ASPIRE #35 by AMSA International

ASPIRE

#35

One Health in Everyday Lives

Getting into One Health Explore new knowledge about one health concept in our everyday lives through the articles and creative works in ASPIRE #35 !

AMSA International Activities

Creative Corner

Featuring the 1st AMSA International Summit, masterclass, and 74th Sessions of the WHO Regional Committee for Southeast Asia

All creative medical student in this world gather to make the masterpiece! Go check and be inspired by their artworks, photographs, and many more !

T N S

FOREWORD A

EDITORIAL BOARD

CONTRIBUTORS

EXCECUTIVE COMMITEES

AMSA INTL ACTIVITIES

CHAPTER/ UNIVERSITY PROFILE & EVENTS

MEET THE EXPERT

HEALTH ISSUES

162

HOBBIES

168

154

CREATIVE CORNER

158

FEEDBACK SURVEY

GOOD NEWS SECTION

CLINICAL CHALLENGE

182

183

PARTNERS & SPONSORS

FOREWORD reetings, People of Tomorrow! Welcome back to AMSA International eNewsletter: ASPIRE #35! It has been several months since the last eNewsletter’s publication, and a lot has happened since then. AMSA International managed to kickstart a new tenure, and ASPIRE #35 marks the first issue of the 2021/2022 tenure. In this issue, we brought up an extremely interesting topic: One Health in Everyday Lives, which is also in collaboration with one of our esteemed partners, One Health Lessons. In this edition, you will find a lot of articles, creative works, and many more from our beloved members. Moreover, we also have included several AMSA International events recap for you who missed them — including our Masterclasses. We sincerely wish that you would enjoy this edition as much as we do. A special shoutout for my Editorial Board members — we could have never done this without you. Virtus et Doctrina, Viva AMSA!

Best Regards, Kassie Gracella Putri Chief Editor of eNewsletter AMSA International

EDITORIAL BOARD AMSA INTERNATIONAL 2021/2022

CHAPTER REPRESENTATIVES AUSTRALIA

BANGLADESH

ENGLAND

HONG KONG

INDIA

INDONESIA

Kirsten Tsan

Nashita Nowshin

Macy Au

Tania Chan

Samneet Singh

Priscilla Sayogo

KYRGYZSTAN

MALAYSIA

MYANMAR

NEPAL

PAKISTAN

PHILLIPINES

Rahul Gautam

Hasanah N

Irene

Susmita K

Bisma Arif

Lloyd Anicier B

SCOTLAND

TAIWAN

Samantha Goh

Wendy Liu

PROOFREADERS TEAM AUSTRALIA

INDONESIA

PHILLIPINES

Justin Lee

Garry Soloan

Gifta Hamiseno

Shafira Meutia

Celestina Salvador

INDONESIA Charlotte Lintang

DESIGNER

LAYOUT

INDONESIA

INDIA

Florentia Amanda

Jauda Hanoon

M Raihan Ramdhan

Disha Suresh

Malinga Paddy Derick FAMSA

Herman Lai AMSA HongKong

Harsheena Gobind AMSA Indonesia

Keith Lee AMSA HongKong

Samantha Goh AMSA England

Lauren Fong AMSA HongKong

Tania Chan AMSA HongKong

Nicole Tung AMSA HongKong

Bernard So AMSA HongKong

Ajeng Rahastri AMSA Indonesia

Elizabeth Lam AMSA HongKong

Aramva Adhikari AMSA Nepal

Diksha Kandpal AMSA India

Muhammad Afif Naufal AMSA Indonesia

Gifta Hamiseno AMSA Indonesia

Novonil Deb AMSA India

Raynanda Sabta Charis Binti AMSA Indonesia

Prachi Singh AMSA India

Jibin Chacko AMSA Phillipines

Divya Chauhan AMSA India

Manali Sarkar AMSA India

Praveen Bharath S. AMSA India

M Mikail Athif Zhafir Asyura AMSA Indonesia

Rachita Reddy AMSA India

Reece Ansaar AMSA Australia

A.D AMSA Nepal

Rounak Singh AMSA India

Anveshak AMSA India

Shekhar Khatiwada AMSA Nepal

Jeshika Yadav AMSA Nepal

Shreya Datta AMSA India

Lloyd Anicier Barba AMSA Phillipines

Susmita Khatiwada AMSA Nepal

Manvi Lamba AMSA India

Upama Kalita AMSA India

Michelle Joshalyn N AMSA Indonesia

Harshul Sood AMSA India Kirsten Tsan AMSA Australia Khania Inayah Aini AMSA Indonesia Yu Ming Zien AMSA Malaysia Priscilla Sayogo AMSA Indonesia Garry Soloan AMSA Indonesia Nashita Nowshin AMSA Bangladesh

AMSA Intl

ACTIVITIES

PNP X IT RENEWS MASTERCLASS ON

BRANDING & WEB DEVELOPMENT

Greetings, People of Tomorrow! After the successful conduct of last year’s masterclass, the Departments of Publications and Promotions (PnP) and Information Technology (IT) hosted again this year a two-day masterclass on branding and web development, held on November 27-28, 2021. The masterclass was divided into two sessions with the themes “Branding: Bridging your Chapter Identity into Greater Heights” and “Starting in Web Design and Development:

Publications and Promotions: Branding

Bringing your Chapter Identity into the Greater Heights When you hear the word “Branding”, what pops into your mind? Is it one of the various clothing brands that you adore? The brand of your smartphone? Or is it the logo of a famous company? In this Masterclass session, the division of Publications and Promotions of AMSA International brings its audience another insightful session regarding the importance of branding, and where it fits within the scope of a large organisation such as AMSA International. The session was opened with a lecture session by Dr. Ahmad Aulia Rizaly, a general practitioner, who was once, the Director of Publications and Promotions of AMSA International in the tenure 2014/2015, and the General Secretary of AMSA International in 2015/2016. During this session, participants were challenged to approach design unconventionally, where dr. Ahmad stresses out that Publications and Promotions were never just the “social media administrator” or “video guy”, but it is what makes AMSA International, a one-of-a-kind organisation among others. To achieve this, Dr. Ahmad Aulia Rizaly stresses several principles such as to never blindly follow the current trend, as what works for others, may not work for us. Second, Dr. Ahmad also believes that the practice of following contemporary trends would not be ideal in creating an attachment between the audience and the brand that any organization should always aim to achieve.

T o c l o s e off the lecture, Dr. Ahmad Aulia Rizaly hopes that the participants would hold dear several tips in creating designs, which are to first, mind our audience, never alienate them, as we seek to establish attachment with the audience, we should never use too much jargon or oversimplify a design. The second is to create an efficient design, we should always aim to be able to convey essential information from our design in seconds. Lastly, is to keep our design simple, as dr. Ahmad believes that no one would like a confusing design to represent a brand. The lecture session is followed by an interactive Question and Answer session, which allows participants to clarify their doubts regarding the lecture material. Aside from the lecture session, participants were also invited to participate in an interactive workshop session, where they got the chance to directly apply the knowledge that was learned, as they try to create their designs, with the help and guidance of the current Director of Publications and Promotions, Revina Maharani and Faida Ufari Prameswari. With the workshop, the first Masterclass of the week came to an end, and participants were invited to take a picture together to commemorate the event. However, this was just the first Masterclass session, as the participants look forward to the next session regarding web development from the Information Technology Masterclass.

The Roadmap of Web Development On the second day, Muiz Ibrahim, AMSA International’s Director of IT, briefed the participants on how to navigate the “confusing complex maze of technologies” used in web design and development. Highlighting the “roadmap” which consists of frameworks, tools, and other key points, he tackled the implications of web design and the front-end and back-end aspects of web development. Front-end development covers both designing and implementing web design in programming languages such as CSS/ HTML/JS. Back-end development, on the other hand, involves programming the server side of the website.

On addressing the challenges of web design, Mohammed Jailam stressed that it is a continuous challenge to learn new technologies and standards that are evolving and born every single day. “It is important that you standardize your work, understand the best practices that developers do,” he further emphasized. Arushad Ahmed, meanwhile, pointed out that for beginners who want to set up a website for their own organizations, there are tons of other technologies that do not require coding like WordPress where users can opt for free or premium themes to achieve a professional look for their websites. Mohammed Jailam banked on this, saying that “no-code” technologies are already on the rise to give power to people

Also present during the session were co-founders of Javaabu Pvt Ltd, Arushad Ahmed (CTO), and Mohammed Jailam (MD).

Written by : Garry Soloan eNewsletter Editorial Board 2020/2021

Lloyd Anicier Barba eNewsletter Editorial Board 2020/2021

AMSA INTERNATIONAL

GLOBAL HEALTH MASTERCLASS On 31 October 2021, AMSA International held their very first masterclass of the tenure, the Global Health Masterclass. With the theme “Public Health”, the masterclass focused on how to conduct a public health project in a systematic way, the importance of public health projects, as well as encouraging AMSA members to create beneficial public health projects. Over 120 delegates from 27 AMSA chapters attended the event via Zoom meeting, which lasted for approximately two and a half hours (17:00-19:30 GMT+8).

he masterclass was opened by an introduction to the Global Health subsidiary of AMSA International. Ms. Ang Zi Qi, current Director of Global Health of AMSA International 2021/2022, gave a brief explanation on the subsidiary, which includes their objectives, what they do, and the past events that were held by the Global Health subsidiary. It was a good start of the session and the delegates were able to learn more about the Global Health subsidiary and the fun experiences of previous members.

To lighten up the mood, the session was continued by a small ice breaker led by the moderator, Ms. Jeslynn Koh. Through the website mentimeter, the delegates were given questions to answer, such as where they are from, what they expected from the masterclass, and even their favorite foods. The delegates enthusiastically participated in the activity and by the end of the activity, the delegates were able to warm up to each other before moving to the next session. Ms. Helena Arnetta Puteri, the former Regional Chairperson of AMSA-Indonesia 2020/2021, Advisory Board of AMSA-Indonesia 2021/2022, and Founder and Chief Executive Officer of the Touch Hearts Project, then presented a lecture on the basics of public health management. She suggested that the success of a global health project boils down to five main steps: needs assessment, planning and preparation of the project, proposal creation, development of key partnerships and program evaluation.

Needs Assesment A needs assessment intends to identify the target audience of the project and clarify their issues and priorities. This information helps to determine the scope, scale and nature of the project. She provided the example of the recent

AMSA Indonesia national needs assessment - the data from the questionnaires was analysed and highlighted prevalent health issues in different regions. With this information, they were able to determine what projects should be prioritised in various regions and distributed their resources and efforts accordingly.

Planning & Preparation Once a target audience has been identified, it is time to design the project in terms of its approach, aims, goals and success criteria. The approach should be catered to the target audience, and there should be objective goals and criteria in order to be able to clearly evaluate the success of the project at its conclusion.

Proposal & Partnership Development The creation of a proposal is not always necessary depending on the scale of the project, but it is very useful to assist with building relationships with external partners. A proposal should include some background on your organisation, the objectives and details of the project, and contact details for discussion of interest.

Partnerships can be developed with a range of different organisations, ranging from professional organisations to youth groups to local communities.

Program Evaluation After the project has concluded, it is important to have both internal and external evaluations of its success. Internal evaluations are based on the predetermined success criteria and feedback from members of the team involved in the project. External evaluations take audience feedback into consideration, typically through pre- and post-event questionnaires or surveys, and assess the audience response to the event.

or the next session, the delegates were directed to enter their respective breakout rooms according to their groups to do a small group discussion. In each breakout room, there was a Global Health manager who led the discussion. For this session, each group was required to discuss a topic, make a Powerpoint, and present the result within the breakout room. The topic was about Zoom fatigue and its definition, causes, and possible solutions. The delegates were given 25 minutes to complete the Powerpoint and 5 minutes to present.The presentation was recorded by the Global Health manager in each breakout room in starting a project without prior experience was to be confident in your goal, and stay connected with the AMSA community for support!

The masterclass was apprec ated greatly by attendees, an the vast majority of participan felt much more confident abou participating in or planning their own public health projects in the future. We received lots of positive feedback from the participants and many felt that they

came away m u c h more confident and with new f riends from the small group discussions. The session was closed by the Director of Global Health, Ms. Ang Zi Qi and the moderator. Overall, the delegates enjoyed the masterclass and took home valuable knowledge.

cind nts ut

Written by : Gifta Hamiseno eNewsletter Editorial Board 2020/2021

Kirsten Tsan eNewsletter Editorial Board 2020/2021

Session of the WHO Regional Committee for Southeast Asia

Day

After the group discussions, a panel of current and past Directors of Public and Global Health shared their experiences running global health projects and answered questions from the audience. The panel included Ms Saundarya Monga (AMSA India), Mr Shahrukh Shahriar (AMSA Bangladesh), Ms Evelyn Calista (AMSA Indonesia) and Mr Mason Iao Kai Hei (AMSA Macau). They emphasised the importance of understanding one’s target audience and their needs, timely communication with external partners and close foll o w - u p , and reaching out to fellow AMSA members and mentors for advice and assistance throughout the project. Most of all, their advice to those interested

The second day highlights the Ministerial Roundtable involving the Member States of the WHO SEARO region debating about the coronavirus pandemic. Dr Bharati Pravin Pawar, Minister of State for Health and Family Welfare of India shared key learnings from India in dealing with COVID-19. She informed the Member States that having strong and decisive leadership who makes proactive decisions [not only] slows down the spread of COVID-19, but also spared enough time to build public health infrastructures to manage the pandemic. On the other hand, Dr Dante Saksono Harbuwono, Vice Minister of Health, Indonesia stressed that the Indonesian government guaranteed the supply of [COVID-19] vaccines by increasing local production capacity and importing new medicines and vaccines through unilateral and multilateral channels. The Director-General (DG) of the WHO, Dr Tedros Adhanom Ghebreyesus explained that successive waves of COVID-19 exposed the longstanding gaps in national and sub-national health systems and essential health services have been badly disrupted as a result. He also outlined that any emerging structures and mechanisms should be grounded in 5 principles: (1) They must be equitable in the engagement and ownership of all countries. (2) They must be multisectoral involving partners across the One Health Spectrum. (3) They must have a covenant within the national health regulation. (4) They must be rooted into the constitutional mandate of WHO, and, (5) They must be accountable and transparent.

