NOV | 2018
EDITION NO. 10
SPECTRUM H E A L T H A N D M E D I C A L E D U C A T I O N S Y S T E M S
OVERCOMING INEQUITIES IN HEALTH SYSTEM OF THE AMERICAS Based on SDGs
AEMPPI-ECUADOR, AN INNOVATIVE ALTERNATIVE In the way Medical Students can change the world
AN INCLUSIVE MEDICAL EDUCATION SYSTEM PHOTO | FREE ACCESS | ONLINE
LGBTI+ population and others in vulnerable conditions
CONTENTS
!YRASREVINNA t s r i f YPPAH
communities, helping them grow, little by little, step by step. And, of course, to our general community. In such a way, as the months passed, another goal was added to our mission, and that was: To cover the demand for existing knowledge in our societies, so as not to make the same mistakes of yesterday. Dearest readers,
A year ago today, the first edition of SPECTRUM was published. An activity that born with the aim of giving an opportunity to publish to all medical students around the world interested in writing articles about science and something else. But, all this time, you most have wondered what is the reason of this name, SPECTRUM. For me, SPECTRUM means unity, equality, work and passion. I have always believed that, no matter where you are from, what your socioeconomic status is, in which university you are studying now or the year you are pursuing, regardless of such absurd differences, each one of us have something to give, something to show, something to prove. Because, together we can build the world that our grandparents dreamed, and the world that we are fighting for translating into reality. That is all SPECTRUM means for me and, I am planning SPECTRUM will be a legacy not only for our beloved organization, AEMPPI-UCuenca, but also for AEMPPIEcuador and the entire Americas region. It has been a path of hard work, with falls and defeats, with tears and bad nights. But, we have been there, punctual with each edition. Providing quality information to our student medical
In this edition, because of our first anniversary, I bring you something different. For this reason, we cover the following topic: “Medical Education Systems and Health Systems: A health of all and for all”. I hope that, with all my heart and as a little dreamer, this edition will be to your liking and, from now on, I invite you to join and be part of SPECTRUM and its next editions. In advance, I want to thank to the moon and back to Xavier “my dear Presi”, Selena “my favorite designer”, Frank “the layman”, Cintya “the professional editor”, Anto “my advisor”, Alek “my PC” and Xime “the VPP”, who supported me in all the phases of organization, publication and presentation. My friends, without you none of this would be possible. Also, I thank to my esteemed teacher, Julio Jaramillo O., PhD. for his advices, and more than anyone else, to you, my readers. Continue to accompany us! Warmest regards and,
Remember that, you let us keep growing!, Damary S. Jaramillo Editor in Chief of SPECTRUM from 2017 President at AEMPPI–UCuenca, 2019
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OVERCOMING INEQUITIES IN HEALTH SYSTEM OF THE AMERICAS Ivan Fabrizzio Canaval Díaz
Regional Director for the Americas, 2018 | Vice– President for Members, 2019 Antenor Orrego Private | University, Perú
In 2015, 193 nations committed to the United Nations sustainable development goals (SDGs), defined in Transforming our world: the 2030 agenda for sustainable development. The SDGs are based on the principle of advancing equity and leaving no one behind in the process of economic, social and environmental development. The health-related targets of the SDG agenda, emphasized under SDG 3, reiterate this call for equity, with the overarching aim of ensuring healthy lives and promoting wellbeing for all at all ages. The SDGs require concerted efforts across diverse stakeholders within and outside the health sector to achieve improvements in the many conditions that affect health and the opportunity for health, such as poverty, gender discrimination, lack of educational opportunities, degradation of the natural environment and poor working conditions. As countries work to improve health and its determinants in the SDG era, national monitoring of health inequalities will be a priority. Identifying health inequalities (differences in health across population subgroups) is an important part of addressing health inequities
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IFMSA (differences in health that are deemed unfair or ethically problematic). Monitoring health inequalities helps countries to track progress towards SDG 3 and other healthrelated goals, and ensure that disadvantaged or hard-to-reach populations are not left behind. Thus, health inequality monitoring generates evidence to inform equity oriented policies, programmes and practices that align with the intersectoral nature of the SDGs. For instance, progress towards universal health coverage – whereby whereby people receive the health services they need without suffering financial hardship – requires monitoring of how essential health services are being expanded to serve the general public as well as the most disadvantaged population subgroups. Transforming our world: the 2030 agenda for sustainable development promotes the improvement of health equity, which entails ongoing monitoring of health inequalities. The World Health Organization has developed a multistep approach to health inequality monitoring consisting of: determining the scope of monitoring; obtaining data; analysing data; reporting results; and implementing changes. This is an approach that have been also took into consideration by the the IFMSA, in which our medical students are joining forces to work in community based activities and also international initiatives in order to create regional and global impact and awareness about our priorities. In terms of equity it is also important to highlight the role of our regional priority for second consecutive year, which are the sustainable development goals and their already explained relevance in the equality are. The mission of our medical students, local organizations and 29 national member organizations (NMOs) in The Americas region of IFMSA is in line with SDGs, believing in not leaving people behind and most importantly thinking globally and acting locally.
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REFERENCES: http://www.who.int/bulletin/volumes/96/ 9/18-210401.pdf Resolution A/RES/70/1. Transforming our world: the 2030 agenda for sustainable development. In: Seventieth United Nations General Assembly, New York, 25 September 2015. New York: United Nations; 2015. Available from: http://www.un.org/ga/search/view_doc.a sp?symbol=A/ RES/70/1&Lang=E [cited 2018 May 1]. Hosseinpoor AR, Bergen N, Magar V. Monitoring inequality: an emerging priority for health post-2015. Bull World Health Organ. 2015 Sep 1;93(9):591–591A. doi: http://dx.doi.org/10.2471/BLT.15.162081 PMID: 26478619
QUALITY OVER QUANTITY OF EDUCATION: THE RIGHT OF FUTURE HEALTH PROFESSIONALS Pablo Daniel Estrella Porter
Standing Committee Director on Medical Education, 2018 | Universidad San Francisco de Quito
Education is one of the key aspects within the professional training of a doctor. Medical education is where the most important changes in medical practice can be made and have a direct impact on health systems. However, in Ecuador, the percentage of medical students who are actively involved in medical education is low. By performing a very simple activity, you can see the lack of knowledge and understanding of medical education in medical schools in Ecuador and over the world. The activity consists of asking medical students of different levels, about what they understand by medical education. Many of them give general answers and do not cover the basic points of this concept. Medical education can be briefly defined as the "...process of teaching, learning and training of students, with a progressive integration of knowledge, experiences, skills, attitudes, responsibility and values so ultimately, they can practice medicine" (Wojtczak, July / Sept. 2003). In 1951, the International Federation of Medical Student’s Associations, IFMSA, was founded. This is the largest student association in the world that represents more than 127 countries around the world.One of its three founding committees is the Standing Committee on Medical Education - SCOME. This committee focuses on educating and
training medical students around the world, through workshops, projects, student representation and high-level advocacy activities to create health advocates in medical education systems and health systems. The work done in SCOME in the past 78 years has shown that medical students are an essential part to improve not only the quality of future doctors but also the quality of healthcare. In Ecuador, the work of this committee under the Asociación de Estudiantes de Medicina para Proyectos e Intercambios (AEMPPI Ecuador), has focused on complimenting students' knowledge and medical skills. At the same time, it has focused on the development of advocacy, student representation and global health skills in their members. In conclusion, medical students in Ecuador have a unique opportunity to become active members of their medical education. SCOME is an ideal platform that offers its members the capabilities and resources to make changes, whether in the medical curriculum, teaching methodologies, accreditation processes, among others. REFERENCES: Wojtczak, A. (2003). Glosario de términos de educación médica. Educ. méd. vol.6 supl.2.
