Ann was quite excited about the chance to work with an nongovernment organization in a developing country where she hoped she would be able to make a real difference in people's lives. She soon found...

Ann was quite excited about the chance to work with an nongovernment organization in a developing country where she hoped she would be able to make a real difference in people's lives. She soon found that the health problems she was seeing were often different from those she was used to at home. This was because problems that were often quickly dealt with in an industrialized country were left untreated for much longer in a place with few resources, poor transport and a great shortage of accessible health care. Ann turned to available clinical practice guidelines for help and was pleased to find several that seemed relevant but was disappointed to find that most were oriented towards the industrialized societies she had left behind and didn't seem useful when deciding what to do with the patients she was seeing now. However, she did have some access to the Internet and found that a group was trying to adapt some of the guidelines for settings just like hers. She was reassured when she discovered that the group was not only using the rigorous SAGE model but was focussing on the Tier 3 level and looking for low-cost and effective ways that the local population would be able to implement. Ann volunteered to become a contributor to the team and as someone ‘on the ground’ felt that she could make a real difference by testing out some of the proposals and giving feedback as the work developed. She knew that involvement by people like her, who knew just what the local problems were, would give credibility to the adapted guidelines that would eventually be produced and shared.