Day

The third day focuses on the prevention of non-communicable diseases (NCDs) in the WHO Southeast Asia region. Prof. Jeyaraj Pandian, Vice President of the World Stroke Organisation raised that the Member States must prioritise delivering acute stroke care amidst the pandemic to maintain time-dependent processes to optimise the delivery of thrombolysis and endovascular therapy. Meanwhile, Prof. Dr Aman Pulungan, Executive Director of the International Pediatric Association delineated the measures required to control NCDs among targeted populations such as providing access to accurate information, education, and training that is tailored to the specific language and culture of the community. Mr Kanate Temtrirath from the Ministry of Public Health in Thailand suggested that tackling NCDs require multisectoral actions such as malnutrition, control of commercial and social determinants of NCDs, increasing tobacco and alcohol tax in gross settings. Dr Palitha Abeykoon, WHO DG’s special envoy for COVID-19 Preparedness and Response focused on the need to foster the One Health approach for coordinated action at the human, animal, and environment interface to prevent and respond to zoonotic diseases and risks, including climate change and Antimicrobial Res i s tance (AMR).

Day

The fourth day zooms in on the importance of sustainable Universal Health Coverage (UHC). Mrs Carolin Spannuth Verma, United Nations High Commissioner for Refugees (UNHCR) Representative of Nepal urged the Member States to weigh more on civil registration and vital statistics for all residents, including documentation and 100% complete registration coverage [for any nationwide programs]. As both are crucial for formal, long-term, and reliable access to public health, and other public services for all residents, especially the most marginalised ones. Prof. Dr Man M. Mehndiratta, President of the Indian Epilepsy Society, detailed that people with epilepsy have a rate of premature death 3 times more than the general population. Hence, warrants the need for access to effective, safe, quality, and affordable medical products, diagnostics, and devices to achieve UHC and the 2030 agenda of the SDGs.

Day

During the closing ceremony, the chair of the Regional Committee determined the host of the 75th Session of the WHO Regional Committee for Southeast Asia will be the Royal Government of Bhutan. Things that the delegates found astonished were the 3-minute-stretches and the 5-minute breathing exercises at intervals, considering the event to last an entire day. In addition, 5-minute long-timers were introduced during the RCM, which improves the efficiency of each session. All delegates were delighted when they knew that they could receive official publications (in physical form) from the WHO RCM, which adds the cherry to the top of the cake. Overall, AMSA Internation- al delegates learned d e e p l y about health issues and will implement projects to help those in need in their re-

Everything that this subsidiary has presented has made me fall in love with it more and more. It’s not only broadened my understanding of healthcare but also opened my eyes to the difficulties faced by policymakers.

Written by : Yu Ming Zien Liaison Officer to GO and NGO AMSA International

ST AMSA INTERNATIONAL SUMMIT

“MENTAL HEALTH IN

AN UNEQUAL WORLD

Following AMSA International’s effort in contributing to the awareness, the 1st AMSA International summit was held, adapting the theme of “Mental Health in an Unequal World”. During the summit, participants were greeted with multiple keynote speakers, oral presentation from finalists, and even our very own psychiatric interview competition. With that in mind, I hope this small section in ASPIRE #35 could further extend my congratulatory remarks to all the participants and winners for the competitions in the 1st summit.

Although, a tricky question arises when talking about mental health from a One Health perspective. With the effort of connecting the human-animal-environment aspect, mental health (or social well-being) do play a unique role in this framework. Whether it is animal-assisted therapy as a treatment for post-traumatic stress disorder (PTSD), or the phenomeno logical and psychological relationship between the human and earth systems, the mention of mental health has never ceased from our daily lives.

TUL ATIO

y definition, mental health encompassess our emotional, psychological, and social well-being. Considered as a Global Health Issue, the topic is commonly discussed due to its broad relatability and multiple global awareness efforts, such as the recently commemorated World Mental Health Day (WMHD)

CON G R

SCIENTIFIC PAPER 1st Place Bendix Samarta Witarto, Visuddho, & Andro Pramana Witarto AMSA Indonesia Effectiveness Of Online Mindfulness-Based Interventions In Improving Mental Health During The Covid-19 Pandemic: A Systematic Review And Meta-Analysis Of Randomized Controlled Trials 1st Runner Up Nathaniel Gilbert D., Valerie Josephine Dirjayanto, & Priscilla Geraldine AMSA Indonesia Efficacy Of Internet-Based Cognitive Behavioral Therapy For Psychiatric Problems In Cancer Survivors: A Systematic Review And Meta-Analysis Of Randomized Controlled Trials 2nd Runner Up Joshua Joel F. Cahatol, Denisse Lorraine C. Bayalan, & Patricia Felise N. Perez AMSA Phillipines Mental Health Systems In Transition: A Comparative Analysis Of Indonesia, Malaysia, Philippines, And Thailand During The Covid-19 Pandemic

PUBLIC POSTER 1st Place Adara Kirana AMSA Indonesia Battling Schizophrenia Surrounded By Stigma 1st Runner Up Kelly Laurecia Hadi AMSA Indonesia Mental Health In Children: The Fight Against Ignorance And Disparity 2nd Runner Up Anggie Tri Andiani, Ester Septalyna, & Grace Shafadita Rahmani Herucakra AMSA Indonesia The Relation Of Toxic Masculinity Towards Mental Health

PSYCHIATRIC INTERVIEW COMPETITION 1st Place Aldithya Fakhri, Nathaniel Gilbert D., & Kassie Gracella Putri AMSA Indonesia 1st Runner Up Yue (Cherry) Shi, Emily Sun,& Garry Zhu AMSA Australia 2nd Runner Up Shintya Octaviana Baliulina, M. Fathi Athallah Zaky,& Fatimah Az Zahra AMSA Indonesia

CONGRA TULATIONS See you in the

2nd AMSA International Summit

Best Regards, Muhammad Mikail Athif Zhafir Asyura Director of Academics AMSA International

FAMSA PROFILE ORGANISATION NAME

Federation of African Medical Students’ Associations (FAMSA) (in French, Fédérations des Associations des Étudiants en Médecine d’Afrique).

YEAR OF FOUNDATION 1968

DESCRIPTION An independent, non-political, not-forprofit organisation of medical student associations in Africa was founded to foster the spirit of friendship and cooperation among African medical students. It is a project-oriented body and the forum for medical students throughout the African continent to discuss topics related to health, education, and medicine, formulate action plans from such discussions and carry out appropriate activities.

VISION To become a strong network of medical students who are aware of global health issues and are responsive to the current problems facing the medical profession and global health.

MOTTO

… towards the improvement of health in Africa

OBJECTIVES 1. To project the image of African medical students both on the continental and international scene. 2. To enhance and broaden the general and special education of member medical students in various parts of Africa and, thus, contribute to the improvement of medical education in Africa. 3. To establish contact with every Medical Students’ Association (MSA) in Africa on purely professional matters. 4. To promote an exchange of international correspondences, publication of news of medical interest through journals, and the organization of professional exchange of medical students between various countries. 5. To generate initiatives in population and health surveys as well as in biomedical research among African medical students and to collate and disseminate original findings on all matters pertaining to health in Africa. 6. To encourage and assist member associations in fulfilling the essence of our medical education, which is to contribute towards the improvement of health in Africa by rendering help in all projects where medical students can be of assistance.

STRUCTURE & ORGANS

A. The Executive Council

These are elected officials of FAMSA who carry out duties assigned by the General Assembly. It comprises the President, Vice President, General Secretary, Treasurer, Assistant General Secretary, Chairs of Standing Committees, Regional Council Coordinators (coordinate activities in each of the FAMSA regions corresponding to the 5 regions in Africa; North, Central, East, West, and South Africa), Special Executives, and the FAMSA Headquarters’ Administrator.

Standing Committees

FAMSA has 5 Standing Committees which coordinate its programs. Standing Committee on Health and Environment (SCOHE): responsible for all of FAMSA’s work related to health and the environment. For example, marking of International health days such as World Health Day, World AIDS Day, World Cancer Day, etc. Standing Committee on Medical Education and Research (SCOMER): coordinates all of FAMSA’s activities involving the education of its members, the building of research capacity, and carrying out research work. Standing Committee on Professional Exchange (SCOPE): coordinates student exchange programmes, including the FAMSA-AMSA Exchange Programme (FAMSEP) and the FAMSA Health Educative School where medical students from all over Africa come together to exchange professional information. Standing Committee on Publications (SCOPUB): responsible for FAMSA’s publications including the official journal AFROMEDICA and periodic newsletters. Standing Committee on Population Activity (SCOPA): coordinate all of FAMSA’s activities related to population dynamics and family planning.

The Headquarters

Serves as FAMSA’s information repository and a pivot for membership recruitment and formation of partnerships. FAMSA’s permanent Headquarters is located in the University College Hospital, Ibadan, Nigeria, under the care of the University of Ibadan Medical Students’ Association.

D. Medical Student Associations (MSAs)

These are the members of FAMSA. They are associations representing medical students in the different African medical schools which have been approved by the FAMSA General Assembly and have agreed to abide by the FAMSA constitution. The Federation has over 200 MSA members from over 40 African countries.

The General Assembly

The General Assembly is the highest authority and decision-making body of FAMSA. It holds annually with a two-fold purpose: the scientific conference, where panel discussions are held on topical health issues, and the General Assembly proper where the activities of the previous year are evaluated and new officials elected to execute the plans for the new administrative year. FAMSA has had 34 General Assemblies since its inception. The 35th FAMSA General Assembly will hold from December 20-23, 2021 in Cotonou, Benin Republic hosted by one of our members, Associations des Étudiants en Médecine de Cotonou (AEMC). The theme of the conference is ’SDG 3 in Africa amidst the COVID-19 Pandemic’

CONTACT DETAILS

Permanent Address FAMSA Headquarters, c/o Office of the Provost, College of Medicine, University College Hospital, Ibadan - 200212- Nigeria. Email: famsaarchives@gmail.com Website: www.famsanet.org Instagram and Twitter: @official_famsa YouTube: Official FAMSA Facebook: Official FAMSA

THE 2021 SCOHE-FAMSA TREK The era of the covid-19 pandemic has presented unprecedented challenges in every aspect of living and these passing 2 grueling years have scorched down the activities done in the health sector. With the world embracing an online model of teaching, meetings, and delivering services, FAMSA-SCOHE has not relented in exercising its mandate in championing progress in the field of health and environment. With COVID 19 SOPs at the helm early this year, we held awareness campaigns purely online. World malaria day was celebrated through online flyers with information regarding prevention as well as achievements highlighting how a malaria-free country is possible.

Written by : Malinga Paddy Derrick FAMSA

In May, we held a zoom educative session on how to measure accurate blood pressure and prevention of hypertension in celebration of World Hypertension Day on the 17. It was purely student-led and a success. Notably was the discussion on salt intake which is a staple ingredient if not in all, most of the African dishes. In celebration of World Environment Day under the theme, “Reimagine, Recreate and Restore”, students all over Africa sent in their creative submissions and the top 3 were shared on FAMSA platforms with recognition of the winners. The winner was Muhammad-Olodo Opeyemi from Ilorin University Medical Students Association (ILUMSA), 1st runner up – Boluwatife David Elusiyan f rom University of Ibadan Medical Students Association (UIMSA), and 2nd runner up with the best story – Akinjobi Temitope f rom University of Ibadan Medical Students Association (UIMSA). Lastly, UIMSA carried out a clean-up of Oyo state physically in advocacy. The 2-day 3-hours webinar on noncommunicable diseases on 20 and 21 August was the hallmark of our online activities. We hosted over 12 speakers under the main theme, “fostering youth inclusiveness in the fight against NCDs” having over 300 students attending across Africa from Nigeria, Uganda, Zimbabwe, Sudan, Ethiopia, Kenya, Libya, Sierra Leone, Cameroon, and South Africa. This was timely as one of the sub-themes was mental health which was rampant with lockdowns in most countries with depression the most common mental illness prevailing. In the same vein, a symposium on diabetes and Covid 19 has been held recently in celebration of world diabetes day. Students learned how Covid 19 affects persons with diabetes as well as the state of diabetes care in Af rica with key speakers from the Uganda NCD alliance, abstracts from clinical researcher D r . Andrew Peter Kyazze, and so much more. These are simply highlights of the many activities carried out by FAMSA-SCOHE excluding the full October Pink Project where we dedicated all 30 days to breast cancer awareness, world antimicrobial awareness week to mention but a few. As the Standing Committee on Health and Environment, w e have made large strides towards the improvement of healthcare in Af rica despite being in the middle of a worldwide pandemic. Kudos to the SCOHE committee executive and the local officers who have gone at length to see to it that all plans and activities come to fruition and tremendous success.