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IFMSA
SOCIAL ACCOUNTABILITY, UTOPIA IN MEDICAL EDUCATION Ximena Alexandra Núñez Mejía
Teaching Medical Skills Program Coordinator at IFMSA, 2018 Vice–President for Projects at AEMPPI–Ecuador, 2019 | Universidad Internacional del Ecuador
Have you ever wondered if the way you study medicine can make the difference for a specific population? I am sure you haven’t, and that’s where universities have been slow to put the stick high in primary health care. The national health system in Ecuador is divided into two large groups: public and private. As a medical student, you have probably had the opportunity to do your practice or externship hours in at least one health care center belonging to the public sector. Either, a hospital of the Ministry of Public Health, administered by the Ecuadorian Institute of Social Security, or belonging to entities of military or police forces. Considering that all these services offer to the general population, health free of charge or at very low costs, do you think that the doctors who work in each of these entities are prepared for the problems of their community? To answer this question, it would be enough to analyze the basic data of the INEC, where among the first 10 causes of death of Ecuadorian men and women, there is a mixture of communicable and noncommunicable diseases. In this way, you can assume that, if a medical student masters knowledge in these specific areas, then he is training for his community. However, the reality of medical education in Ecuador is very different. Each University has given priority to a different teaching method,
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according to the philosophy by which it is guided. The differences can be as subtle as differing in the type of questions that are taken in their final exams, as well as in the number of semesters needed to graduate. How can we explain that these differences exist, if we all want to serve the same Ecuadorian community? Maybe the social accountability, which both IFMSA and WHO defend, has not generated awareness in the faculties of our Amazonian country. As medical students, we should advocate for a medical education system that goes hand in hand with the national health system and its needs. An education system that can satisfy its population, its infrastructure and based on the resources we have available. It is time for social responsibility, stop being a utopia, and become a reality. In the end, we all wanted to be doctors, to help our people.
REFERENCES: Lucio Ruth, Villacrés Nilhda, Henríquez Rodrigo. Sistema de salud de Ecuador. Salud pública Méx [revista en la Internet]. 2011 Ene [citado 2018 Sep 16] ; 53( Suppl 2 ): s177-s187. Disponible en: http://www.scielo.org.mx/scielo.php? script=sci_arttext&pid=S003636342011000800013&lng=es.
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AEMPPI-ECUADOR
AEMPPI-ECUADOR, AN INNOVATIVE ALTERNATIVE Paúl Moreno Barahona
NMO President AEMPPI–Ecuador, 2018 | Universidad de las Américas
Since a little more than 10 years ago, the Ecuadorian health system undergoes a great structural change and health professionals have embarked on new challenges of standardization and stratification of medical resources. Likewise, in 2005 a group of Ecuadorian medical students started an organization that sought to train leaders in health that generate local and global change. The Association of Medical Students for Projects and Exchanges (AEMPPI) is the result of several years of hard work; we have maintained our mission of forming an integral medical student, which stands out from the rest of its peers. We have achieved through our projects, trainings, events and exchanges to generate a generational change in future health professionals, the approach we propose are a tool for professional complementation for students. AEMPPI follows the line of the international structure (thanks to IFMSA), our initiatives are based on multidisciplinary objectives oriented not only to public health and medical education, but also to other underdeveloped areas in traditional education systems such as human rights and peace and interculturality. Those of us who are part of AEMPPI have been growing along with this new line of changes that have been implemented in our health system and adapting to this regime in which we will be the main actors. Our organization is an innovative
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alternative since our programs are also oriented to many administrative and capacity building areas, where the student acquires unique skills to which they are not confronted in their daily lives. The advantage of these trainings is that they are based on an international experience that is constantly updated, the opportunities at IFMSA are exceptional and we have currently transported this knowledge at the national level to strengthen our local members in the 10 cities where there are medical faculties in Ecuador. The present demands us to make a change, we must understand that we are not only authors of the system when we have our degree, we can always start to implement the idea of change from our classrooms. It is only up to us to be critical and look for different initiatives, discuss about education systems and propose strategies to improve them, advocate and act for global health. The medical student who is involved in the work of AEMPPI and IFMSA since the beginning of its career, without a doubt, manages to interfere in all these issues and becomes the entity of change that we need.
Ecuadorian medical students can change the world!
IFMSA EXCHANGES VS. HEALTH AND MEDICAL EDUCATION SYSTEMS Sebastián Reyes & Germania Muñóz
National Officer on Proffesional Exchanges, 2018 & National Officer on Research Exchanges, 2018 at AEMPPI–Ecuador | Universidad de las Américas & Universidad de Cuenca
For everyone who has knowledge in the topic or that has in some way related to the health system in our country, knows that this is not a very efficient system, for the fact that the resources are not enough, the personal in charge is not always right for the job or simply the users are not aware enough to benefit properly from it. That is why we, as medical students and AEMPPI members, representing IFMSA in the country, must understand the current events in the country in matter of health system and what should be done in the future to repair failures or improve success. For this reason, the IFMSA exchanges programs, make possible that each year more than fifteen thousand students can carry out their professional or research exchange in different countries around the world, which shows us the importance of leaving our comfort zone and undertake an adventure, which in addition to helping the student's personal growth, creates a sense of cultural sensitivity towards inequities of Health systems around the world. This essentially involves the mission of the SCOPE and SCORE programs worldwide, which constitute the perfect opportunity for future medical students to become aware of the differences between health systems around the world and the different problems that affect health in different countries.
another health system, at the same time that they reinforce their capacities to adopt certain strategies that can be implemented at thelocal level. Having the ability to compare systems and understand health problems will help future medical students contribute to international health and public health as well. This constitutes what we know as Global Health and we, as organization, firmly believe that it is the pillar in which we must work to achieve the objective. Every medical student should be clear about this, for the goal is to dissipate existing inequities around the world, by acting local at our country, city, university, etc. to cause an impact in the world.
