Blog entry by Arif Khwaja
In the last few weeks I've received 2 contrasting emails from the UK Renal Association (RA) and the International Society of Nephrology both concerning the appointments of people to various positions in each respective society. The RA approach is very simple - any member can stand for any position and is elected by a simple electronic and postal ballot. In other words one member one vote and all the key positions are usually elected.
In contrast the process for the selection of the president elect of the ISN seems much more opaque. I can nominate somebody, but the nominations are scrutinised by the 'nominations committee' to ensure that the candidate fits in with the 'ISN mission, mindset and spirit.' After that the process to me as an ordinary member isnt clear - but as far as I can tell a shortlist of screened candidates are then voted on in a secret ballot of the ISN council - I maybe wrong on the precise mechanics here but I know one thing is clear - members of the ISN arent able to directly elect the president of the ISN on the basis of one member one vote.
Does any of this really matter? After all the ISN is a great organisation and I'm a proud member of it. For a small fee I get 2 excellent journals ( Kidney International and the brilliant Nature Nephrology Reviews) as well as access to a wealth of educational initiatives and meetings. As an example the Sister Renal Centre and the fellowship programs have been fantastic initiatives in transforming care and developing relationships around the world. I am particularly proud of of our own relationship in Sheffield with Sister Renal Centres in Bosnia and Egypt.
However going back to the process of electing the president of the ISN a few things are clear... if any member wants to change the 'mission, mindset and spirit' of the ISN they would presumably be unable to get past the nominations committee. The contrast with the RA is striking... members stand for various positions with a short statement of their manifesto i.e. what they would like to do. The membership then votes for people on the basis of their positions and whoever gets the most votes assumes the position. Its a great way of ensuring the the leadership of a society reflects the beliefs and wishes of the membership.
When I go to WCN meetings I am always struck by the huge number of people attending from all over the world - a huge mix of nationalities and ethnicities that presumably in part reflects the ISNs very diverse, international membership. Yet a quick look the 22 presidents of the ISN paints a completely different picture: 20 out the 22 presidents have been from Europe, USA and Australia. The remaining 2 were from Japan and Venezuela, both as far as I can tell had worked in the USA. There has never been a black or brown president. It is amazing that a society that is supposed to represent the international nephrology voice has never had a president from Africa, the Middle East, India or China.
Does this matter when the presidents have all clearly been people of outstanding calibre? Well yes I think it does matter - societies need to reflect their memberships and for societies to thrive they need to be actively evolving their 'mission, mindset and spirit' to meet the needs of their membership but more importantly the global needs of patients with kidney disease. Its for this reason I hope that one day we will have a president of the ISN who hasn't trained in an academic centre of excellence in North America, Europe or Australasia but somebody who has experienced a completely different clinical environment and who can thereby develop and evolve the ISN further. Diversity matters - not as a sop to political correctness - but as a way of hearing different voices and perspectives and so strenghtening and enriching organisations.
The Athenians first established a democratic process around 2500 years ago and generally the concept has been seen as pretty successful. In the 21st century maybe the ISN should start to look again at the way it chooses its' president.....