AMSA HONG KONG

(SCOE)

AMSAHK Standing Committee on

Exchange

The “AMSEP HKxIndia Virtual Exchange - Medtech’’ was successfully organised over a total of 6 days from 29th October to 7th November. This online event was attended by 30 medical students from both Hong Kong and India via Zoom. Highlights of the event included sharings on “Blockchain and its Relation to Medical Education” by Dr. Christopher See from Hong Kong, and “Nanotech in Healthcare” by Dr. Mamta Mohan from India. We are incredibly grateful for their support, and we hope our participants have gained valuable insights on these socially relevant topics. Aside from allowing medical students to approach a health issue in different social and cultural settings, this event also fostered friendships between participants through interactive socio-cultural activities. Our participants enjoyed activities such as a language workshop on Cantonese, Hindi and Marathi, a live cooking show featuring Indian desserts, and a traditional Chinese paper cutting workshop! As organisers, it is undoubtedly a delight to see participants actively engaging in the sessions and bonding with their counterparts from a different region. AMSEP is an invaluable opportunity for medical students to broaden their p e r spectives in the midst of a pandemic, and we hope that the friendships our participants have forged will blossom into lifelong bonds!

AMSAHK Standing Committee on

Sexual and Reproductive Health and Rights including HIV & AIDS

(SCORA

On 29 October and 12 November, SCORA organised two sessions of “Speak Up: Sexually Smarter” in collaboration with SCOME and Sagami Hong Kong. The event was well attended by a total of 40 medical students from both the Chinese University of Hong Kong and The University of Hong Kong. Overall, this was a highly engaging workshop, and we hope that our participants were able to learn the technicality in what makes a good and safe condom. Last but not least, we would like to offer our heartfelt thanks to SCOME and Sagami Hong Kong, our collaborators, for joining us in hosting this meaningful event!

“Walking with Women: Empowering Young Women in Sexual Reproductive Health Matters” is a new initiative launched by SCORA in collaboration with Teen’s Key - Young Women Development Network. This event took place on 5 November over Zoom, and a total of 20 participants including medical students, the general public, and other sexual and reproductive health and rights (SRHR) non-governmental organisations attended the event. This meeting was organised as a casual conversation with healthcare professionals, which helped to encourage young women to speak up about SRHR topics that might be considered taboo.

Participants were exposed to a diverse range of opinions regarding SRHR misinformation and stigmatisation, which helped them develop a holistic understanding of the public health challenges Dr. Brian, Cheng Kim Fung, Dr. Tam Ching posed by these problems. Ting, and Ms. Carey Choi were invited to share their unique experiences and in- After this event, we gained a deeper apsights on resources available for abortion, preciation of how healthcare professionals contraception and sexually transmitted could empower young women in sexual diseases (STD) testing in Hong Kong. They and reproductive health matters. Before also educated participants on how STDs any medical treatment can happen, we could be prevented and debunked com- must first engender judgment-free safe mon myths surrounding STDs. spaces for young women to consult professionals, which would encourage them to seek help. In addition, proper sexual health education programmes should be integrated into school curriculums, which is the key to preventing SRHR issues.

(SCOME)

AMSAHK Standing Committee on

Medical Education

“Breaking The Silence”, one of SCOME’s annual events in collaboration with Sign Bilingualism and Co-enrolment Community Resources, was successfully concluded on 7 November. A total of 4 weekly workshops were held for 34 pre-clinical year students in Hong Kong. Breaking The Silence is an interactive event that teaches sign language for future clinical application. It also aims to raise awareness of the trials and tribulations faced by the deaf community, which has helped many generations of participants become more empathetic and compassionate towards their needs. Aside f rom learning basic sign language communication, participants also had the opportunity to participate in “Touch my heart”, which was a series of mini-activities including: listening to and understanding audio contents that simulated the hearing of auditorily impaired or mute people, a lip reading challenge, understanding sign language syntax, and many more. Last but not least, Dr. Wong Chi Tak, the parent of a deaf daughter, delivered a heartfelt sharing on his experience nurturing his deaf daughter and his subsequent journey advocating for the education of the deaf as a medical professional. All in all, Breaking the Silence was undoubtedly an eye-opening experience that allowed all of us to learn more about the deaf community, while providing us with useful skills for our future medical career. Taking this opportunity, we would also like to express our sincere gratitude to our sign language tutor (Ms. Bou Suet Yee Amy), hearing facilitator (Ms. Cheng Yee Ting), sign interpreter (Mr. Man Ho Ching), and Dr. Wong Chi Tak for helping to make this event a resounding success!

(SCOPH)

AMSAHK Standing Committee on

Public Health

On 9 November, SCOPH was honoured to be joined by two guest speakers, Professor Joyce Ma from the Department of Social Work and Ms Daisy Wu, the Centre-In-Charge of the Hong Kong Eating Disorders Association, in organising “Understanding Eating Disorders”. This event was held on Zoom for 30 medical students from both the Chinese University of Hong Kong and the University of Hong Kong. The speakers kindly shared about their clinical experiences on eating disorders, provided students with advice on how to support those suffering from eating disorders, and gave some relevant self-help tips. As both of them are experienced counsellors and social workers, our participants were able to realise the truly multidisciplinary nature of patient care for those with eating disorders. One highlight of the event was reviewing the omnipresent influence of social media and culture on medical conditions, as one of our speakers shared about social media trends that promoted toxic slimming culture. Another was learning about the “family therapy” approach, where therapy for eating disorders targeted the entire family dynamic, rather than focusing on the suffering individual. In general, SCOPH hopes that this raise medical students’ awareness of which we had observed to be quite past. We wish this event was able to ods to support friends with eating even prevent oneself from developing disordered eating habits. Once again, thank you to both of our guest speakers for helping us make this valuable learning experience a reality!

webinar helped to eating disorders, lacking in the promote methdisorders, or

AMSAHK Standing Committee on

(SCORP

Human Rights and Peace This year, SCORP is super excited to rebrand our social media refugee campaign from last year, “Bridging the Gap”, into an interactive workshop to be held in mid-November! The Health Advisor and Coordinator of RunHK, Dr. Charlotte Beckett, will also be present to educate medical students about humanitarian work regarding the refugee crisis in Hong Kong from a medical perspective.

In the upcoming year, we have plans to continue our previous endeavours such as Disabilities Experience Day and the Disaster Medicine Workshop. We also plan to collaborate with SCORA to explore current gender equality issues in Hong Kong and relevant human rights concerns that might arise from this.

(ACAD)

AMSAHK

Academic Department

ACAD has plans to participate in the scientific paper competition at the Asian Medical Students’ Conference (AMSC) 2022. Currently, we are brainstorming our research in collaboration with Professor Jason Cheung from the Li Ka Shing Faculty of Medicine, The University of Hong Kong. Our team is also excited to kickstart a series of workshops on empowering medical

Final editor Tania Chan AMSA Hong Kong Faculty of Medicine, The Chinese University of Hong Kong SCOE article author Lauren Fong AMSA Hong Kong Faculty of Medicine, The Chinese University of Hong Kong SCORA articles author Bernard So AMSA Hong Kong Faculty of Medicine, The Chinese University of Hong Kong

SCOME article author Herman Lai AMSA Hong Kong Faculty of Medicine, The Chinese University of Hong Kong

SCOPH article author Nicole Tung AMSA Hong Kong Li Ka Shing Faculty of Medicine, The University of Hong

SCORP article author Keith Lee AMSA Hong Kong Faculty of Medicine, The Chinese University of Hong Kong ACAD article author Elizabeth Lam AMSA Hong Kong Faculty of Medicine, The Chinese University of Hong Kong

NGO VIRTUAL VISIT AMSA-Universitas Trisakti Asian Medical Students’ Association-Trisakti University has carried out a social activity entitled NGO Visit Virtual in collaboration with the Indonesian Cancer Child Care Foundation (YKAKI) on Monday, August 23, 2021, at 15:00 – 17:00 GMT +7 online via zoom teleconference. The NGO Visit Virtual was filled with talk shows together with sharing and caring sessions in 2 breakout rooms. The event began with remarks from the Project Officer of NGO Visit Virtual, Anita Febrilia Andreane, Representative of AMSA-Usakti 2021/2022, Harsheena Gobind, Deputy Dean III of Faculty of Medicine, Trisakti University, dr. Tubagus Ferdi Fadilah, Sp.A, M.Kes., and the Chairperson of YKAKI, Ira Soelistyo. The main activity started with a video showing the introduction of YKAKI’s members from 8 branches. Following that, NGO Visit Virtual entered the core of the activity, namely a talk show to find out more about YKAKI. The talk show speakers at the NGO Visit Virtual were Mrs. Nurul Hijeriyati as the Head of the YKAKI-Makassar Branch, Mrs. Yatik Indah Satyani as the Representative of the YKAKI-Surabaya ‘My School’ teacher, Mrs. Lusiana was the Representative of the parents for YKAKI-Riau, and Vika Triani was the Representative for children in YKAKI-Jakarta.

We discussed many things such as how the kids from YKAKI adapt to this pandemic situation with their current condition, their hobbies, how they cope with their condition and many more. The event continued with a sharing and caring session in 2 Breakout Rooms. In each breakout room, the kids were asked to draw their own dreams, tell & share what they drew, and play the game Simon Says. Lastly, we AMSA-Usakti members presented YKAKI with a symbolic donation of Rp 14.402.201 for operational and medical expenses for the patients at YKAKI.

The NGO Visit Virtual was attended by all members of AMSA-Usakti 2021/2022, Volunteers from the Trisakti University student organisation, and YKAKI members from 8 branches (Jakarta, Bandung, Yogyakarta, Riau, Surabaya, Manado, Makassar, and Semarang). The YKAKI members include administrators, teachers, parents, children, and also invited guests.

By holding this event, we hope AMSA-Usakti members and volunteers can instill the values of caring for others, foster empathy, increase experience in social activities and share with the community. We hope that we can also strengthen and establish good relations with Non-Governmental Organizations, which on this occasion is the Indonesian Cancer Child Foundation or YKAKI.

Written by : Harsheena Gobind AMSA Indonesia Faculty of Medicine, Trisakti University

AMSA SCOTLAND INTER -UNIVERSITY DIALOGUE

After having been in lockdown for over a year, AMSA Scotland was finally able to have their first Social Event for the 2021/2022 tenure! What better way to begin the tenure than with an AMSA Inter-University Dialogue, a series of 3 mini-exchange programmes among the different AMSA members in Scotland. As a fairly new chapter, it was a good opportunity to be able to meet and connect with members from the different universities, namely AMSA Aberdeen, AMSA Edinburgh, and AMSA Glasgow.

The first part of this series was a 2-day exchange programme in Glasgow from 9 to 10 October 2021. The day began with delegates arriving at Glasgow’s city centre Buchanan Bus Station at around 11:30 am. They then proceeded to have lunch at one of Glasgow’s famous eateries ‘Bread meets Bread’. The trip was filled with meals at restaurants that were well-known among the locals such as ‘Same-Same’, a Malaysian-Chinese restaurant and ‘Mozza’- a Neapolitan pizza place.

After lunch, it was time for the main activity and also the highlight of the trip - The Amazing Glasgow. This was a team-building activity with a lot of sightseeing. Similar to the concept of Amazing Race, delegates were required to travel around Glasgow City on the subway to complete their tasks at each station. They would then use the clue earned at that station to proceed to the next station

After a long and tiring day, running between stations and braving through the rain, it was finally time for the social night! We had board games, snacks, drinks and a good time bonding with each other.

The next day, the sightseeing continued with a tour of the University of Glasgow’s campus followed by a 1-hour basic suture session. The session was conducted by two Foundation Year (FY2) doctors who are both alumni from the University of Glasgow. They taught basic suturing skills and shared valuable tips on how to improve their suturing skills. The trip concluded with a scrumptious lunch at a pizza place. Although the delegates were heavy-hearted to bid farewell to each other, we knew it was only a matter of time before we would be able to meet again in the next AMSA Inter-University Dialogue (Part 2) in Edinburgh that will be happening on the 27-28th November!

Written by : Samantha Goh Jia En AMSA Scotland MBChB, University of Glasgow

AFTERNOON TEA WITH AMSA MEET THE EXPERT: Dr. Deborah Thomson, DVM

Written by:

Nashita Nowshin AMSA Bangladesh Faculty of Medicine, University of Dhaka

Pricilla Sayogo AMSA Indonesia Faculty of Medicine, Hang Tuah University

he AMSA International eNewsletter recently launched a brand new segment - ‘Meet the Expert’ session and the very first guest celebrity of this session was Dr Deborah Thomson, DVM, the founder and President of ‘One Health Lessons’. This special episode was aired on Sunday, 17 October, 2021, through Instagram live, on a very exciting topic: “Understanding the role of One Health in Everyday life.”We began this live at 20:00 GMT+8, inviting our guest celebrity of the session and welcomed her warmly with a short intro. The host of the session was Priscilla Sayogo, Chapter Representative of AMSA Indonesia and Nashita Nowshin, Chapter Representative of AMSA Bangladesh.