The main objective of these exchanges is to build future doctors who experience
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AEMPPI-ECUADOR
THE IMPORTANCE AND IMPACT OF EXCHANGES IN MEDICAL EDUCATION Mercedes Amanda Robles Galarza
National Assitant on Research Exchanges, 2018 at AEMPPI–Ecuador | Universidad de Guayaquil
Medical education has been evolving in Ecuador since the adoption of different healthcare systems and the access of information that could help improve the medical practice. We have now a more comprehensive model including other social and environmental determinants of health. Since the early introduction of medical students in the medical practice, it has been more important to motivate future physicians extend their frontiers and improve their range of knowledge acquisition. Exchanges has become a substantial part in the formation of an integral medical professional. It helps to develop a cultural sensible perspective towards inequities around healthcare systems around the world.
Exchanges provide: An internationalization component Exposure to research through hands-on experience Enhanced communication skills Exposure to a different healthcare system Exposure to diseases that might not be common in the sending country. Exchanges allow students to focus in global health issues, encourage them to acknowledge different healthcare around
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the world and improve healthcare practices by recognizing problems, motivating them to change statements in the current healthcare system.
THE RIGHT TO HEALTH AND OUR COMMITMENT AS MEDICAL STUDENTS Santiago Israel Bravo Loaiza
President at AEMPPI–UNL, 2018 Members Development Assistant, 2019 at AEMPPI–Ecuador | Universidad Nacional de Loja
Health is a right guaranteed by the State, the realization of which is linked to the exercise of other rights, including the right to water, food, education, physical education, work, social security, healthy environments and others that support good living. I start with this article of our constitution to reflect on the shortcomings in the Health System of Ecuador, and thus, motivate the medical student to create solutions. When talking about the problems of the country's Health System, one must take into account the errors we found in the Medical Education System. In 2017, the Regional Conference of the Latin American and Caribbean Association of Faculties and Schools of Medicine (ALAFEM) took place, in which Dr. Germán Fajardo, president of the association, was able to clearly manifest the deficiencies in medical education at the level of our region. I would mainly highlight the lack of coordination between universities and health systems, since this is an important factor in defining the number of professionals that each State should train and the competences that they should have in order to respond to the needs of the population; in other words, it is necessary to coordinate between what is being trained and what the State needs. This problem, together with the scarce information available from each country in the region on medical training and its incorporation into the labor market, makes. it difficult to take the
the necessary resolutions. In addition, higher education institutions respond to their own dynamics and not necessarily to the health systems. According to Scielo magazine, the Ecuadorians who receive the greatest health benefits are those who are covered by one of the social security institutes. However, there are a number of inhabitants who do not have access to social security; and although it is true, there are guidelines in the National Health Policy that safeguard the right to health of these people, but I personally feel that it is not enough. As a medical student, I believe that it is not fair to do anything, it is time to take the initiative and fight for a more coordinated health system, which can reflect the needs of our society, being active in the public decisions of our country and always look after the health of every citizen. REFERENCES: Asamblea Nacional Constituyente de Ecuador de 2007-2008. (2008). Constitución de Ecuador. Ciudad Alfaro, Montecristi. Ruth Lucio, E. M., Nilhda Villacrés, M. M., & Rodrigo Henríquez, M. (2011). Sistema de salud de Ecuador. Scielo. Veletanga, J. (24 de Octubre de 2017). La educación médica necesita más coordinación entre universidades y sistemas de salud. Redacción médica.
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AEMPPI-ECUADOR
AN INCLUSIVE MEDICAL EDUCATION SYSTEM, HEALTH IN LGBTI+ POPULATION María Paz Lasso
National Officer on Sexual & Reproductive Health Including HIV/AIDS at AEMPPI–Ecuador, 2018 | Universidad de las Américas
Physicians must know the different variations of human sexuality. Scientific research indicates that the different types of sexual orientation and gender identity are a natural variation of human sexuality without an intrinsically harmful consequence for health. Discrimination, stigmatization, rejection and harassment have a negative impact on the psychological and physical health of people in the LGBTI + community, as many studies show that due to stigma and ignorance within society and the health system, the members of this community do not have adequate medical attention. In addition to the medical attention deficit, they may suffer impediments to access services that are available to other members of the population. (WHO / PAHO, 2013). These negative experiences lead to a higher prevalence of depression, substance abuse, anxiety and suicidal ideas among people of the LGBTI community + four times higher than that of their peers (CDC, 2017). On the other hand, confidentiality is very important, because revealing the identity of a person as a member of that community often leads to discrimination, physical harm or even death by hate crime. Because of this, they can avoid health care, diagnostic tests or access to appropriate treatments, which leads to inequality in their health compared to the rest of the population (Clark, 2014).
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Medical schools and residency programs should incorporate LGBTI + health issues into their curriculum mesh. It is important to include the correct realization of a clinical history and physical examination of a person from that community, since the homophobic, lesbophobic or transphobic attitudes that health personnel can have can cause LGBTI + people to hide their sexual orientation, which would reinforce the feeling of being isolated from health services and make it difficult to receive quality care. This difficulty in communicating with health personnel is a barrier to obtaining adequate information in medical care, which prevents an accurate diagnosis to understand a disease, achieve adherence to treatment, know relevant behaviors and provide health education effectively. Today there are training and resources available for health centers to help improve health care for LGBTI + people. Policies in the field of health have been constructed from a hetero-normative approach that has not been inclusive of the needs and demands of this population, generating that they tend to use less health services for fear of finding homophobic attitudes on the part of the population. health personnel. The training of health personnel does not usually incorporate a holistic approach to health care for LGBTI persons, which has led to a
lack of technical skills in this area, making it difficult to provide adequate information and services. In addition, LGBTI+ people face the risks of homophobic violence at all levels, including in the family environment: 70.9% reported that they experienced discrimination in their family environment, of which 72.1% suffered some type of control experience, 74.1% experienced some type of imposition, 65.9% suffered rejection and 61.4% violence. In an analysis of the health situation of the LGBTI + population, conducted by the MSP in 2014, the most frequent reasons for consultation in this population were investigated, obtaining that the most frequent are: STI / HIV, health information consultation sexual, depression and / or anxiety, and related problems. With all this information we can conclude that the medical education system should include in its curriculum the appropriate medical attention to a person from the LGBTI+ community, understanding the variations of human sexuality with a comprehensive and free of stigmatization approach to provide care quality. For now, it is up to each one to provide the best service to that population. REFERENCES: http://www.who.int/bulletin/volumes/96/ 9/18-210401.pdf Resolution A/RES/70/1. Transforming our world: the 2030 agenda for sustainable development. In: Seventieth United Nations General Assembly, New York, 25 September 2015. New York: United Nations; 2015. Available from: http://www.un.org/ga/search/view_doc.a sp?symbol=A/ RES/70/1&Lang=E [cited 2018 May 1]. Hosseinpoor AR, Bergen N, Magar V. Monitoring inequality: an emerging priority for health post-2015. Bull World Health Organ. 2015 Sep 1;93(9):591–591A. doi: http://dx.doi.org/10.2471/BLT.15.162081 PMID: 26478619
