Vector: Issue 5 October 2007 by The Australian Medical Students' Association

spreading the challenge of addressing international health issues

indigenous health issues — real people and real lives at risk

issue 5

october 2007 1

editorial by nicola sandler & cara fox

reflections on six months in alice springs by bae corlette

close the gap by tom crowhurst & michael cilento

2-3

story of jonathan humphries by kia alizadeh

john flynn scholarship by justin sherwin

reflections on dwc ‘07 by alp atik & ming chen

ifmsa aug ‘07 ga report by anthea lindquist

news review by kong

global health quiz by kong

prizes for prose comp

Photo © Charlie Lawrence, www.sxc.hu

editorial We’ve all heard the statistics. The Indigenous people have a lower life expectancy, less access to health care, and prevalence of diabetes and cardiovascular disease. Indigenous health has been shown to be worse than some of the third world nations. But what does this all mean to us as medical students? And what can we really do to help? As many of you know, these are not just statistics. They are not just numbers and facts, but they are real people and real people’s lives at risk. This edition of Vector focuses on Indigenous health, where we have heard a lot of great things about what medical

students are doing around the country to help raise awareness, and to help to try and make this situation better. Some have raised money in their hometowns, and some have gone into the Indigenous communities, and gotten to know the people first hand. Each of these stories signifies a step forward, and each signifies an effort to make a change. As this was our first issue as the new co-editors, we found it an imperative issue to start on, and one that could not be more relevant. We hope that this too inspires you to action, and at the very least, gives you a good idea of what is really going on.

nicola sandler & cara fox, editors of vector by

reflections on six months in alice springs

—a

unique 3rd year experience

lice Springs is an unusual place and the population here is very transient. It is a service town whose number one industry is health and social services, followed by tourism as perhaps a close second. The gravity of health and social services need on the ground is almost impossible to overlook. Although sadly, ‘almost’ is the operative word. Not less than six weeks after I arrived here it struck me that in the course of daily work I hadn’t managed to engage with the indigenous community – who make up the vast majority of our patients – at all. Despite spending my time between the Central Australian Aboriginal Congress, the Alice Springs Hospital and remote community clinical visits, the opportunity for conversation remained amongst the stafﬁng realm only. And what’s more, conversations proved to be unceasingly about the great dilemma of patient behaviour frustrating their health outcomes. We are endlessly inquisitive on our short-term visits, which is probably a good thing, but might also serve to perpetuate this dissonance if we don’t stop to catch ourselves from jumping on board and blaming patients before we’ve even had a chance to know them. Bridging this dissonance means somehow ﬁnding time that we don’t have to spend with patients in a setting where dominance is in equal balance between us. So am I saying that we must have a deep appreciation for the socio-cultural context of all our patients’ before we can work effectively with any of them? I don’t know, maybe that’s not feasible in practice. But surely as a student it is the time to explore

that alternative rather than simply learning how to deal with a presumed problem. True, we are pressed for time to learn our basic syllabus, but really what’s the worth of all our medical knowledge without the humanity to apply it? The perennial theme I hear is one of feeling helpless in the setting of such immense problems that are too big to be addressed by medical care. And can anyone really dispute that the determinants of indigenous ill health go well beyond the conﬁnes of the clinical setting? Equally, can we hope to have any impact in indigenous health if we choose to accept that our role is unrelated to the determinants of ill health? The rational conclusion from this line of argument can only be to move away from medicine or from indigenous health all together, in which case was there really anything to gain from a stint in a place like Alice Springs to start with? Could this disillusionment with indigenous health somewhat underlie the recent surge in interest in global health amongst medical students nationally? The truth is that without efforts to engage with local people in the community, the opportunity for greater insight into working with indigenous people can be lost. While it is the curriculum of third year medicine that will help to pass exams (wherever you learn it), it is the experiences with people in the community will help to become a doctor. I hope that I never forget that. by bae corlette, flinders university

indigenous health issues — real people and real lives at risk

close the gap

fundraiser report O n Wednesday, 22nd August 2007, ﬁfteen second year MBBS students from the University of Adelaide conducted a fundraiser in support of the Oxfam “Close the Gap” campaign - which endeavours to reduce the shocking inequality in life expectancy currently existing between Indigenous and non-Indigenous Australians.