As many of us are not very familiar with one health lessons approach we asked Dr. Thomson for a short introduction about the organisation. Our wonderful guest was humble enough to give us an insight of the organisation. According to her, One Health Lessons is an organisation that inspires children and adults around the world, to value the interconnection between our health and the health of the environment, animals and plants.

We further asked Dr. Thomson about what inspired her to start this wonderful journey and her answer was really inspiring. In reply she told us that she used to teach French and English to little children in a school and from that she understood that she loved teaching. After entering veterinary school, she learnt about one health. One health can be described in 2 ways: as a concept itself and as an approach. The concept is the interconnection between our health and the health of the environment, animals and plants and the approach is a teamwork between people of different disciplines, strength and we come together helping to solve and prevent often complicated health problems. This core concept inspired her deeply and she decided to start this organisation with the help of her friends and family. She ended up writing lessons about one health and teaching them in the classroom after her 12 hour shifts in hospital. And then in May 2020, was when onehealthlessons.com was born as a website. Now the lessons are being translated to almost 88 languages by volunteers around the world. The outcome was incredible.

As One Health lessons are also taught to children, we were curious to know about why we need to know one health lesson from early years and why it is important to teach one health lesson to children from an early age. So she explained to us that children are like stem cells, they can grow into anything. They can grow into parents, grandparents and continue to educate the next generation and beyond them, they can become politicians and policymakers. Imagine if policy makers already knew about one health, what huge difference it would make!

Dr. Deborah also wrote a book titled “The Art of Science and Communication (sharing knowledge with students, the public and policymakers) in which she shares true and tried strategies for everyone to use when communicating with children, navigating politics, and conversing with the public about science. In this session, she explained different ways available for us to contribute to the global one health education movement, one of them is to translate lessons. Those lessons are currently being translated to a total of 88 languages and 26 of them are available and posted on onehealthlessons.com. She also explained that the translators and reviewers will be credited.

Another programme that she mentioned is the lesson leaders programme. It is a programme to train the trainers which focuses on science communication and is accessible to everyone who is 18 years or older. By joining this programme we can learn and practice numerous communication skills. It is a very useful experience especially for medical students, because we are so used to using ‘the language of medicine’ which consist of words or terms that might not be familiar to the public where in the clinical years we’ll have to translate that to normal speech.

There are 4 steps that have to be taken and each step is 1 hour long. The first step is to attend an online training where we learn how to talk to different age groups. Then, watch an online recording of Dr. Thompson about teaching techniques, to understand different teaching techniques. The third step is to watch and observe a live online lesson, and the last one is to teach the lessons. If you want to make a greater impact and contribute to the community, you can continue the journey by being the One Health Lessons Ambassador. The requirements to become a One Health Lessons Ambassador is to teach 5 times in your first language and in your own community about those 4 initial steps.

Other than being a one health lessons ambassador you can also become an Intern. The interns will be working towards promoting one health education around the world on a weekly to daily basis. This internship is not a paid internship but it uses a barter system where Dr Thomson will provide mentorship in networking, leadership and communication skills. Some of the positions that are available are social media intern, regional promotions intern, language expansion intern, administrative interns, senior promotion intern,

website design intern, JOMAS liaison intern and management/business intern. She also mentioned that the next opportunity to become an intern is in June 2022, and to stay tuned on one health lessons’ social media and Dr Thomson’s Linked In. Further information about these programmes can be accessed through onehealthlessons.com .

She also explained to us about ways to build partnership with One Health Lessons. For universities that are interested, ways to build partnership and synergise with One Health Lessons is by making MOU or grants for sponsorship which the university will lead. After that, the university students will be trained and they will be put into classrooms as a science guest. She also mentioned that the goals of the partnership is not only to inspire people to act but also get the students’ science communication skills up to where they need to be. Dr. Thomson excitedly told us about the two new programmes that One Health lessons have. The first one is the pen pal programme where the main goal for this programme is to connect classrooms and motivated teachers with each other. Through this programme the teachers can take part in and get the classroom involved. She also hopes that through this programme, the children can realise that there might be other countries that are facing the same problem as theirs and that it would bring the world in a child’s mind so much closer together.

The second programme is called One medicine initiative which is done on a quarterly basis. It is a programme that implements comparative medicine or one medicine where human medicine and veterinary medicine together in the same room working on case studies. In this programme, One Health Medicine will be gathering medical, nursing, veterinary and veterinary technician students and professionals, also clinicians to do a case study where there is a possibility that it might apply to all species or the species that we tend to work on. Here, they hope that we can go through the clinical thinking process to help solve the case and gain new knowledge. The first event will happen in January 2022, and the physician will be coming from the United Kingdom and the Veterinarian is coming from the United States. Dr Thomson also expressed her excitement for this interesting programme and that this is a chance to learn from specialists that you don’t want to miss. Another programme that has been conducted is the global art and music contest, where the goal is to share the message of one health through the universal language of art. There are two categories available which are visual arts and performing arts.

Lastly, when we asked about the trajectory of one health in 5 years, Dr Deborah expressed her gratitude for all the people that have contributed to the growth of One Health Lessons despite the young age of 1,5 years. In conclusion, she said that the trajectory depends on how much we want to contribute to our community and make a difference. She also mentioned that what she ultimately hoped for One Health Lessons is sustainability and for One Health Lessons to continue to be global.

HEALTH

ISSUES

IDENTIFYING

ONE HEALTH CONCEPT IN DAILY BASIS

alking about COVID-19, it is quite closely related to zoonotic disease. To manage and solve pandemics, it is not only through a human health approach, but also other aspects such as animal health and environmental health that are used as catalysts in handling the COVID-19 pandemic. The collaboration of the three components works to support in solving health problems which are called one health concept. The One Health concept emphasizes communication, coordination, and collaboration. One Health approach has been found since the 1800s, but the One Health concept has received recognition from various parties in the 20th century. The One Health concept was reused in 2003-2004 in the treatment of Severe Acute Respiratory Disease. (SARS), followed by the emergence of cases of

H5N1 in various countries in the world. In addition, the term One Health became increasingly popular when the emergence of the Covid-19 virus could spread between animals into humans (Mackenzie and Jeggo, 2019). Another study states that the popularity of One Health began with the International One Health Conference in 2013 which promoted a cross-disciplinary collaboration from aspects of human, animal, and environmental health (CDC, 2016). The main goal of one health is to collaborate with multidisciplinary and multisectoral approaches to reduce the boundaries between human, animal, and environmental health. The concept of one health focuses on the promotive and preventive aspects. If this term is carried out optimally, it can improve the health status in the community. Several

studies have shown that One Health interventions can reduce infections from animals to humans. This is in line with the principles of public health to prioritize preventive rather than curative and rehabilitative (Cleaveland et al., 2017) The scope of one of health is quite extensive including the issue of food safety, environment, economy, control of zoonotic disease, lab services, neglected tropical disease, environmental health, and antimicrobial resistance (Acharya et al., 2019) The implementation of the One Health approach has been widely carried out in various countries, for example in Indonesia. In managing the Covid-19 pandemic, Indonesia involves various crosssectors to reduce the spread of the virus.

It looked by the policy that involves agencies outside the ministry of health in the technical process of COVID management in the field. The form of synergy efforts carried out is by empowering communities who are members of disaster risk management forums. The job description of each member in the forum are quite varied, starting from coordinating the number of covid patients at the village level to the sub-district health team, managing the covid infectious covid waste of self-isolation patients, educating residents related to covid, and so on. The concept of one health is quite implementable even if it lacks it was not running perfectly.

Besides Indonesia, several countries have started to use a one health approach in dealing with zoonotic diseases, such as several countries in the Middle Eastern Continent, South Asia, Africa, and so on. One health intervention very the potential to overcome social, political, and economic cases that might constrain healthcare services (Cleaveland et al., 2017) Although the legal basis for One Health has not been written officially, indirectly the concept is applied in the community. Another application of one health concept is research about Wolbachia,

Written By:

AJENG RAHASTRI

AMSA-Indonesia Graduate Student of Public Health, Gajah Mada University

it involves vector control to reduce dengue cases by inserting the Wolbachia virus into the body of the aegypti mosquito (Utarini et al., 2021). Practically, the implementation of One Health can be started by increasing our awareness of keeping the environment healthy and safe, for example by disposing of waste according to the character of the waste, promoting One Health to children, protecting certain animals and their habitats, and so on. As explained above, there are so many things related to one health concept. The term “One health can be applied from small until huge thing impact. We can start promoting one health in many ways and at any time.

REFERENCES Acharya KP, Karki S, Shrestha K, Kaphle K. One health approach in Nepal: Scope, opportunities and challenges. One Health. 2019 Dec 1;8:100101. Cleaveland S, Sharp J, Abela-Ridder B, Allan KJ, Buza J, Crump JA, Davis A, Del Rio Vilas VJ, De Glanville WA, Kazwala RR, Kibona T. One Health contributions towards more effective and equitable approaches to health in lowand middle-income countries. Philosophical Transactions of the Royal Society B: Biological Sciences. 2017 Jul 19;372(1725):20160168. Mackenzie JS, Jeggo M. The One Health approach—Why is it so important?. Utarini A, Indriani C, Ahmad RA, Tantowijoyo W, Arguni E, Ansari MR, Supriyati E, Wardana DS, Meitika Y, Ernesia I, Nurhayati I. Efficacy of Wol-

“Healthy citizens are the greatest asset any country can have” - Winston Churchill

Johne Donne stated 400 years ago that human is a social animal as it needs a certain society for its survival that includes animals and the environment, making one health concept a vital area to be looked for. It generally refers to the interaction between these three communities and also involves various expert opinions from different fields like medicine, ecology, animal health, epidemiology and many more at local, national and global levels.

The term ‘One Health’ was coined by Calvin Schwabe in 1976. It promotes systematic collaboration between veterinarians, physicians and others in order to emphasize various pathogen-associated problems in changing environments. This concept was earlier referred to as ‘One Medicine’ but later evolved to one health concept based on practical implementation and their importance for global animal and public health.

It is not a new concept; the realization of its significance arose because of poor sanitation and the emergence of various zoonotic diseases in the ancient era like smallpox, tuberculosis etc. In recent years massive population growth, rapid urbanization, intrusion of ecosystems e.g. deforestation because of globalized trading and trafficking has added to its further importance. Thus, it is not wrong to say that-

It’s a global movement for challenge driven teamwork.

The concept of one health involves a number of national and state medical agencies and organisations like the Centre for Disease Control, World Health Organization and American Medical Association. This calls for the formation of student one health interest groups involving several medical schools, health centres and veterinary clinical complexes that focusses on approaches towards research and education. It enables the development of various diagnostic methods, vaccines and other measures to prevent future pandemics. This ultimately benefits the patients and promotes sustainable development thereby improving environmental conditions for the benefit of biodiversity. According to a report every 6 out of 10 infectious diseases in people are caused by animals like rabies, West Nile virus, Lyme’s disease, Bubonic plaque, Salmonellosis, etc. Thus, the importance of reducing zoonotic risk in farms should be the priority for both human and animal health. This also requires close collaboration between public health workers, veterinarians and occupational health professionals. According to the world bank reports for influenza pandemic Level of Pandemic

Reduction in GDP (approx)

Low

Moderate

Serious

The above table indicates that this pandemic led to severe economic loss which is also evident during the recent Covid 19 pandemic where global growth of $ 9 trillion was found to be affected in the subsequent 2 years.

Sustainable developmental goals refer to the importance of ensuring a healthy environment for the survival of people and animals along with developmental goals. It requires a far-sighted approach involving several implementation policies and programmes at the local, regional, national and state levels. It can give fruitful results and can be more beneficial when supported by any government agency. Several emerging infectious diseases like West Africa Ebola virus that resulted in high mortality and economic losses shows a need for effective strategies to deal with, predict and respond to such outbreaks of international concern. Nowadays, the emergence of antimicrobial resistance is also a concern that requires proper surveillance for preventing endemic zoonotic diseases like Brucellosis, Tuberculosis etc.

SARS CoV- 2 virus originated from China in December 2019 has led to the situation where the whole world got on its knees. This pandemic clearly shows how government involvement led to the control of this havoc by the large production of vaccines for immediate use. This pandemic not only impacted the economics but also led to the severe loss of human lives. Even the idea of another pandemic could not be imagined in our worst dreams. Thus, there is a need to prepare ourselves to respond to any such situations by developing certain public health programmes, policies, recognizing research gaps etc.

In the present scenario, a lot are still out of control, particularly the protection of wildlife species, community ecology and several related ecological issues that are still neglected. A simple understanding of zoonotic risk and toxic substances cannot solve the problem. It is important to consider the diversity, liabilities, susceptibilities of human beings and also different ways of their interaction with animals and the environment. The basic knowledge of plant ecology and epidemiology has also played an important role. The best example of it is interference of RNA that alters the gene regulation provides a barrier for the entry of various plant inhabitants that are responsible for food contamination subsequently affecting human health. One health concept is far beyond science and impact politics, laws and ethics. Although, it is an old concept still has a long road to go ahead.