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AEMPPI-ECUADOR
HUMAN RIGHTS AND PEACE: THE BUILD OF A HEALTH AND MEDICAL EDUCATION EQUALITY SYSTEM Ana Paula Estrella Saá
National Officer on Human Rights and Peace at AEMPPI– Ecuador, 2019 | Universidad de las Américas
Throughout my life I have heard several people, in different situations, talk about the importance of the famous "Human Rights and Peace", and I think I speak out for everyone when I say that, the little we know about them is what we have heard in history classes. They told us that they appeared for the first time in the Cyrus Cylinder and were officially recognized thanks to the Universal Declaration of Human Rights in 1948, but my big question is: What really are Human Rights? And how do they apply to health globally? According to the UNHCR, they are "... inherent rights to all human beings, without distinction of nationality, residence, sex, ethnic origin, color, religion, language, or any other condition." From my own perspective, they are the features that make us coexist as brothers and emerge the best of us and above all make us develop empathy and respect for ourselves and our fellow citizens. Within the Ecuadorian health system, in the article 32 of the Constitution, it is mentioned that "... health is a right guaranteed by the State, whose realization is linked to the execution of other basic rights and others that sustain the good living." Furthermore, I believe that it goes beyond a nominal definition, since we must mold it to several contexts in which we are immersed. As a medical student, I consider that the construction of an inclusive and global health system is based on a responsible medical education. By this I mean that
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within the professional education, there there must be reforms which not only guarantee high academic standards, but engender committed students who warranty and protect the rights of their future patients. As a future professional, I hope that the health system in our country works based on the basic rights of people and apply them from primary care practices, adapting to the realities of the current complex health scenery and thus can constitute the basis to improve health systems. Finally, as a natural person I firmly believe that the basis of a continuous improvement on the health field is empathy, respect and brotherhood starting from us to make a general change that soon becomes a philosophy of life. REFERENCES: Echegoyemberry, M. N., Castiglia, G., & Yavich, N. (2017). Desafíos de la implementación de la atención primaria de la salud desde el enfoque de derechos humanos. Mihr, A. (2017). Educación en Derechos Humanos en el ámbito universitario. Tarbiya, revista de Investigación e Innovación Educativa, (35). Giovanella, L., Almeida, P. F. D., Vega Romero, R., Oliveira, S., & Tejerina Silva, H. (2015). Panorama de la Atención Primaria de Salud en Suramérica: concepciones, componentes y desafíos. Saúde em Debate, 39, 300-322.
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AEMPPI-UCuenca
BEING A MEDICAL STUDENT: ¿SAD REALITY OR BEAUTIFUL REALITY? Frank Eliécer Vélez Zambrano
Secretary at AEMPPI–UCuenca, 2019 | Universidad de Cuenca
It has been evidenced, through the national media, that medicine is one of the careers most demanded by Ecuadorian youth, but unfortunately not all of them manage to obtain a quota for it. However, what about those who get the quota and start the race? We started with the great desire to one day be doctors and with that purpose that the vast majority have "help others". It was already said and said, “he who wants, can" and does not remain in words but is shown in the acts that we each manifest in our daily life, next to this great lifestyle because medicine is that , a lifestyle that requires late nights, absence in family gatherings, hunger, tears and many other difficult situations that make us suffer but that will be worthwhile to reach our goal. Sometimes we think we faint and say or think the typical phrases "I can not do this anymore", "this is not for me", "I have to study a lot", "I'm very sleepy" and unfortunately there are those who call us "cocky" the simple fact of saying them, when in reality, we say them but in a momentary way as to "release stress" because this lifestyle is a beautiful reality that only the one who lives it can understand. Medicine hypnotizes us to the point that we would never leave it because something we learn subconsciously is that information creates knowledge and knowledge encourages practice and that is how we will serve society.
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LEARN TO TEACH: A LIFE EXPERIENCE Gabriela Andrade
Member at AEMPPI–UCuenca | Universidad de Cuenca
Several years ago, I received a phone call informing me that I was going to teach a group of students around my same age. They gave me a topic and 24 hours to redact and assimilate all the information that had cost me to "learn" in a year. It was a topic that in my opinion was somewhat complicated; It contained several unpronounceable and little comprehensible terms. I decided to accept the proposal, I hung up the phone and frankly I did not know where to start. What was I thinking? I took the book and opened on the first page where they wrote a lot of neurotransmitters and chemical reactions with names that lengthened more than one line and that made it seem impossible to learn. How was I going to transmit that to others? I looked for other help resources such as previous slides, taken notes, or more information that would help me to better understand what I was supposed to already know and therefore teach, but it did not work. I decided to change my strategy, I developed a series of graphs, mental diagrams, charts and mnemonics. I studied page by page in order to understand all the topic and therefore be able to share and explain to others. The next day, with a little doubt still, I presented the topic for my students, (brilliant, by the way). At the beginning, it was a little difficult to organize my ideas and transmit them to others. However. I found it much easier to repeat the terms that seemed written in Irish or another foreign language. That way, a little time after, the
subject that seemed extremely complicated a couple of years ago, had become easy to understand and chiefly to transmit it. What changed? There are several scientific studies that demonstrate that people who devote their time to teach what they have learned, have a better domain of the subject compared to those students who only study and review a particular topic. Wi Lin Koh and his collaborators decided to prove this theory, through the famous "testing effect" which explains that people are able to create a deeper and lasting understanding through resources such as: writing, audios, mental schemes or better yet testing ourselves by means of strategies like "questions and answers" (similar to the academic evaluations) or transmit and teach others. According to several authors and studies published in the magazines Science and Intelligence this is one of the best ways to learn compared to passively assimilate the information through several readings. But, can we use all this to our benefit? Yes! It is true that in medicine time seems always short. However, there is a solution and it is the organization. Finally, remember that we are students, but also human beings, therefore, we need to correctly distribute the time between study hours, sleep and why not, recreation time. A good doctor cannot become such, if he does not start out as a good person and a good person cannot provide his time to others, if he does not provide quality time for himself.
