved in a study directed by INSERM regarding the effect of biguanides on insulin resistance. Over time I spent nearly 10 years working for the Ministry of Health Hospitals in Mauritius. I also practiced in Saudi Arabia as Consultant Internist/Endocrinologist for 8 years which gave me the opportunity of running the gestational diabetes clinic in addition to inpatient and outpatient diabetes management. Moving forward, I explored opportunities in North America and eventually became the Chief of Internal Medicine at the Chatham Kent health Alliance in Ontario. Upon my further interest in diabetes, I spent 4 weeks in Mauritius in 2007 during my Internal Medicine Residency at the University of Toronto working on a project for the Ministry of Health in Mauritius on preconception care and management of gestational diabetes. At the Chatham Health Care Alliance, we run the urgent coronary artery disease, transient ischemic attack and stroke prevention clinics on a daily basis using a team approach consisting of ward clerks and nurses experienced in non-communicable diseases. We provide counseling about diet and lifestyle modification and necessary testing (cardiac stress testing, ambulatory ecg monitoring, carotid dopplers, neuroimaging) and referral for coronary angiogram (and eventual coronary revascularization if required) and carotid revascularization. Patients are screened, investigated and managed in a timely fashion. The concept of the nurse practitioner is unknown in Mauritius.  During my time spent in Canada, I have been able to appreciate how helpful and beneficial a nurse practitioner could be in University as well as in community hospitals. The Community Hospital in which I am currently practicing have nurse practitioners in the medicine wards and ICU/CCU.  They generally work under the supervision of a physician and are qualified to take a history, perform a physical examination, order investigations, and formulating management plans. I have personally worked with them in ICU/CCU. They are very thorough and efficient in their comprehensive assessment and management of patients who therefore feel that they are really cared for. I am delighted at the opportunity to serve my home country, Mauritius, as we get on board the challenging project 5-2035.  Through my experience and interest in Internal Medicine including diabetes, cardiovascular and cerebrovascular diseases, I feel that I will be able to contribute to the incorporation of the North American system into the healthcare organization in Mauritius in a way to suit the local context. The aim is to engage the community in the prevention and management of non-communicable diseases (i.e. Type 2 diabetes, cardiovascular diseases and stroke) within a structured framework with the nurse practitioner playing a central role under the supervising physicians as we practice patient-centered care. Dr. Rajabalee Bio.