REFERENCES: 1. Destoumieux-Garzón D, Mavingui P, Boetsch G, Boissier J, Darriet F, Duboz P, et al. The one health concept: 10 years old and a long road ahead. Front Vet Sci. 2018; 5: 14. 2. Rabozzi G, Bonizzi L, Crespi E, Somaruga C, Sokooti M, Tabibi R, et al. Emerging zoonoses: the “one health approach”. Saf Health Work. 2012; 3(1):77–83. 3. Rabinowitz PM, Natterson-Horowitz BJ, Kahn LH. Kock R, Pappaioanou M. Incorporating one health into medical education. BMC Med Educ. 2017; 17: 45.

The Climate

Global Responsibility o

ver the last fortnight or so, some of the world’s most renowned and recognizable faces have gathered, as they do once every few years, for a common mission to change people’s lives for the better. They have duly delivered, as they always do, helping us bring a smile on our faces and shining a hope that maybe the future isn't too shabby at all. But enough about the Cricket World Cup because I am writing an article on climate change and have a word limit I need to abide by. So, Scotland’s capital Glasgow played

host to the 2021 United Nations Climate Change Conference, also known as COP26. Described in the popular media as humanity’s last best chance to put a stop to the looming climate crisis, it was attended by about 25 thousand delegates from 200 countries around the world including 120 heads of state. On the face of it, it seems daft for a random vicenarian sitting behind his screen in a third world country to

have any say on this elite assembly of that magnitude.

However, the onus to tackle climate change has forever been thrust on commoners like me and the blame shifted conveniently away from world leaders likewise. When a teenager seemingly intent on breaking the record for uttering the word ‘blah’ for the highest number of times in a speech makes more sense than all the supposed ‘powers that be’ of the world combined, you know we are in trouble. Still, it was quite refreshing to witness the vast public interest, with the twelve-day event believed to be one of the mostwatched international summits ever. With the world watching, the dignitaries elected to represent the best of what humankind has to offer surely did justice to our hopes and expectations, right?

Conundrum: r Blatant Blame-Shift? Written By:

Let’s see. Leaders from around the world arrived in 76 private jets for the COP26 itself, emitting an average of 11.3 tons of carbon to the atmosphere per jet.1 Talk about setting a precedent and sending a message. The average carbon footprint of an ordinary citizen in a whole year is 8 tons.2 Now think of all the places you travel and all the food you eat in a year. I am not asking these luminaries to walk barefoot across continents and swim through oceans surviving on nothing but cabbage to get to the most critical climate summit in years. Neither am I about to pull a rabbit out of a hat by unveiling to the world a new negative-emission transport capsule right out of a sci-fi movie. But when the richest 1% of the world population cause 50% of the global aviation emissions3 while suggesting the rest of us give up our private vehicles as a way to minimize our carbon footprint, you are walking a previously thin line of hypocrisy. There are so many ways to ensure that global events on how to stop climate change can actually show how to stop climate change. Not having an extortionate menu

ARAMVA ADHIKARI AMSA Nepal Institute of Medicine, Tribhuvan University

with meals offering a carbon footprint seven times the recommended value they agreed upon just 6 years ago4 would be a good place to start. No wonder it has been likened to serving cigarettes at a lung cancer conference. I know extravagant symbolisms will not bring down the global temperature on its own, but when it comes to a global campaign with a largely bottom-up approach whose chief strategy so far has been to keep reminding us of our efforts to save the planet, we do tend to expect a tad more. Before being accused of turning a blind eye to the progress that has been made, I do think COP26 in part has been a breath of fresh air. The 2nd biggest carbon emitter in the world sending its head of state to the climate summit was refreshing to see for a change, though this might demonstrate just how low the bar had been set beforehand (Yes, Donald Trump really did refuse to attend the conference the last time out). Amidst the customary token gestures, futile deals and speeches that rang hollow, the joint statement released by two of the world's biggest greenhouse giants, the United States and China, pledging to work together for climate action seemed to earn the most plaudits. But with unfulfilled promises recently sneaking in above CO2 as the most toxic emission, it would be interesting to see how this pans out. Oh, and developed countries seem to have continued to be left out in the cold by their richer counterparts, but that is hardly something you couldn't have

seen coming from a mile away. Look, we shall continue to eat our vegetables, stitch our torn jeans and commute in our crummy public transport for all you like. But unless the elite clan in their private jets hear our calls of cry above the sound of their roaring engines, we're all going to be drowned by the same body of water soon enough. Nonetheless, a snide part of me thinks the ultra-rich might be more vulnerable than the rest of us given their fondness for regular retreats in their multi million private islands. Before I cross any lines here, I should probably hurry back to school. How dare you!

references

1. BBC News. COP26: What’s the climate impact of private jets? [Internet]. [place unknown]: BBC News; 2021 Nov 3 [cited 2021 Nov 11]. Available from: https://www. bbc.com/news/59135899 2. Abraham B. Leaders came to Glasgow for COP26 summit on 118 private jets, burning over 1,400 tons of CO2 [Internet]. India: India Times; 2021 Nov 10 [cited 2021 Nov 11]. Available from: https://www. indiatimes.com/news/world/leaderscame-to-glasgow-for-cop26-summit-on118-private-jets-burning-over-1400-tonsof-co2-553772.html 3. Transport & Environment. Private jets: can the super-rich supercharge zero-emission aviation? [Internet]. [place unknown]: Transport & Environment; 2021 May 27 [cited 2021 Nov 11]. Available from: https://www.transportenvironment.org/ discover/private-jets-can-the-super-richsupercharge-zero-emission-aviation/ 4. Choi J. COP26 criticized for its environmentally unfriendly menu [Internet]. United States: The Hill [Internet]. [cited 2021 Nov 11]. Available from: https://thehill.com/policy/equilibrium-sustainability/579971-cop26-criticized-for-its-envi-

You live only once is the motto of many youths. They believe it’s better to take care of their own lives rather than caring for something that they are not involved with apparently. Of course, People would be pointing fingers at them for being selfish and not caring for the ever-giving mother earth.

Here’s a piece of fresh news! Tending to Nature is now a form of self-care. In today’s world, emerging and re-emerging infectious diseases and antimicrobial resistance are associated with the changes in land use, population explosion, urbanisation, globalisation and climate change. As a result, a transdisciplinary approach among human, animal and environmental health disciplines was introduced as the One Health Concept. . As for environmental health, none other than the ongoing pandemic serves as a better example. The greater contact of humans and wildlife has ironically been increasing ever since civilisations started. Humans have blurred the borderline between themselves and the flora and fauna of their habitat through deforestation, melting permafrost, extractive mining and captive breeding. These incidents end up exposing long latent microbes that may introduce or re-introduce zoonotic infections thereby paving way for many further outbreaks. The possibility of such outbreaks becoming a pandemic is also high, owing to the present globalised economy and microbes along with humans are also able to travel far lengths in greater speed, giving us the need to make our defences more agile. As seen by the Rabies control initiative in Tamil Nadu, India conducted in 2009 that encompassed a multi-sectoral and multi-disciplinary approach, the One Health approach not only needed technical support that knowledgeable professionals provide but needed strong political will and behaviour. And for the analytics, intense risk-assessment exercises must accompany surveillance-strengthening initiatives. (1)

But before such stunts are performed it is important to know that these played a vital role in that accomplishment: 1. The initial policy changes that had led to such development 2. The already existing robust operational intersectoral coordination mechanisms 3. They were instituted at the state- and district-level with clearly defined roles for each agency

The inherent potential of One Health Initiative includes (2) 1. Demands in-depth health information data 2. Promotes collaborative effort 3. All experts under-one-roof make it easier to address and reach out to experts 4. Better surveillance and monitoring of strategic programmes. 5. Preparedness for Health Emergencies

• • • • •

Hurdles, of course, to be tackled are: (3)

Lack of trained personnel Lack of health promotion to the uninformed Scarcity of interventions, innovations and technologies Absence of resource allocation Requirement of new policies

“India being home to a large portion of the world’s livestock farmers, the absence of a policy framework that ratifies the One Health approach in development and health policies is a major hurdle in eliminating poverty and poverty-related disease” (4)

• • • •

Strategies required to achieve One Health: (5)

Effective Communication Willingness to cooperate for a joint action Collective responsibility Action, collaboration and coordination between various stakeholders • Continual reporting and surveillance • Critical reviewing • Crisis control

Ever since scientists discovered the similarities in the disease processes of animals and humans, they have strived to reveal a “One Health Model” as a wholesome entity and not limited to an individual. Being selfish or generous is a personal decision, but the influence of our environment on us has never had dawned upon us before this pandemic, you’ll have to give it some second thoughts. “Rememb, upon the conduct of each depends on the fate of all.” – Alexander The Great.

REFERENCES: 1. Abbas S, Venkataramanan V, Pathak G, Kakkar M. Rabies control initiative in Tamil Nadu, India: a test case for the ‘One Health’ approach. Int Health. 2011;3(4):231-9. 2. Dasgupta R, Tomley F, Alders R, Barbuddhe S, Kotwani A. Adopting an intersectoral One Health approach in India. Indian J Med Res. 2021;153(3):281-6. 3. Reddy KS, Mathur MR. Pandemics & one health. Indian J Med Res. 2021; 153(3):245-8. 4. McKenzie JS, Dahal R, Kakkar M, Debnath N, Rahman M, Dorjee S, et al. One Health research and training and government support for One Health in South Asia. Infect Ecol Epidemiol. 2016;6:33842. 5. Gongal G, Ofrin RH, de Balogh K, Oh Y, Kugita H, Dukpa K. Operationalization of One Health and tripartite collaboration in the Asia-Pacific region. WHO South-East Asia J Public Health. 2020;9(1):21–5

MÉNAGE À TRIOS Effect of Environment Health on Animal and Human Health

Written by:

DIKSHA KANDPAL AMSA India Veterinary Pathology, College of Veterinary and Animal Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences

he 1992 summit at Rio de Janeiro popularly known as the Earth Summit discussed the ways to mitigate the harm being produced to the environment as it directly hampers the health of human and animals and emphasised the earlier signed Montreal, Kyoto and Vienna conventions to reduce the use of substances harming environment safety. The environmental health deterioration has a direct impact on human and animal health predisposing to serious health implications. As all the three components are connected and have been a topic of discussion since 2005 under one health discussing major areas of human and animal interface. substances harming environment safety.

Intensive modernisation, urbanisation and expansion of agricultural lands, use of intensive techniques have put pressure on nature and have increased animal and human conflicts3. The conflicts have paved the way for an increase in incidences related to emerging and reemerging diseases and have given rise to an increase in transboundary disease in animals. Increased demand of animal food products such as milk, meat, eggs have led to use of various drugs and chemicals in animal rearing practices, later involving biomagnifications of such compounds in consumers. Moreover, uses of drugs at lower dose rate as immunity enhancer have led to rapid mutation in microorganisms’ resulting in antimicrobial resistant microorganisms.

The presence of a resistant group of microorganisms predisposes the animal to overt and deprecatory disease conditions and also exposes them to other secondary infections. The close association of humans and animals exposes the vulnerable human population to diseases of zoonotic potential. Various incidences of zoonotic disease in humans have been a result of human animal conflict and deteriorating environmental health. Tracking the epidemiology of diseases that have crossed species barrier to infect humans such as Plague, Avian Influenza (H1N5), HIV AIDS, Salmonella, Shigella outbreaks and other viral and bacterial outbreaks and the recent occurrence of Covid-19 pandemic can be linked to environment alteration. Imbalanced ecosystems due to habitat destruction, increased urbanisation and industrialisation, etc., lead to increased vector breeding causing extensive disease occurrence. Increased industrialisation has led to

deposition of various toxic metals and pollutants in air and water reservoirs damaging both the atmosphere and the hydrosphere. The accumulation of toxic metals in rivers and water resources affects marine life (fish, prawns, and crabs), wildlife feral animals and when meat products of affected animals are consumed leads to accumulation of trace amounts of toxic compounds in humans. Poor air quality affects the respiratory tract thereby causing increased incidence of respiratory illness and chronic obstructive pulmonary disease in humans and animals.

The United Nations Environment Program (UNEP, 1972) was developed to ensure environment safety and since then has been dedicated to protecting the environment and stressing about the adverse effect of environment health on the ecosystem. UNEP in 2016 emphasised upon the occurrence of emerging and re-emerging diseases and diseases of zoonotic potentials declaring exhaustive anthropogenic activities possess global threat to environment animal and human health8. Over the decades, extreme change in weather conditions, increased temperature, frequent floods and hurricanes, droughts, unplanned urbanisation, increased animal husbandry practices, improper disposal of wastes from hospitals industries and indiscriminate use of pesticides have all led onto creating conducive environment for breeding of vectors, reservoir and provided conditions for etiological agents of animal origin (viruses) to acclimatise accordingly and

Increased trades in animals of wild origin, migratory birds, pangolins, deer for their hides, skin and meat act as an easy portal for entry of novel pathogens to human population. The recent cases of Japanese encephalitis and fever of unknown origin in young children in Uttar Pradesh, India probably can be accounted to increased population, urbanisation along with poor sanitation, henceforth favouring breeding of the vectors and reservoirs animals. Vectors play an important role in pathogen transmission from animals to the human population. With the extreme alteration in the climatic conditions the vectors have widened their host range thereby elevating the disease occurrences6. In the past, no cases of avian and swine influenza in humans were reported although climatic variation and mutation of the virus crossed the species barrier. Increased demands of meat products, exhaustive livestock practices, and improper disposal of wastes are the precipitation factors for disease occurrence owing to humananimal conflict.