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Based on Medical Education Systems
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Medical Education
ECUADORIAN HEALTH SYSTEM, REASONS FOR POLITICAL DISPUTE? Alan Mateo Galarza Jumbo
Member at AEMPPI–UCuenca | Universidad de Cuenca
The Ecuadorian Public Health Ministry, was created in 1967 by the National Constituent Assembly with Dr. César Vázquez at the head. Ecuador was the only country that did not have a health system governed by a ministry at that time. It is necessary to have regulatory authorities of all the resources destined for the health of the country. And in the same way they can process the reception of these resources by the Central Government. But, what happens if the authorities imposed by the government are based on an economic model of health? Health models should not be established for political or economic purposes but should be implemented in every corner of the country because it is NECESSARY. The Ecuadorian free health policy for all people established in the constitution, serves approximately 27,000 patients per week, with optimization system for the staff, giving a maximum of 40 minutes for pregnant women on their first appointment and 20 minutes for any patient. Take into account that the complete physical examination lasts an average of 1520 minutes depending on the skill of the professional. The medical history must be perfect in writing. Not only because it is a medical-legal document, but also because it contains personal and specific information about patients. How does the professional fill in the data perfectly and examine the patient in 20 minutes? What does te health staff do to meet the proposed goals? Really "optimize", the health system is correct? Personally, many doctors lost their humanistic mission to
achieve goals, a matter that as a . As users, is the attention provided really the desired one? According to personal criteria, the relevant authorities should strive to create a health model, in which the quality is evaluated before the amount of care provided. There is no point in attending 24 patients a day, if the last 8 withdraw from the consultation with emotional distress due to bad treatment by the health professional. Remember that doctors are people who have feelings and needs just like everyone else. Germán Fajardo, president of ALAFEM in the Regional Conference of 2017 stated that "The training of doctors represents one of the great challenges in the training of human resources necessary for health care. However, "higher education institutions respond to their own dynamics and not necessarily to health systems". The information that comes from the national health system is crucial for our professional training. It is the obligation of both the ministry and ours to maintain an effective national health system. Without forgetting, that the most important thing will always be the health of the people. REFERENCES Avilés E. Enciclopedia del Ecuador. [Online]. [cited 2018 Septiembre 11. Available from: http://www.enciclopediadelecuador.com/ historia-del-ecuador/ministerio-saludpublica/. INEC. Instituto Nacional de Estadísticas y Censos. [Online].; 2017 [cited 2018 Septiembre 12. Available from: http://www.ecuadorencifras.gob.ec/salud/
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Medical Education
THE SECRET TO STRENGTHEN THE FIGHT AND DEFENSE OF HUMAN RIGHTS IN THE MEDICAL AND GENERAL COMMUNITY Natalia Adela García Paguay
Member at AEMPPI–UCuenca | Universidad de Cuenca
From 1948, where the General Assembly of the United Nations adopted the Universal Declaration of Human Rights; thousands of legislations have been established in order to recognize the inalienable dignity of human beings; which is free of discrimination, inequality or distinctions of any kind. The Constitution of 2008 is mentioned in Art. 3 It is the primary duties of the State to guarantee without any discrimination the effective enjoyment of the rights established in the constitution and in international instruments, in particular education, health, food, security social and water. As we see there are laws that support our rights. But now we must ask ourselves: Do we know our rights? Do governments base their public policies on the fulfillment of those rights? For the moment not completely, but we know that a National Plan of Human Rights Education has entered into force that will allow the creation and maintenance of a culture of peace, tolerance and respect for human rights in all societies and cultures. This education is aimed at all people; and it allows the full development of human rights. Now as medical students and future health managers, we are in charge of the right to health. Right that until now has been considered a privilege; due to the lack of inclusion in the policies and action plans of Health Systems and Medical Education; this due to a wrong approach to Health.
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It is vital to establish a focus on health based on human rights as a framework for health development and education programs. This approach will allow us to adopt a gender perspective and recognize that biological and sociocultural factors have a considerable influence on people's health; therefore, it is necessary to keep these differences in mind when creating health policies and education programs. In addition, in order to monitor compliance with these programs, it is necessary to define reference points and indicators of the progressive realization of rights in the health sphere. All in order to guarantee and respect human dignity, allowing universal access and without discrimination to health programs. REFERENCES: CONSTITUCIÓN DEL ECUADOR. Constitución del Ecuador - 2008. Regist Of [Internet]. 2008;449 (Principios de la participación Art.):67. Available from: http://www.asambleanacional.gov.ec/do cumentos/constitucion_de_bolsillo.pdf OMS. Veinticinco preguntas y respuestas sobre salud y derechos humanos. Organización Mundial de la Salud. Ser publicaciones sobre salud y derechos humanos, N° 1 [Internet]. 2002;34. Available from: http://www.who.int/hhr/activities/Q%26 AfinalversionSpanish.pdf
IT IS NOT MONEY, RELIGION OR CULTURE: IT IS SKILL! Kattya Grace Criollo Montalvo
President at AEMPPI–ESPOCH, 2018 Vice–President for Finances and Register at AEMPPI–Ecuador, 2019. | Escuela Superior Politécnica de Chimborazo The Latin American and Caribbean Association of Faculties and Schools of Medicine (ALAFEM for it’s acronym in Spanish) indicates "...to train doctors according to the reality of each country, it is necessary that there is more coordination between universities and health systems. This is an important factor in defining the number of professionals that each State should have and the competencies they should have to respond to the needs of the population". (Veletanga, 2017) In Latin America there is a marked tendency to the analysis and critical examination of medical education, to adapt it to the development of scientific knowledge; social transformations; demographic needs and the organization of medicine as an integral element of community life. Ecuador, currently has a model focused on primary health care, which, in order to be adequate and efficient, is based on the fact that general and family medical professionals are the gateway to most health problems, except in urgent-emergency medical circumstances. (MSP, 2012) An efficient health system is accompanied by changes in society, education, technological advances and integration of all actors: government, private sector, academia, health professionals, patients and those of us who want to accept the challenge, with courage, to be part of it and fight not only for knowledge. The education of which I speak as part of the system, goes beyond the memory and training to pass an exam, the teacher at the head of
the classroom must get to transmit beyond the theoretical knowledge. In order to provide quality care, the competencies in which we must be trained are translated into constant preparation, discipline, technological innovation, with which significant changes in the professional profile to which we aspire to be able to prioritize and interpret health interventions are produced. From an analysis of social and life conditions to arrive at the final purpose of deciding together with the patient an integral form of medical approach. The skills that a doctor must develop throughout their training are a fundamental part to face and understand the patient's health problems, as well as the management of the essential elements of the health system such as the interculturality of the country, the accessible nature and adaptability to the needs of the environment, and the relationship between the health system and other components of socio-economic development. ( Zurro & Jodar Solà , 2014). Thereby the construction of the Quality Health System begins in the classrooms with the decision to be agents of change in society, regardless of economic condition, creed or culture, the study of medicine depends on commitment, discipline and seriousness to take on the challenge. REFERENCES: Ministerio de Salud Pública, M. d. (2012). Manual del Modelo de Atención Integral de salud -MAIS-. Quito.