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and the event itself. Aboriginal and Torres-Strait Islander ﬂags were hung from the wall of the Medical School for the afternoon, and; Oxfam “Close the Gap” posters, stickers and pamphlets were to be seen everywhere.

Aboriginal and Torres Strait Islanders have a life expectancy 17 years less than other Australians. The fundraiser had two aims: 1. To raise student awareness of the inequality in life expectancy, and general health, that Indigenous Australians currently suffer; associated with this was the goal to raise awareness of, and support for, the Oxfam “Close the Gap” campaign 2. To raise funds to donate to the Oxfam “Close the Gap” campaign This event took the form of a barbeque, located outside the School of Medicine. Thanks to the help of Jenni Caruso, from the Indigenous Health Unit, this turned out to be a highly successful event, where: • Students, staff, and passers-by were able to choose from a delicious range of lunchtime selections, including halal and vegetarian options. • A PA system was organised, through which a pair of Indigenous artists performed two fantastic sets of Indigenous music featuring a wellbalanced contemporary inﬂuence. • A large canvas was sourced, on which the “Close the Gap” slogan was dot-painted by students as they ate their lunch: this piece will soon be hung in the University of Adelaide Medical School as a lasting tribute to the “Close the Gap” campaign

The fundraiser successfully achieved its two primary aims. By the end of the afternoon, over 200 students and staff had signed the petition pledging their support for the Oxfam “Close the Gap” campaign and a great deal of Oxfam “Close the Gap” pamphlets and stickers were handed out – it is hoped that these items will raise awareness for the cause. The “Close the Gap” dot-painting, will be hung in the medical school, where it shall serve in the years to come as a poignant reminder of the health inequality that Indigenous Australians currently face. Thanks to the huge amount of support offered by University of Adelaide staff and students, the event also managed to raise $663.20 for the Oxfam “Close the Gap campaign - and it was raised in just one afternoon by a few medical students. Let’s help close the gap.

tom crowhurst & michael cilento university of adelaide

Close the gap: The ﬁnal touches are added.

Music: Two fantastic sets of indigenous music added another dimension to the day.

BBQ: The ﬁnal sausages are sold to conclude an overwhelmingly successful day.

the story of jonathan humphries

page 2

met Jonathan Humphries in the town of Kellerberrin, WA. It was a meeting by coincidence, yet he insisted that I afford him the time to listen to his story, record the interview and pass it on to as many as I can. Jonathan begins his tale by citing the story of his grandfather, who was born in 1910 in Beverly, only two years prior to when the local post ofﬁce was built in Kellerberrin. He tells me the sad story of a man who was practically forced to help clear the sacred land around Kellerberrin – ready for seeding and harvest. Jonathan claims this legacy of agriculture as only one of the factors which

to this day prevents him from passing on practical and traditional aboriginal knowledge to younger generations; “I want to teach the kids the traditional way, the traditional way to hunt, to cook – but what was always a black man’s property is now a white man’s property”. He recalls the plight of his mother and grandmother, who although would work in the town during the daytime – would retreat to the outskirts as soon as curfew came around each evening. The time before 1967 (when aboriginal suffrage is granted) is remembered for racism and injustice. Jonathan stumbles through his story – He says that he is a qualiﬁed welder and slaughterman – with traditional aboriginal skills in tracking. He is angry and frustrated, and blames prejudice for his unemployment “…they think we don’t know how to work”. According to Jonathan his unemployment is

continued on page 3

the cause of his alcohol and substance abuse, but the effects are self proliferating. At only thirty-eight years of age, Jonathan looks more like a man in his mid-ﬁfties. He lives within a family structure where everything is owned and shared by all – even alcohol and cigarettes are shared – a ‘kind’ gesture which only diffuses and replicates his problem with other younger family members. For three hours I sit and listen. I ﬁght my own prejudices as I hear a meandering account of misery and despondency – a story that could leave anyone wondering where to start helping and how to provide that help. Jonathan bemoans the fate of his people. He is an appeal not only to the health professions but to all Australians to acknowledge this situation – to become aware of the wider picture of rural and remote indigenous help, before embarking on an

the john f l y n n scholarship

The encounter leaves me embarrassed; that for so long I have been part of the neglectful majority. Before Jonathan and I part ways we shake hands – he reminds me that to progress we need to “be as one, live as one people”.