Anthropogenic activities have created a scenario of biodiversity imbalance disturbing and severely affecting the ecosystem. This has damaged the prey predator relationship in the food chain. Extinction or severe reduction in number of one species leads to enormous increase of other species population, also reduction of plantation has resulted in shift in feed pattern of wild animals thereby creating an imbalance and is responsible for increased human-animal conflict and spread of various viral diseases (Nipah, CCHF and West Nile Virus). The rising temperature at the pole is of concern as warm conditions at the poles provide an environment for pathogens to survive thereby stretching pathogens and their effects to polar areas. Extreme weather alteration has been a vital factor both in spread and maintenance of the disease in a particular geographical area and globally5,7,9.

“Use of veterinary knowledge along with medical knowledge would successfully help mitigate diseases of zoonotic potential.”

One health is a transdisciplinary approach with its interweaving environment of human and animal health such that the health of one affects the health of all. One health was used in 2003-2004 with the emergence of Severe Acute Respiratory Syndrome (SARS) and propounded by wildlife conservation society along with ‘Manhattan principles’. Various acts by WHO, United Nations have been implied nationally and internationally to mitigate the damage being caused to the environment. However, strict norms and better understanding of one health is needed. Use of veterinary knowledge along with medical knowledge would successfully help mitigate diseases of

zoonotic potential. The diversified trends opted by the pathogens and change in life cycle and affect and association of environmental factors in spread of disease are perilous for public health. One health involves an integrated approach involving environmentalists, ecologists, ethnobiologists, clinicians, epidemiologists, veterinarians to study the diseases based on epidemiological model and study interdependent changes of all the three components that advances changes in pathogenesis and virulence of the disease.

Lack of knowledge in one health aspect is the major loophole in failing the objective set under one health approach and only integrated efforts of each section of the society is needed to achieve the motive of one health. Students at school level are acquainted with one health and the society must know globally how the disturbance in environmental health could jeopardise human and animal health. Present facing of the pandemic should be a warning enough that further annihilation of environmental health possesses threats of more severe pandemics in future.

REFERENCES

1. Hernandez, E., Torres, R. and Joyce, A.L., 2019. Environmental and sociological factors associated with the incidence of West Nile virus cases in the Northern San Joaquin Valley of California, 2011–2015. Vector-Borne and Zoonotic Diseases, 19(11), pp.851-858. 2. IPCC W (2013) Climate Change 2013: the physical science basis contribution of working Group I to the fifth assessment report of the intergovern-mental panel on climate change stocker. In: F T, Qin D, Plattner G-K, Tignor M, Allen SK, Boschung J, Nauels A, Xia Y, Bex V, Midgley PM (eds) Cambridge University Press, Cambridge, p 1535 3. Mishra, J., Mishra, P. and Arora, N.K., 2021. Linkages between environmental issues and zoonotic diseases: with reference to COVID-19 pandemic. Environmental Sustainability, pp.1-13. 4. One Health. https://www.oie.int/en/for-themedia/onehealth/. 5. Paz, S. and Semenza, J.C., 2013. Environmental drivers of West Nile fever epidemiology in Europe and Western Asia—a review. International journal of environmental research and public health, 10(8), pp.3543-3562. 6. Singh, H., Singh, N. and Mall, R.K., 2020. Japanese encephalitis and associated environmental risk factors in eastern Uttar Pradesh: a time series analysis from 2001 to 2016. Acta Tropica, 212, p.105701. 7. Singh, R.K., Dhama, K., Chakraborty, S., Tiwari, R., Natesan, S., Khandia, R., Munjal, A., Vora, K.S., Latheef, S.K., Karthik, K. and Singh Malik, Y., 2019. Nipah virus: epidemiology, pathology, immunobiology and advances in diagnosis, vaccine designing and control strategies–a comprehensive review. Veterinary Quarterly, 39(1), pp.26-55. 8. UNEP (2016) UNEP frontiers 2016 report: emerging issues of environmental concern united nations environment programme, Nairob 9. Vescio, F.M., Busani, L., Mughini-Gras, L., Khoury, C., Avellis, L., Taseva, E., Rezza, G. and Christova, I., 2012. Environmental correlates of Crimean-Congo haemorrhagic fever incidence in Bulgaria. BMC Public Health, 12(1), pp.1-7.

The interrelationship of environmental, human, and animal health is alluded to as “one health.” It is a cohesive, intersectoral, and interdisciplinary approach to attain the best possible care by establishing a relationship between people, animals, and the environment. Any change in the ecosystem will result in a positive or negative effect.

NEGATIVE EFFECTS

Any human behavior harming the environment increases the vulnerability of acquiring psychological problems, cardiorespiratory issues, stress, and cholesterol. Animals also struggle to flourish in lethal environments due to issues such as malnutrition and exhaustion. Urbanization along with technology is one of the numerous factors hurting the environment. Commodities like radio waves affect public and animal health. For example, the recent decline of birds has been due to the absorption of high-frequency radio waves. Humans too absorb radio waves which can destroy tissues in the body.

Another factor is our constantly-growing population, leading to increased human activity. These activities are wreaking havoc on the environment, which has catastrophic ramifications for animal and human life.

The second factor influencing health is rising temperatures, as well as the frequency and intensity of climatic changes. Depending on the severity and duration of the heat, it might affect cattle health, creating metabolic instabilities and recurrent infections.

Many human diseases are of animal origin. The repeated annihilation of wildlife allows increased human-animal contact and has prepared the road for disease transmission to people. Additionally, the combustion of fossil fuels has led to an increase in greenhouse gases in the atmosphere. These gases have significantly lowered air quality making people more susceptible to respiratory disorders. Likewise, a polluted atmosphere increases UV radiation exposure, which causes skin disorders and malignancies.

The release of untreated industrial water into the rivers and oceans is affecting wild and marine life. It has widely increased their mortality rates. Consequently, people consuming this water are prone to infections like cholera and typhoid.

POSITIVE EFFECTS A flourishing environment with clean air and water accompanied by a healthier lifestyle can improve the wellbeing of individuals by lowering illness, increasing task productivity, improving the lives of people, and reducing stress.

Closer proximity to nature has proven to reduce stress levels and decrease symptom severity for psychological distress, while direct interaction with the environment can enhance cognition in people with attention deficits and people with distress.

In a healthy atmosphere, anxiety, and depression diminish, while positive emotions are strengthened. A happy environment not only relieves stress but also enhances your physical health. It also assists in the regulation of hormone levels. A healthy environment allows us to be illness-free and creates a safe place for animals to thrive.

In a clean environment, animals can survive easily and maintain healthy reproductive and developmental behavior. They become less sensitive to illnesses and feel safe when there is no human interaction.

Many researchers have associated living in a healthy environment with living a happy life. So, despite the ever-increasing potential pollution, anyone who understands the advantages of a safe environment understands that establishing one is a must. This is an objective that must be accomplished at all costs.

USING ONE HEAL COMBAT ANTIBIO RESISTANCE Getting to Know Antibiotic Resistance and One Health Antibiotics, a group of medications that can defeat bacteria, have such an important role in the world of medicine. The World Health Organization (WHO) defined antibiotic resistance as the changes in the response of bacteria to antibiotics, from getting ‘bullied’ by the medication, into becoming the ‘bully’ within the fight1. As antibiotics are used everywhere in the health sector, from medicine, agriculture, to veterinary, bacterial resistance to antibiotics has become such a huge global threat.

LTH TO OTIC

WRITTEN BY:

GIFTA MARSHANDA RAYNANDA SABTA QANITAH HAMISENO CHARIS BINTI UNIVERITAS AIRLANGGA AMSA-INDONESIA

CDC defined One Health as “a collaborative, multisectoral, and transdisciplinary approach” to obtaining optimal health outcomes2. This is done by recognising the interconnections between living things such as plants, animals, and humans, as well as the environment. One Health works at the local, regional, national, and international levels.

Researchers and health workers have worked hand-in-hand to combat antibiotic resistance through One Health. Hence, let’s go over the two topics together to see how they can complete each other and eventually reduce the rate of antibiotic resistance worldwide.

1Irrational use of antibiotics When consuming antibiotics, we are always told to follow the doctor’s instructions. One thing that doctors always advise their patients is to “finish the dose as prescribed”. This is because when antibiotics enter our body, we want the medication to eradicate the targeted bacteria to make sure that the “strongest among all” do not reproduce. Unfortunately, this is one crucial piece of advice that many patients ignore. Patients tend to stop taking medications once they feel better. As a result, the strongest ones reproduce, causing antibiotic resistance.

Antibiotics are sold without prescriptions Patients should not purchase antibiotics without a prescription from their physician. However, unfortunately, there are still a lot of cases where patients treat antibiotics as over-the-counter medications. They can freely purchase antibiotics from places that are not regulated closely by the government. Research conducted by the Antibiotic Resistance Control Committee of the Indonesian Ministry of Health and a few universities found that approximately twothirds of pharmacies and drug stores in Indonesia sell antibiotics without a prescription3. This is concerning because more and more antibiotic resistance can occur due to the irrational use of antibiotics.

Causes of Antibiotic Resistance

Lack of education and awareness The awareness of the people is a very important aspect of rational drug use. Patients need to understand the effects, dosage, adverse effects, and contraindications of a drug. However, many people still do not realise the importance of these aspects, causing carelessness in drug consumption, including antibiotics.

4 Lack of control

The government, especially the Ministry of Health and the Drug and Food Supervisor (such as the FDA) have important roles in controlling the distribution of drugs across a country. As it may sound difficult because there are a lot of factors that can contribute as obstacles, such as the population, habits, and the area of the country, the authorities must work harder to control antibiotic resistance. This way, irrational drug use can be reduced.

The Urgency As mentioned, antibiotic resistance must be avoided at all costs due to its massive negative effects on many countries worldwide, including higher medical costs, increased mortality, increased difficulty of treating health conditions, and so on. Therefore, countries plan out their strategies to combat the issue in the medical, veterinary, and

Take Indonesia as an example. For decades, Indonesia has been putting efforts into reducing the percentage of antibiotic resistance in the country. It is a problem that started even in the mid-1990s. In 2005, a four-monthlong survey investigated the prevalence of extended-spectrum beta-lactamase (ESBL) Enterobacteriaceae in Dr. Soetomo Hospital in Surabaya, Indonesia4.

The result showed that the number of ESBL Enterobacteriaceae was incredibly high. The E. coli sample obtained was ampicillin-resistant (73%), cotrimoxazole-resistant (56%), and ciprofloxacinresistant (22%). Another meta-analysis also showed that from 2001 to 2012, Indonesia ranked first as the Asian country with the highest antibiotic resistance rates to imipenem, which is 6%5. From just one country, we can tell the urgency of combating antibiotic resistance.

Public health is considered to be the consequence of antibiotic resistance in bacteria of animal origin, although not limited there. The antibiotic resistance of animal pathogens might lead to therapy failure and have a direct negative effect on animal health and welfare. Dogs, cats, and even horses are often considered family members or companions with strong emotional bonds. In the last decade, an increasing number of reports on community and hospital-associated infections with multi-resistant Gramnegative bacteria with resistance to third-generation cephalosporins alike in dogs and horses are reported. This indicates that the consequences of infections and antibiotic resistance show negative emotional, social effects, and economic impacts on the owners and their families. The consequences of antibiotic resistance in bacteria are the same in humans and veterinary medicine6.

Many studies have documented antimicrobial residues in ecosystems influenced by both urban and agricultural activities. In these environments, antimicrobials are widely used for people, livestock, poultry, pets, plants, etc. Not only for the treatment of infections, but also for prophylaxis, disease control, and to promote growth in food-producing animals. The percentage of the dosage that is absorbed or metabolised ranges from 10% to over 80%, with the remainder excreted through urine and faeces into the environment. Then, soils and water streams are contaminated by antimicrobial treatments used for disease control in plant production and also by residues in manures and wastes applied as crop fertilizers. An understanding of the ecology of AMR regarding its impact on environmental contamination with antimicrobial residues, resistant bacteria, and antimicrobial resistance genes (ARGs) still needs to be studied further. For example, the magnitude of the public health threat posed by AMR organisms and ARGs in the environment, and the effects of antimicrobial residues on soil ecosystem services, such as biogeochemical cycles7.

The Role of One Health As per definition, One Health connects humans, animals, and the environment. Here, we know that antibiotics do not only affect humans, but also animals, plants, and other living things in the environment. With One Health, we would be able to observe and solve antibiotic resistance holistically. Fortunately, this has been conducted more intensively by the health systems. For example is the FAO-OIE-WHO Tripartite collaboration, which is a movement by three notable organisations to build better global health security via One Health [8]. By doing so, antibiotic resistance can be tackled through three different aspects of the health industry, leading to a more effective way to take down this massive health issue.