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Medical Education
INCLUSION IN MEDICAL EDUCATION AND PROFESSIONAL LIFE Ana Lorena Ullaguari GuamĂĄn
Member at AEMPPI–UCuenca | Universidad de Cuenca
Do we really understand what the term inclusion implies in Medicine? First of all, it is necessary to clarify its concept. According to the RAE dictionary, it is defined as "action and effect of including" (put something inside another thing or within its limits "and also as" connection or friendship of someone with another person". These concepts are widely interrelated to the health area. The following text describes the important role of health professionals in providing an inclusive care from an intercultural approach. In health services, the doctor has the immense responsibility not only to scope the correct diagnosis, but also to provide integral care. This denotes the fact that the disease cannot be approached only as a somatic mechanism, it must also be enclosed in a macro-cultural context that includes the physical-biological, emotional and cultural feature of the patient. Understanding this relation is key to develop a correct training of the future professionals in the health area. Ecuador is an Intercultural and Multicultural country that enforces the respect and horizontality of the different cultural groups which interact among them with their own traditions and beliefs, promoting openness for dialogue and mutual enrichment. However, this concept is far from being fulfilled. Regarding the services of health institutions, they are constantly inquired about the lack of sensitivity, listening and respect in the treatment received, outlooks that ultimately clout the satisfaction of spatients. Along with this comes
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consequences such as detachment from medical indications, a greater incidence of abandonment of treatments and rebuff of the use of health services. As future professionals, we must consider that there are different smatterings of the health-disease process within each cultural group. It is vital to know and respect the holistic nature of the so-called ethnomedicines to provide care that does not diminish their beliefs. Physicians must have a training that enables the intercultural approach of the healthdisease process. This knowledge must originate at the study plans related to medical training, which emphasizes the need to deepen the understanding of cultural differences around health. As a medical student, I believe that in order to encourage intercultural health, active participation should be promoted both by students and by communities where pre-professional practices are performed, also execute integration activities, where the leaders or wisest from the communities can share their medical practices with the students and be able to integrate both approaches of traditional medicine and Contemporary medicine. In summary, I believe that as students, we can contribute to the construction of an inclusive health system by immersing in medical practice in different communities to learn about their beliefs and customs and therefore learn how to provide a quality care.
Based on health various themes
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Other themes
THE CRISIS REFUGEE: THE ROLL OF NATIONS AND CITIZENS OF THE WORLD Damary Silvana Jaramillo Aguilar
Editor in Chief of SPECTRUM from 2017 | President at AEMPPI–UCuenca, 2019 | Universidad de Cuenca
According to Global Trends 2016, approximately 65.6 million people were displaced around the world because of human rights violations, armed conflict, persecution, and others. Of these, 55% came from Syrian Arab Republic, Afghanistan, South Sudan; being 51% children under the age of 18, and mostly unaccompanied or separated of their families. In front of this, be refugee, stateless, asylum-seeker or displaced person has been a source of wealth for some people, this by sexual exploitation, labour exploitation, forced begging, and so on. Also, a cause for fierce and ongoing social struggle in front of breakdown of the mother culture and the invasion of private places. It should be noted that, all of that has resulted in the voluntary repatriation of refugees and severe mental health problems, as for example: anxiety, panic attack, stress and depression. In this way, what is the roll that nations should take against of the crisis refugee? And as citizens of the world, what can we do about the continuing violation of refugee rights? Without exception, the entire refugee set out their lives for crossing land and sea in search of security and protection in any territory aside from its own, this more than few times. The asylum alternatives tend to be in developing countries that, despite their exuberant population and limited resources have opened their doors to million people; clear examples are Turkey, Sub Saharan Africa, Cameroon, Ethiopia, Uganda, and Democratic Republic of the
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Congo. However, larger and more powerful nations do not have the same figures, and the problem amounted to an injustice and unaccountability on the part of the latter. To this, a more viable solution would be to redeploy the refugee burden in the nations of the world, that, in dependence of their population and the gross domestic product; as Canada, Germany, Austria, Netherlands did five years ago. Since, only thus will it be possible to meet the needs of the refugee and balance the problem. The Geneva Convention in 1951 established refugees have the right to “…gainful employment, decent housing, free and public education, medical assistance, and freedom of religion” like any other citizen in the country. But even so, all do not enjoy the same rights and their wishes of selfimprovement have been subordinated to camps, on the streets and some bits of cardboard. Perhaps they are afraid to face war or xenophobes’ mock. As citizen of the world, we have an obligation to contribute to this cause starting from organize to remedy this situation though the recruitment violations of refugee human rights, awareness of the population about the traumatic experiences of refugees and how important is to involve them on the national environment by testimonies, and statistics. Finally, to boost the social partnership though aid programmes. Unless we act now, great problems like hunger, poverty, illiteracy and violence will increase and in future, we could not take the control of all these.
REFERENCES
United Nations High Commissioner for Refugees. Global Trends, forced displacement in 2016. Geneva: UNHCR, The UN Refugee Agency; 2017. Refugee Health Technical Assistance Center. Mental Health [Internet]. [Cited 18 January 2018]. Available from: http://refugeehealthta.org/physicalmental-health/mental-health/ Amnesty International. Tackling the Global Refugee Crisis from shirking to sharing responsibility. London: Amnesty International Ltd.; 2016. United Nations High Commissioner for Refugees. ¿Cuáles son los derechos de los refugiados en el mundo? Madrid: UNHCR, The UN Refugee Agency Spanish Committee; 2016. United Nations High Commissioner for Refugees. The State of the World’s Refugees in Search of Solidarity. Geneva: UNHCR, The UN Refugee Agency; 2012.