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continued from page 2

effort to contribute to a resolution. No amount of learning regarding this challenge is wasted. An understanding of the history and customs of the Noonghar, Wongi and Yamatji people for instance, could assist a student of medicine hoping to be a partner in healing. Professions like medicine, nursing and most allied health for that matter can be at the forefront of the paradigm shift of thinking required in this country.

by kia alizadeh, 1st year medical student notre dame, fremantle

reflections on

developing world conference 2007

y placement took on more of a community flavour on this occasion. I undertook many different activities aside from regular hospital duties. These included assisting the doctor with a talk he gave to members of a service club about prostate cancer, as well as join him on his weekly community radio segment. Items discussed included fitness, nutrition and mental health. I felt comfortable interacting with the community because of my past experience in the same setting. Memorable moments from a social perspective included attended the hospital’s staff Christmas party, participating in a community triathlon, as well as hiking with fellow medical students. My mentor provided me with a valuable insight into being an efficient and successful medical practitioner as well as an insight into the role of a rural doctor. Because of the need to cover basic surgical, anaesthetic and obstetric services, doctors here are multiskilled, and need to be able to hold up one end of the operating table! Overall, the experience has been enriching, allowing a fantastic insight into healthcare in a rural and remote community. On further visits, I envisage improving my diagnostic and treatment skills, as well as continuing to build my relationship with the community; all form the basic objectives of the John Flynn experience. by justin sherwin, monash university

delaide certainly delivered a fantastic DWC. Whether it be the free ‘fairtrade coffee’ given to all attendees in their conference bags (something that was certainly required throughout conference) to the myriad of amazing speakers who enlightened us with their knowledge and experience, this year’s DWC was a resounding success. We also saw the ﬁrst time a conference book was handed out to delegates – a mammoth compilation with contributions from students and doctors around the world. Congratulations to all the organisers – AMSA Global and the DWC certainly have made massive progress. by a l p atik ghn representative university of newcastle

Friends from Australia and New Zealand re-unite!

delaide was the proud host of Bond’s ﬁrst DWC delegates. DWC provided us with an understanding of just about every discipline involved in improving global health through not only excellent speakers, debates and case studies, but also a brilliant multi-cultural social program every night. It was also an excellent opportunity to meet students interested in global health throughout Australia and New Zealand. We were able to share ideas and learn more about management through the IFMSA training workshops. We look forward to seeing a learning more at next year’s GHC! by m i n g c h e n ghn representative bond university

Reading the conference book

Dressing up and being ‘south east Asian’ at the dinner of nations

Using the wooden cutlery at dinner

Lending a Hand: the Aid Issue

indigenous health issues — real people and real lives at risk

Photo © Dorothy Williams, www.sxc.hu

—a reflection of my placement on n o r f o l k i sland

ver the past decade, the growing force of globalisation has facilitated the unveiling of vast inequities in our global community. Heralded in part by the establishment of the United Nation’s Millennium Development Goals in 1999, these inequities have started to gain greater recognition by people around the world and we have witnessed rising pressure on governments of developed nations for increased commitments to foreign aid and support and worldwide campaigning for universal improvements in human rights and quality of life. Despite these efforts, the state of health of many communities around the world remains as unacceptable as ever before. The responsibility of ensuring that existing global health needs are adequately addressed is one shared by governments and societies worldwide, but especially falls into the hands of health professionals, including current doctors and training medical students. The International Federation of Medical Students Association (IFMSA) recognises this responsibility and for the past 56 years, has hosted a biannual General