What We Can Do as Medical Students Even though we still have a few more years to become real doctors, it is never too early for us to contribute to better global health. There are some ways that we, medical students, can do to decrease antibiotic resistance.

Learn more about antibiotic resistance

As medical students, we need to keep updated about the current health issues, including antibiotic resistance. Find out more about antibiotic resistance! Learn about what causes it, the current statistics, and so on. This would benefit you as we would be able to pour our ideas to keep the number of resistance low. Furthermore, we would be able to help in combating antibiotic resistance as well!

Educate the people around you

As mentioned in the previous point, the power of word-of-mouth is proven to be true. So, it is your turn to take advantage of it! Start by educating the people around you: your parents, your siblings, your cousins, and even your neighbours. Tell them that antibiotics should be taken with a prescription because they are not over-the-counter drugs! This is a good start for us to stop the irrational use of antibiotics near us.

Spread the word!

In this era, spreading news and information can be done at the speed of light. News online can go viral within minutes. As medical students, we can take advantage of this privilege that we have. Utilise your social media accounts! Share the information regarding antibiotic resistance in the simplest way possible. This way, the information can be digested and even spread easily. Word-of-mouth is proven to have a very strong efficacy in spreading information!

Let’s Combat It Together! The One Health approach is a positive way for health workers to handle health problems in the world. As mentioned before, the world is taking this approach more seriously these days in facing health issues, which is a good start. As future doctors, we must support this at all costs as well. Learn about it, spread the word. This way, we would be able to go hand-in-hand to create a more sustainable future.

References

1. Antibiotic resistance [Internet]. Who.int. 2021 [cited 25 November 2021]. Available from: https://www.who.int/news-room/fact-sheets/ detail/antibiotic-resistance 2. One Health Basics | One Health | CDC [Internet]. Cdc.gov. 2021 [cited 25 November 2021]. Available from: https://www.cdc.gov/ onehealth/basics/index.html 3. Research Reveals 70% of Pharmacies in Indonesia Dispense Antibiotics Without Prescriptions | Universitas Gadjah Mada [Internet]. Ugm.ac.id. 2021 [cited 25 November 2021]. Available from: https:// ugm.ac.id/en/news/21515-research-reveals70-of-pharmacies-in-indonesia-dispenseantibiotics-without-prescriptions 4. Severin J, Mertaniasih N, Kuntaman K, Lestari E, Purwanta M, Lemmens-Den Toom N et al. Molecular characterization of extendedspectrum β-lactamases in clinical Escherichia coli and Klebsiella pneumoniae isolates from Surabaya, Indonesia. Journal of Antimicrobial Chemotherapy. 2010;65(3):465-469. 5. Yanling Xu T. Epidemiology of carbapenem resistant Enterobacteriaceae (CRE) during 2000-2012 in Asia [Internet]. PubMed Central (PMC). 2021 [cited 25 November 2021]. Available from: https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC4387446/ 6. Bengtsson B, Greko C. Antibiotic resistance— consequences for animal health, welfare, and food production. Upsala Journal of Medical Sciences. 2014;119(2):96-102. 7. Antimicrobial Resistance in the Environment. Summary Report of an FAO Meeting of Experts [Internet]. 2018 [cited 25 November 2021];. Available from: https://www.fao.org/3/ BU656en/bu656en.pdf 8. SINCLAIR J. Importance of a One Health approach in advancing global health security and the Sustainable Development Goals. Revue Scientifique et Technique de l'OIE. 2019;38(1):145-154.

Water water everywhere, Nor any drop to drink The above lines are from ‘the Rime of the Ancient Mariner’, a poem by Samuel Taylor Coleridge. The speaker, a sailor on a becalmed ship is surrounded by saltwater that he cannot drink to satiate his thirst. This mimics the situation most people find themselves in an age of technology and overflow of information. We are drowned in easy-access information, but most don’t know how to utilise the information or differentiate between a trusted source and random nonsense posted online. This has never been truer than it is in the context of health over the past 2 years since the pandemic began.

There have been countless claims of COVID-19 being a fake disease, a scheme of the ultra-elite to wipe out populations, vaccines containing electronic chips to control minds, and endless ‘natural’ remedies to combat COVID-19 infection. These claims have taken a life and momentum of their own to spread online like wildfire reaching masses more easily via social media than any doctor’s advice. It has led to increased vaccine hesitancy, mistrust of the health sector, and mass protests worldwide where people push back against certain health measures citing concerns of ‘freedom’.

One Health emphasises a collaborative approach towards healthcare. One cannot help but think what has failed us during this pandemic is health education, and filtering through information overflow more than anything else. Sure, there is concerns of vaccine inequity with richer countries having the capacity to cover most of their population, almost for a third time now. Whereas, most underdeveloped countries that rely on donations still lag behind. However, will these countries even take the vaccines if delivered to them?

Vaccine mistrust, hesitancy, and outright denial of the effects of the virus have marred herd immunity and return to normalcy of the pre-pandemic levels in most developed countries that have had priority access to vaccines. Most of Europe is going through a severe 4th wave which is likely to cause a return to lockdowns. Mistrust and hesitancy are rampant all over the world. It signals a failure of the overall system in educating everyone what exactly viral diseases, vaccines, and pandemics are.

Most countries scrambled to create infographics on handwashing, mask-wearing, and basic hygiene measures when the pandemic broke out. It is concerning and slightly embarrassing that populations do not know how to perform these basic tasks. We can provide all the health services, drugs, vaccines and advice that is possible, however, it is all rendered irrelevant if not everyone utilises them to achieve the desired outcome of herd immunity, disease reduction and return to normalcy.

People mostly follow the routines and traditions of the environment in which they grow up. If the community does not follow basic health measures and are mistrustful of the health system, many others are bound to follow similar sentiments through time. It would be very ‘OneHealth-esque’ to target people at the root of their mistrust, which stems from various factors including incorrect information, lack of information, hearsay, a bad personal experience, and overall mistrust of governments and health organisations. Targeting the root of the problem would be to educate where to seek appropriate information, and how to sort the right information from the vast plethora that is available.

Countries manage to indoctrinate their populations to follow certain beliefs through constant education and supplementation of that education with a reminder at every step. It would not go amiss if investments were made to teach populations about healthcare, and more importantly the ability to decipher and sort trustworthy and reputable information. Never before has information been so readily accessible and transferable as it is now. It is time for us to realise this accessibility – as much as it is a blessing, can be used in a harmful manner to misguide. And ‘misguided’ is what we least can afford in a pandemic where its ramification will be felt for years to come socially, economically, and in terms of human life.

THE MIGHT & HOLD IN A CONNECTION – ONE HEALTH O

ne health in simple terms is an idea in health that can stay without any chance of vanishing. The pandemic as to the current situation in the world has made us understand how interconnected humans are with the other beings in nature. This list would obviously include humans, animals, plants & the environment having each of their existence shared. The One Health target thus focuses on the state of optimal balance in health that has to be achieved.

WRITTEN BY: JIBIN CHACKO AMSA Philippines Gullas College of Medicine

The One Health reality would be of prime importance in the growing years especially as with the booming population that we have in front of us. Migration to newer places & zones also creates a pathway in some or the other way as to how the human life is exposed more to the animal life & other factors in nature. The factor of dependence is also not to be left out as in this sphere, all of us have made ourselves dependent on each other for our needs.

Humans depend on animals & plants for several of their daily needs & so vice versa. Apart from the interaction with animals for having pets & livestock, animals are also an essential means in food , transport, sports & several others. As with the status of the Globe, climate change & other disruptions have also stimulated internal factors within to affect the animal & plant life which has direct/indirect consequences on the human life as to its order. Means of exchange between different countries also does add gravity to this matter just like in the case of COVID.

The prime heat of importance would thus need efficient & most important ways as to how this connection can move safely. This push is also highly advised as with the emergence of the different zoonotic diseases, issues related to food safety & security ,vector based diseases & other dilapidations in the usual change that has posed a threat to the very working of the sphere. According to the Centre for Disease Control & Prevention, the foundation for One Health is properly established with active & strengthened means of communication , coordination & collaboration. To have this measure kicked in, the call for an expert option arises. This would compass the team of doctors & health force , infectious disease analysts, animal diseases handlers as to veterinarians & other experts in the various professions including environmentalists, policy makers & advocates. As with the views established by EcoHealth Alliance , doctors today deal with their patients in such a way that the practice of One Health is established at some or the other points. This starts from the side of each one of us even with the most sustainable & genuine steps that we initiate to protect the way our planet is supposed to be.

According to the light by World Organisation for Animal Health , 60% of pathogens that cause human diseases originate from domestic animals or wildlife, 75% of emerging human pathogens are of animal origin & 80% of pathogens that are of bioterrorism concern originate in animals. In terms of security, more than 70% additional animal protein will be needed to feed the world by 2050. Meanwhile, more than 20% of global animal production losses are linked to animal diseases. As with the environment , humans and their livestock are more likely to encounter wildlife when more than 25% of an original forest cover is lost. Human actions have severely altered 75% of terrestrial environments and 66% of marine environments. Lastly as with the economy , animal diseases pose a direct threat to the incomes of rural communities that depend on livestock production.

REFERENCES

The mass outcome of a stable One Health system is critical enough in determining several factors that are associated with the very means of dependence & existence. This concept of One Health is thus very much essential in all ways to be implemented into our health system to capacitate & develop our interconnection with nature & its being for a safer & brighter tomorrow to come. One Health promises a better key not just for humans , it’s a colourful world for all!

1. https://www.ecohealthalliance. org/2017/09/how-tolive-a-one-health-life 2. https://www.cdc.gov/ onehealth/basics/index.html 3. https://www.oie.int/en/ what-we-do/global-initiatives/one-health/

Human activity is transforming Earth’s ecosystem in methods that might be profound, pervasive, and accelerating. This transformation is generating a myriad of poorly characterised health effects for animals and humans. Today, sufficient evidence exists that nearly every dimension of human and animal fitness is being laid low with changing environmental fitness, and the disease burden related to the ecosystem alterations is likely large and growing.

Some instances and factors which create environmental disturbances impending animal and human health effects are as follows: Hunting and increasing human-wildlife interactions can be an important source of zoonotic diseases. Human encroachment into wildlife habitats and consumption of untamed meat can offer appropriate vitamins as well as land for agriculture and settlements. However, these activities additionally create the potential for zoonotic infections to move from animal to human populations. There is compelling evidence that these mechanisms played a critical role in initial outbreaks of HIV, Ebola virus, and other zoonoses. The strength of those shifts in animal-human interactions to have an effect on ailment transmission helps to explain the fact that more or less 75% of emerging infectious illnesses are zoonoses.

Land-use change involves the destruction of entire ecological systems and the services that they provide. One instance is the loss of coastal barrier structures inclusive of coastal mangroves, coral reefs etc. Their worldwide destruction places humans and animals which live within 100 km off the shore and at less than 50 m above sea level at greater threat. At the same time, sea levels are rising and more extreme tropical storms increase the threat of storm surge and coastal flooding.

Diversity damage through deforestation and ecosystem loss; the risk of West Nile virus exposure in the United States rises as avian biodiversity falls and, in addition, Lyme sickness exposure will increase with falling mammalian diversity. For Chagas disease in Panama and the Brazilian Amazon, the risk of human exposure is positively correlated with reduced mammalian species diversity as cited in various published researches. These findings explain the “dilution effect”—whereby a greater diversity of intermediate hosts can dilute the pool of hosts that amplify transmission (competent hosts), resulting in decreased exposure to vector-borne disease.

Forest clearing in many parts of the world has led to not just loss of habitats for wildlife but also reduced access to fuel for cooking fires, creating a disproportionate burden on women and girls especially in the rural and underdeveloped world who are often responsible for gathering such fuelwood impending them to a wide range of respiratory diseases such as asbestosis.

Forest cover may reduce flooding and landslide activity during extreme storms. Wetlands and woodland watersheds can clear out pollution and pathogens from surface water components and, to a point, forests filter out particulates from the air.

Poverty; the large environmental share of health problems like diarrhoea in developing countries in South East Asia is primarily due to factors associated with poverty, consisting of restrained access to the right food, housing, healthcare and drinking water. Chemicals and pollutants exposure; pollutants destroy the environment. For example, through emissions from industries, anti-fouling paints on marine vessels, pesticides in agriculture, waste incineration and leakage from waste disposal sites. Their uptake through inhalation and food consumption is another important source of chemical exposure. Intensive agricultural production uses chemicals in pesticides and fertilisers, and feed additives and medication for livestock. Their residues remain in fruit, grains, vegetables, meat and dairy products, all of which can reach the consumer via biomagnification. Other sources of chemicals in food include bioaccumulative chemicals in the environment, such as heavy metals and persistent organic pollutants (POPs), which can be found in fish, meat, and dairy products.

For example, Dioxins that accidentally contaminated poultry feed can move up the food chain to humans and using feeds that contain diseased animal remains can cause “mad cow disease” (BSE) in livestock which has been linked to a new form of Creutzfeldt-Jacobs disease in consumers. The effects on health from exposure to chemicals and air pollutants vary from allergies to cancers in pets and humans. Even at low exposure levels, rising levels of urban air pollutants and AQI levels can cause asthma, allergies, respiratory diseases and cardiovascular diseases if the exposure is continuous or long term.