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Other themes
CLIMATE CHANGE AND HEALTH: AN OPPORTUNITY TO ADVANCE Doménica Elisa Lazo Vivar
Member at AEMPPI–UDLA | Universidad de las Américas Climate change is an uncomfortable and alarming reality, which has already begun to leave traces in the lives of human beings. The WHO in 2016 said that 24% to 25% of global mortality and morbidity are caused by environmental insalubrity, with around 12.6 million deaths per year. (World Health Organization, 2016) The main problems are related to the cardiovascular and respiratory system, putting in first place the deaths due to cerebrovascular accidents. Trying to being blind to a reality that becomes more palpable is no longer an option, climate change will not only modify the ecosystems of the earth, but also can affect the human being in more than one aspect, mainly in their quality of life. A study conducted in the United Kingdom by the Department of Social and Environmental Health Research of the London School of Hygiene and Tropical Medicine and the Center for Radiological, Chemical and Environmental Risks calculated that by the year 2020, the increase in temperature on the planet will increase by 66% of mortality rates, while in 2050, if there is no adequate adaptation for the part of the human being, it could multiply this percentage up to 257%.(Hajat et al., 2014) Medicine and climate change are closely linked, each one can help and harm to the other. The emission of gases, the contamination of water and land have helped to increase the number of people with noncommunicable diseases such as cancer, chronic lung diseases and heart
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disease. If human beings do not change their way of interacting with the planet, they will prematurely dying from causes that are preventable. People knows about climate change, but is not fully aware of it or has poor information on what to do with a phenomenon of such magnitude. Health professional play a critical role in the prevention and recognition of symptoms related to poor environmental health, and with the construction of good environmental and occupational medical records they will get a clear idea of common aspect related to toxic exposures. (Kreslake et al., 2017) It’s essential that the physician knows the environment in which operates, because being aware of the changes that occur around them make possible to create projects of prevention against the new diseases that are coming with global warming. In addition they can teach and promote in their patient the environmental awareness that the planet is needing. REFERENCES
Hajat, S., Vardoulakis, S., et al. (2014). Climate change effects on human health: Projections of temperaturerelated mortality for the UK during the 2020s, 2050s and 2080s. Journal of Epidemiology and Community Health, 68(7), 641–648. https://doi.org/10.1136/jech-2013-202449 Kreslake, J. M., Sarfaty, M., et al (2017). The Critical Roles of Health Professionals in Climate Change Prevention and Preparedness. American Journal of Public Health, e1–e2. https://doi.org/10.2105/AJPH.2017.304044
HIV/AIDS: ZERO STIGMAS, ZERO DISCRIMINATION! Yolanda Anabel Gómez Chamba
Member at AEMPPI–UNL | Universidad Nacional de Loja
HIV is an infectious disease caused by the human immunodeficiency virus, which continues to be one of the biggest problems for global public health to charge more than 35 million lives. According to reports from UNAIDS in Ecuador, there were 36 000 cases of children and adults living with HIV, of whom less than 1000 died with AIDS, which is the advanced state of the disease caused by the human immunodeficiency (HIV) virus during 2017. Facing this problem, the Ecuadorian State guarantees response to HIV/AIDS with a high investment of domestic resources for population free of charge access to comprehensive care of the disease. Since the spread of these diseases occurs easily through three ways: blood, sexual and vertical (mother to child), is of utmost importance that the population be made a specific blood test, called HIV antibody test is free, safe and confidential. There are people who are infected without knowing it, hence the importance of an early diagnosis, which would prevent new infections. Thanks to the large barriers that we have in our country, most people do not attend health system of Ecuador, due to the lack of information provided against this problem, what causes a certain degree of discrimination, not only affects the users of health care services, but also to health workers, hindering access to health services and affecting its quality, and at the same time reinforces social exclusion of individuals and groups. It is also very common within the workplace is not granted a vacancy for which may be
suitable, or that for fear of 'contagion', don't give them the same treatment that any other worker. An effective solution to these diseases would be that both health professionals, such as medical students in training, provide lectures to the community about the process of transmission, diagnosis and treatment; in order to intensify the prevention of HIV/AIDS in adolescents and young women in the context of sexual, reproductive health and sex education, as well as develop campaigns at the national level together with Fundation VIHDA, for diagnosis and possible treatment with TAR from these diseases, demanding greater protection of personal rights with them.
REFERENCES: World Health Organization. (2018) HIV / AIDS. Available at: http://www.who.int/es/news-room/factsheets/detail/hiv-aids PAHO.org. (2018). Available at: https://www.paho.org/ecu/index.php? option=com_content & view = article & id = 723: conformacion - Committee Ecuadorian - multisectoral - AIDS & Itemid = 360
"Do not take care of us people, beware of AIDS."
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Other themes
SDGS AND HIV, WHAT ARE THE GIVEN SOLUTIONS AND WHAT REMAINS TO DO? Thalia Petsain
Member at AEMPPI–UCuenca | Universidad de Cuenca
HIV, which continues to be one of the biggest problems for public health, has already claimed more than 35 million lives. In 2016, one million people died worldwide due to causes related to this virus. According to data from the Joint United Nations Program on HIV/AIDS, UNAIDS, in our country, there are about 33,000 adults and children living with HIV, and approximately 1,900 were recently infected. Evidence of the efforts made by our nation in recent years was the week on November 26 to December 2, 2012. In this period, there were carried out promotion and prevention activities in all the Health Districts of the country with the purpose to achieve by 2015 the global goal: "ZERO DISCRIMINATION, ZERO NEW INFECTIONS, ZERO DEATHS FROM AIDS". This strategy, called the National Public Health Strategy for HIV/AIDS-ITS, pursued the following objectives: 1) expand the coverage and quality of health services of the first and second levels, with emphasis on voluntary test offer and Syndromic Management MS-ITS- to the most exposed groups and in vulnerable conditions; 2) expand the coverage and improve quality service from Integral Care Public Services Network  of People Living with HIV -PVV-; 3) increase the timely and efficient use of strategic information systems (Epidemiological Surveillance and M & E of HIV/AIDS-ITS); 4) Increase the multisectoral response to HIV/AIDS-STI in the EMP Framework 20072015 with emphasis on health promotion and prevention and; 5) expand the participation of citizens in the systems of protection and social control in HIV/AIDS-
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STI-s. On the other hand, the International Community has made a commitment to end the AIDS epidemic by 2030. Hence this ambitious goal is part of the 2030 Agenda for Sustainable Development, approved by the General Assembly of the United Nations in September 2015. Called the "Global Health Sector Strategy for HIV 2016-2021", its vision is a world free of new infections, deaths or discrimination due to HIV, and in which people living with the disease can have a long and healthy life; being their frameworks for action: 1) universal health coverage; 2) continuity of HIV services; 3) public health approach. Without further ado, what remains to be done is: 1) to promote combined prevention through new tools; 2) ensure that all people infected with HIV know their serostatus; 3) extension of quality treatment to all people with HIV; 4) preserve the life and health of people through holistic and individual-centered care; 5) protect the most exposed and vulnerable groups, It is necessary to intensify efforts to repeal laws and modify policies that marginalize and stigmatize certain groups, promote risky behaviors, impede access to effective services and perpetuate inequities and inequalities); 6) reduce costs and increase efficiency (drastic savings to expand HIV related services to an unprecedented scale by 2020. It will be necessary to reduce the prices of key medicines and other basic products and increase the efficiency in the provision of services, and lastly achieve a more rational allocation of resources). No more stigma, be free!