Assembly in a collaborative effort to improve the understanding of, and response towards global health issues amongst medical students around the world. In August this year, the IFMSA GA was held in Canterbury, England, and championed the theme ‘Access to Essential Medicines’. Approximately 1000 medical students from over 100 different countries participated in a week-long programme of seminars, workshops, formal meetings and a string of memorable social events! Morning sessions provided an opportunity for Standing Committee’s of the IFMSA to meet and share knowledge, project ideas and enthusiasm. The 16-strong Australian delegation was dispersed amongst the Standing Committees that included Public Health, Human Rights and Peace, Medical Education, Reproductive Health and AIDS, Professional Exchange and Research Exchange. We were all inspired by the work of medical students in different countries and gathered a range of exciting ideas for projects that can be adapted to an Australian or Asia-Paciﬁc context. The complex issues relating to ‘Access to

If you have any questions, please feel free to access the IFMSA website or contact us: Website: www.ifmsa.org Email: aclin123@gmail.com or jakeparker@hotmail.com

anthea lindquist

monash university

& jake parker university of queensland

news review Photo © Jonathan Hillis, www.sxc.hu

saving the babies: a victory in africa Botswana achieves a low mother-to-infant HIV (MI-HIV) transmission rate of 4% this year, as compare to the 12% global transmission rate. Hailed as an “extremely impressive results”, its efforts in reducing MI-HIV transmission are cited as model to other African countries with high HIV burden. To ﬁnd out more, visit: http://www.boston.com/news/globe/health_ science/articles/2007/08/27/saving_the_babies_a_victory_in_africa

pre-empting new and old infectious diseases pandemic: who 2007 health report 39 new pathogens, including HIV, were identiﬁed since 1967. Together with other worsening centuries-old infectious diseases such as TB, they are threatening current global public health security. In response, the new WHO 2007 report recommends upgrading current surveillance and response to these potential infectious diseases pandemic. For more details, visit: http://www.who.int/mediacentre/news/releases/2007/pr44/en/ index.html delivering insecticide-treated mosquito net (itm): commitment, endowment, assistance? A recent Kenyan study, according to WHO, “ends the debate” about how to deliver the much needed insecticide-treated mosquito net (ITM) in malaria infested regions. Free mass distribution of long-lasting net has shown to dramatically increase ITM coverage and reduce mortality rate in vulnerable group. News article on: http://www.who.int/mediacentre/news/ releases/2007/pr43/en/index.html

Photo © Jim Gathany, www.wikipedia.org

Photo © Aram Dulyan, www.wikipedia.org

world facing “arsenic timebomb” BBC reported that about 140 million people, mainly in developing countries, are being poisoned by arsenic in their drinking water. With a higher rate of developing cancer, long term consumption arsenic is precipitating a global “arsenic time bomb”, mainly affecting countries with the least ability to respond. The full story at: http://news.bbc.co.uk/go/em/fr/-/2/hi/ science/nature/6968574.stm

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Essential Medicines’ (AEM), one of Medecins Sans Frontieres strongest campaigns, were explored through a pharmaceutical debate and various small group sessions hosted by prominent members of the ‘AEM’ campaign. Delegates learnt some important truths about the negative impact that unreliable funding, complex logistical challenges and patents enforced through global trade agreements has on the equitable access to essential medicines throughout the world. We were also given an insight into the steps that need to be taken by governments, doctors, allied health workers and medical students to ensure positive changes are galvanised in the near future. The IFMSA GA provided an invaluable opportunity to meet motivated colleagues from around the world and be inspired by their stories and their achievements. Furthermore, the GA offered an important reminder of the responsibility of all medical students to strive towards improving existing global health inequities and to enthuse our fellow medical students to share this commitment.