ECUADOR, THE HOME OF EVERYONE IN LATIN AMERICA Klever Leonel Naranjo Sánchez
Member at AEMPPI–UCE | Universidad Central del Ecuador
In Ecuador, the health system is made of two sectors: the public one and the private one, each one has its own financing way for its activities; the public sector obtains its funds from the state, and its investment represents 9.2% from the GD; the private sector includes for-profit and nonprofit entities from the civil society. In the constitution of Ecuador, health is set as a right, which must be undeniable and guaranteed to the population in the Ecuadorian territory by the state. It is subject to the principles of equity, universality, solidarity, interculturality, quality, efficiency, precaution, bioethics, and always under the perspective of promotion, prevention, recovery and rehabilitation of health, these are the ethic pillars in the teaching of the careers in health sciences in Ecuador. Since 2007, Ecuador has been the LatinAmerican country with the biggest affluence of refugees, which in April 2017, reached 60.560 immigrants in Ecuador, who can have two conditions. The first one is “refugee”, in which migration is produced by causes that prevent the person to return to their country of origin. The second one is “economic immigrant”, in which people travel to another country mostly in search of economic development, with the difference that in this case the person can return to their country of origin at any moment. This is the case of the massive migrations to Ecuador by citizens of neighboring countries, who, for political, economic or
personal issues, have moved to a zone, which offers better life-conditions. The effect on the health system becomes evident over the capacity it has to satisfy the demand of health services, which saturates because of the growth in population, with the same initial resources, and which, in the event that the immigrant population kept growing uncontrollably, the health system could be severely compromised. As possible solutions, we could consider a better control on the access to the country, or a kind of contribution that any other Ecuadorian citizen would make, which, while they do not solve the problems of the Ecuadorian health system, might help reduce the impact on its functions.
REFERENCES: Gilda D, Guerrero A. The relation between the State, ACNUR and the non-government organisms in the humanitarian assistance: the HIAS case in Ecuador in the 2007-2016 period. 2018:168. Espinosa V, Acuña C, Torre D De, Tambini G. The reform in health in Ecuador. Pan Am J Public Health. 2017;41:e96:1-3. ACNU, UNHCR. protecting refugees in Ecuador. :1-16.
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AEMPPI-UCuenca Other themes
ECUADOR FOR OUR CHILDREN, ADULTS AND ELDERS: ENOUGH! NOT ONE LESS! Johanna Belén Illescas Aguilera
Member at AEMPPI–UCuenca | Universidad de Cuenca
The kidnapping and the disappearances in Ecuador are a reality that is felt more and more frequently within the different cities of our country, this problem has reached alarming figures in recent years and the emotional and psychological impact for the general population and much more for the relatives and relatives of the victims is very large. Kidnapping is considered by far a violation of individual freedom that undermines human rights and that brings devastating repercussions in victims who manage to be recovered, but who are left with the trauma associated with the experiences experienced throughout the process, this experience depends of many factors such as the characteristics of the kidnapped subject (personality, motivations, ability to adapt, etc), physical conditions of the situation (treatment received, place, etc.) and the relationship with their kidnappers; In addition to affecting family members and close friends who, with uncertainty and a little hope await the return of their lost self, this creates a state of anxiety and fear in both parts of the situation. (Sanz, 2013) For the UN in its Manual of Fight against Kidnapping (2006), it can be defined as: Unlawful detention of a person or persons against their will in order to demand for their release an illicit profit or any utility of an economic or other material benefit, or to force someone to do or stop doing something . In our country, this crime is handled by the State Attorney General's Office, the Ministry of the Interior, the
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Ombudsman's Office, the National Police and the Judicial Council. The figures arecrude; According to the Ministry of the interior, up to December 2017, approximately 37,000 complaints were made, 96% of cases resolved favorably, but not all victims suffer the same fate because 4% are still under investigation and 1511 people are still missing. The most affected age group is still the adult population with 46% of cases presented, children 25%, seniors 7% and 22% of cases for which data are not available. Of the total number of missing persons, 51% corresponds to the female population. (USFQ, 2017) In conclusion, the phenomenon of disappearances in our country, is a reality that should not be ignored or underestimated, is happening to us and may even affect ourselves, because the social problem it represents should not only touch the hearts of victims and your families; if not of each of the people that are part of this society. REFERENCES: ONU. (2006). Obtenido de https://www.unodc.org/documents/lpobrazil/Topics_crime/Publicacoes/Manual_an tisequestro_ONU.pdf Sanz, M. (11 de Diciembre de 2013). MSG PSICOLOGÍA. Obtenido de https://msgpsicologia.com/el-secuestro-ysus-efectos/ USFQ. (2017). Obtenido de https://desaparecidos.usfqperiodismo.co m/la-desaparicion/
CHILD SEXUAL ABUSE, THE HEART OF THE MATTER Jefferson Abraham Aispur Rivera,
President at AEMPPI–UTA, 2018 | Universidad Ténica de Ambato
Child sexual abuse is a problem around the world, and the majority of the cases are not detected or reported. Such violence causes sequels in the short, medium and long term. He is considered as child sexual abuse to all suggestive acts of a sexual nature between an adult and a minor, in which minor is used for sexual satisfaction of the offender or third parties. Usually offenders are family members, and acquaintances, who take advantage of the inability of the children to agree and understand the fact. Sexual abuse can be physical contact (incest, rape and statutory rape) or can occur without physical contact (exhibitionism and voyeurism) where victims are manipulated to produce pornography and excite to third parties.
How to act in the medical consultation? Health staff that receive the victim, should create a comfortable, friendly and open atmosphere to the dialogue. In the Anamnesis must describe the acts of aggression, always watching the attitude of the victim and the companion. Details of the alleged offender must register, and in the event that the victim is a teenager, it is important to register the menarche, the date of last menstrual period and use of contraceptive methods. In the end, it is transcendental to analyze if there is inconsistency in the information collected. Physical examination often not evidenced the presence of injuries and physical signs
of sexual abuse. The presence of lesions should be described in sense cefalo-caudal, and you must also register the presence of fluids (semen, blood). In the examination of the genitals is an anatomical description and traumatic lesions (abrasions, excoriations). The proctological examination is performed in both sexes. Search of sperm is made in vagina up to 6 days after the attack, from 12 to 14 hours in the mouth, and up to 3 days in the anal hole. Glycoprotein prostate test indicates sexual intercourse in the last 48 hours and values of phosphatase prostatic acid > 50 u/l confirm sexual abuse. (MSP, 2009, p. 86)
How to prevent it? A way to prevent is to create spaces for dialogue and learning with children and adolescents, giving security in themselves and providing them with the tools they need to make decisions about her own body. Let's talk with children and adolescents about the subject. Sexuality must not be a taboo.
Be the change you want to see in this world. M. Gandhi
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ยกthanks for everything, family!
@aemppiucuenca
Editor in Chief: Design and Layout: Translation: Colaborators:
Damary S. Jaramillo Selena X. Jaramillo & Damary S. Jaramillo Ana Ullaguari & Damary S. Jaramillo Thank you so much to all members of our Local Organization and others. Also, to the members of our dearest NMO, 2018. And, specially to our amazing members of the Americas Region and International Teams, PC/SC.
SPECTRUM, an activity by AEMPPI-UCuenca, endorsed by AEMPPI-Ecuador and enrroled to Medical Education Systems Program, one of the most active Programs of IFMSA. For further information: spctm.articles@gmail.com, or +593 939 301318