Image by Ute Frevert & Margaret Shear, www.wikipedia.org

indigenous health issues — real people and real lives at risk

ifmsa august 2007 ga report

south asia floods Diseases, deaths, devastation and destitution plague millions of South Asian Flood victims since the starting of Monsoon this year. Latest death toll hits 2000. With inadequate relief from local authorities, survivors are struggling to rebuild their life; while another 145,000 suffer from diarrhoea and other water-borne illnesses such as typhoid and hepatitis. Visit: http://www.alertnet.org/thenews/newsdesk/DEL201802.html for more information. In addition, Ian Bray, an Oxfam aid worker, has his experience in Bihar, India, published on BBC. The full article is on: http://news.bbc.co.uk/2/hi/south_asia/6941029.stm

compiled by kong university of melbourne

3. On average 800,000 of world population commit suicide every year, how many percentages of them are from middle and low income countries? a. 74% b. 86% c. 53% d. 24% 5. According to a new study published on Eldis, Gross Domestic Product (GDP)/ capita has a higher signiﬁcance than infant mortality rate in determining the likelihood of political instability. True or False? compiled by kong university of melbourne

5. 4.

86%: More than half of the 800,000 are from the age group between 15 and 44, with the highest suicide rates found among men in Eastern European countries. Mental disorders are one of the most significant and preventable causes of suicide. Visit the mental health facts file on http://www.who.int/features/factfiles/ mental_health/en/index.html for a glimpse on global mental health. False: Through a 69 pages working paper exploring the linkage between corruption and conflict (http://www.eldis.org/go/topics/resource-guides/ conflict-and-security&id=33053&type=Document), the author pointed out that past study (http://globalpolicy.gmu.edu/pitf/PITFglobal.pdf) has shown otherwise. IMR seems to be a better indicator of standard of living in a region and therefore better in indicating potential political instability.

answers

competition

he AMSA Global Health Network (GHN) and T Vector magazine would like to extend a very warm congratulations to the winners of this edition’s prizes

for prose competition: Bae Corlette, Anthea Lindquist, and Jake Parker! These three budding writers have each won sensational prizes from Wakeﬁeld Press for their contributions to this edition of Vector magazine: books packed with info about global health. The GHN’s Vector magazine will continue its prizes for prose competition next edition. So get your pens scribbling! If you would like to be part of the writers pool for next edition, please email vectormag@gmail.com.

GHN Publicity Ofﬁcer Nadine Ata publicity.ghn@amsa.org.au

Editors Nicola Sandler & Cara Fox vectormag@gmail.com

credits...

Design & Layout Vanessa Fitzgerald orangebutterﬂyness@hotmail.com

Lending a Hand: the Aid Issue

p r i z e s for prose

indigenous health issues — real people and real lives at risk

2. From an ancient Chinese herbal medicine, what is the backbone of a combination therapy most effective for the widespread chloroquine-resistant malaria parasites? a. Quinine b. Artemesenin c. Erythromycin d. Doxycycline

2. Crop eradication is the one effective policy in tackling illicit drug usage without causing any potential harm to other communities. True or false?

d) Diarrhoea: According to WHO estimation, Diarrhoea causes 17% of under five deaths (Measles 4%, HIV-AIDS 3%, Injuries 3%). Source: Bryce J, BoschiPinto C, Shibuya K, Black RE. WHO estimates of the causes of death in children. Lancet, 2005, 365:1147–1152 b) Artemesenin: According to a seminar paper on Malaria published on the Lancet (Vol 365 April 23, 2005), few regiments of Artemesenin based combination therapy (ACT) has shown great efficacy in some part of Asia and Africa. Visit www.thelancet.com to access this article. False: According to Id21 insight health issue #10, without complementary development initiatives, crop eradication programmes can exacerbate poverty among farmers, accelerate deforestation, and worsen armed conflict. Find out more on: http://www.id21.org/insights/insights-h10/art00.html

1. Globally, 10.7 million children die every year mainly due to preventable diseases. Which of the following are the third most common causes for under-ﬁve deaths (after pneumonia and Neonatal deaths)? a. HIV-AIDS b. Injuries c. Measles d. Diarrhoea

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q u i z

g l o b a l health