Climate Change; changes to Earth’s natural systems affect the quality of the water we drink and the air we breathe by multiple mechanisms and impact our vulnerability and exposure to natural hazards. The depletion of the ozone layer has led to increased exposure to UV radiation and a greater risk of skin cancers. Climate change has decreased crop productivity endangering food security as well. Furthermore, climate change might result in new infectious diseases, as well as changing patterns of known diseases and loss of life due to extreme weather conditions.

Noise also can have an impact on human health and animal health, decreasing the quality of life and potentially contributing to depression. Noise pollution due to mining activities and industrial operations around Elephant corridors near Saranda jungle in Jharkhand, India is leading to human-animal conflicts as elephants move to neighbouring villages and establishments, causing harm to people.

Loss of health due to environmental degradation is substantial and calls for interventions.

It encompasses various of 17 UN sustainable development goals to transform the world: (1) No Poverty, (2) Zero Hunger, (3) Good Health and Well-being, (6) Clean Water and Sanitation, (12) Responsible Consumption and Production, (13) Climate Action, (14) Life Below Water, (15) Life On Land, (17) Partnerships for the Goals. The problems related to exposure to chemicals call for policy interventions to limit industry, energy and transport emissions, agricultural chemical use, and to promote food safety. Environmental policy interventions having the One Health approach at the heart can, in turn, save money on healthcare costs. Multi-sectoral approaches, researches, policies and collaboration is the solution to overcome the impending doom of looking for alternative planets for life.

India and other Asian nations need to leapfrog over the systemic and institutional barriers that prevent an integrated One Health from being operationalised. The alarming frequency with which new pathogens are emerging or old ones are re-emerging in the world calls for extra transparency, cross-country collaborations, and enhanced national infrastructure and capability to incorporate the One Health approach to preserve the environment and stabilise the tricky human-animal relationships.

“OUR PLANET’S ALARM IS GOING OFF, AND IT IS TIME TO WAKE UP AND TAKE ACTION!” — LEONARDO DICAPRIO

EXPLORING THE NEGLECT OF ENVIRONMENTAL HEALTH THROUGH THE LENS OF ANTIMICROBIAL RESISTANCE WRITTEN BY:

MANALI SARKAR

MGM MEDICAL COLLEGE, NAVI MUMBAI AMSA INDIA

INTRODUCTION INTRODUCTION

ne Health is a concept developed by Calvin Schwabe that brings forth the myriad ways human health is interlinked to animal and environmental health. The concept stresses a collaborative, multisectoral, and transdisciplinary approach at local, national, and global levels to achieve optimal health.1 While the component of human and animal health is given due attention, environmental health often remains the ignored stepchild in the One Health triad.2 This neglect has led to the emergence of Antimicrobial Resistance (AMR) that threatens human and animal health.

AMR is the resistance produced by an organism when they are unable to respond to medication that were previously effective on them. Furthermore, WHO has declared AMR to be one of the top 10 global public health threats facing humanity.3 The Review on Antimicrobial Resistance estimates that the total number of annual deaths due to drug-resistant pathogens will increase to 10 million by the year 2050.4 Despite these calamitous foreshadowing, the global usage of antibiotics has steadily increased both in the health as well as the animal husbandry sector.

ANTIBIOTIC RESISTANCE ANTIBIOTIC RESISTANCE AND ENVIRONMENTAL AND ENVIRONMENTAL HEALTH HEALTH

here have been multiple causes affixed to the rise in AMR. Causes such as an increased rate of mutation in microbes, egregious and lackadaisical usage of prescribed antimicrobials, overprescription of antimicrobials for diseases not treated by them, commercial usage of antimicrobials in agriculture and animal husbandry have been implicated in many major reviews and articles.5

All of this overuse has led to an increased frequency of antibiotic pollution in the ecosphere. There is a reason for which I am using the specifier “increased frequency “. Firstly, Antibiotic resistance predates the human use of antibiotics. Secondly, functional antimicrobial genes have been found in bacteria present 6 in an isolated cave microbiome. These findings imply that antibiotic resistance is the “norm” rather than a phenomenon brought about by anthropogenic antibiotic pressure.

Increased awareness of AMR has led to an exponential number of papers documenting AMR in the environment. A high-risk environment for AMR is hospital and healthcare facilities. Hospital sewage has been found to contain antimicrobial-resistant bacteria such as extendedspectrum beta-lactamase (ESBL) producing E.coli and estimates find hospital contributions to environmental antimicrobial pollution to 7 be around 33%.

Although there has been enhanced scrutiny on the effect of hospitals on AMR, hospital settings offer a controlled environment where the usage of antibiotics and the evolution of antimicrobial resistance can be easily tracked. The worrying factor remains the unstudied general population.

In the general population, an overreliance on the usage of antimicrobials for trivial diseases in adjunction to an improper following of treatment regimen has led to an evolution of antimicrobial-resistant bugs to be found in the human microbiome especially gut flora. Even when they are correctly used, 30% of antibiotics are excreted in the changed form in the 8 urine and feces. These lead to the introduction of potent antibiotics of wastewater, sewage, and sullage which act as a culture for production of antimicrobial resistant bacteria. Antibiotics are used extensively in animal husbandry (especially large-scale concentrated animal feeding operations) and aquaculture (both open 9 and closed).

Industrial producers are an oft-ignored interest group during any discourse on AMR. Effluents released by industries lead to downstream contamination and create microbiota conducive for the growth of antimicrobial-resistant organisms.10

HOW INCREASED HOW INCREASED FOCUS ON FOCUS ON ENVIRONMENTAL HEALTH ENVIRONMENTAL HEALTH CAN TACKLE AMR CAN TACKLE AMR

ffective water, sanitation, and hygiene (W.A.S.H) will be a cornerstone in tackling AMR. A dearth of knowledge and usage of hygienic practices especially hand hygiene, absence of basic sanitation facilities in low to middle-income countries have led to increased contamination of the environment. Strengthened awareness campaigns and the development of basic sanitation facilities can mitigate the contamination issue. The creation and enforcement of legislation by local, national, and international interest groups can help in reducing AMR. Existing practices can be banned worldwide such as the usage of sub-therapeutic dose for quick growth production of animals, leading to a higher profit margin for the workers.11 This practice has been banned in the US and EU with an increased incentive given to using vaccination on high-value species of human consumption. Unfortunately in many low to middle-income countries, this practice continues due to a lack of facilities.12

Environmental Health Practitioners (EHPs) are professionals whose work profile includes conducting water and food sampling and analysis for increased antimicrobial content. They also ensure medical examination of food handlers to inhibit transmission of dry-resistant infections. Hence training of Environmental Health Practitioners (EHPs) should be carried out by all countries. Research should also be carried out for the collection, analysis, and dissemination of data to contribute to the body of knowledge of AMR. Also, governments and organisations dedicated to AMR prevention need to allocate more funds and resources to tackle the environmental determinant of AMR.

CONCLUSION CONCLUSION

rue reduction of AMR will only be possible by multidisciplinary collaborative work by all professionals working in the field of human, animal, and environmental health. It’s no wonder that the WHO has called for the 2021 World Antimicrobial Awareness Week (WAAW) to include One Health stakeholders and policymakers.

REFERENCES 1.

Cdc.gov. n.d. One Health Basics | One Health | CDC. [online] Available at: <https://www.cdc.gov/onehealth/basics/index.html> [Accessed 13 November 2021].

Essack S. Environment: the neglected component of the One Health triad. The Lancet Planetary Health. 2018;2(6):e238-e239. doi:10.1016/s25425196(18)30124-4

Antimicrobial resistance. Who.int. https://www.who.int/news-room/factsheets/detail/antimicrobial-resistance. Accessed November 13, 2021.

4. T. P. Robinson, D. P. Bu, J. Carrique-Mas, E. M. Fèvre, M. Gilbert, D. Grace, S. I. Hay, J. Jiwakanon, M. Kakkar, S. Kariuki, R. Laxminarayan, J. Lubroth, U. Magnusson, P. Thi Ngoc, T. P. Van Boeckel, M. E. J. Woolhouse, Antibiotic resistance is the quintessential One Health issue, Transactions of The Royal Society of Tropical Medicine and Hygiene, Volume 110, Issue 7, July 2016, Pages 377–380, https://doi.org/10.1093/trstmh/trw048 5. Michael CA, Dominey-Howes D, Labbate M. The antimicrobial resistance crisis: causes, consequences, and management. Front Public Health. 2014;2:145. Published 2014 Sep 16. doi:10.3389/fpubh.2014.00145 6. Bhullar K, Waglechner N, Pawlowski A, et al. Antibiotic resistance is prevalent in an isolated cave microbiome. PLoS One. 2012;7(4):e34953. doi:10.1371/journal.pone.0034953 7. Hocquet D, Muller A, Bertrand X. What happens in hospitals does not stay in hospitals: antibiotic-resistant bacteria in hospital wastewater systems. J Hosp Infect. 2016 Aug;93(4):395-402. doi: 10.1016/j.jhin.2016.01.010. Epub 2016 Feb 1. PMID: 26944903. 8. Kümmerer K. Antibiotics in the aquatic environment--a review--part II. Chemosphere. 2009 Apr;75(4):435-41. doi: 10.1016/j.chemosphere.2008.12.006. PMID: 19178931. 9. Ventola CL. The antibiotic resistance crisis: part 1: causes and threats. P T. 2015;40(4):277-283. 10. Li D, Yang M, Hu J, Zhang J, Liu R, Gu X, Zhang Y, Wang Z. Antibiotic-resistance profile in environmental bacteria isolated from penicillin production wastewater treatment plant and the receiving river. Environ Microbiol. 2009 Jun;11(6):1506-17. doi: 10.1111/j.1462-2920.2009.01878.x. Epub 2009 Feb 18. PMID: 19226301. 11. TIEDJE J, WANG F, MANAIA C et al. Antibiotic Resistance Genes in the Human-Impacted Environment: A One Health Perspective. Pedosphere. 2019;29(3):273-282. doi:10.1016/s1002-0160(18)60062-1 12. Ayukekbong JA, Ntemgwa M, Atabe AN. The threat of antimicrobial resistance in developing countries: causes and control strategies. Antimicrob Resist Infect Control. 2017;6(1):1–8 https://doi.org/10.1186/s13756-017-0208-x

The abode of all of the creation of nature with mutual as well as non-mutual coexistence within nature forms an environment. There must be a balance between mutualism and non-mutualism of creation in order to sustain nature and form a healthy environment for the existence of everything. We humans got our hands free of the ground for doing anything we desire in a rampant way on whims. We are exploiting nature in the name of development. We are doing everything in the name of mankind exploiting vast volumes of nature in the name of mankind threatening the wilderness of plants and animals. But we are unknowingly placing swords in our throat in the name of mankind. This instability will ultimately bring a troublesome situation. Industrial revolution of the world has done a huge destruction of nature. Though it is the backbone of modern society, digital world, this era has brought many hazards to the environment. There was deforestation, agricultural expansion, pollution, overpopulation etc. Because of pollution people are becoming susceptible to large varieties of diseases. Occupational diseases like asbestosis, silicosis, were prevalent in this age. Radiation related disease due to the exposure to the radioactive substance during its mining has also been reported. Contamination of air, water and soil have deteriorated the natural flora and fauna as well it has provided lots of bacterial and viral diseases. In our society in the present context billions of children are malnourished because of inappropriate food habits due to poverty, unsafe drinking water and lack of sanitation. On the one hand rich people are becoming richer day by day and poor people are sinking in poverty day by day. They are victims of many diseases of environmental concern. We or even our government is not looking after them. We are wasting our money unnecessarily on many plans and policies. We can take examples of countries like America, Russia, China, Japan etc. who are spending billions of dollars for space programs in the motto of colonizing mars, moon, and other planets.

But what do we do after colonizing mars, moon?

We have nothing to do, we will think of eating, shelter…… i.e. basic needs of people. If we can make Mars an unfavorable place (naturally) for human dwelling then why cannot we make our earth a more favorable place for people? People who are under poverty, why are we letting poor people feel earth like hell? Why are we not providing them good facilities of food, health and environmental protection? We are planning Mars to convert like earth and earth to deteriorate day by day.

We are exploding bombs in the name of peace. We are testing nuclear weapons or nuclear explosives in the name of scientific research. Will scientific research bring back the extinct species all of all, which were extinct because of humans? We are exploiting the mass of nature for miniature benefit in the name of scientific research. Can we bring the diverse forest of barren and deforested fields again because of scientific research?

Why can’t we use a part of the money under scientific research for conservation of nature? Why are we being ignorant for our personal benefit or interest of a party only? Will anybody stay happily in an unhealthy environment?

So environmental health is the essence of existence.

Radiation threats because of pollution as well as because of thermonuclear waste is also a subject of concern these days. Patchy holes in the ozone layer may let ultraviolet radiation enter the surface of earth. These radiation causes severe burns in skin, and may lead to basal cell carcinoma of the skin. Thermonuclear waste is hazardous because of the difficulty of management. When people get exposed to radioactive byproducts like thorium, lead, iodine etc. there is an increased tendency of cancer, bone marrow destruction, pulmonary fibrosis, pericarditis, cataract, hair loss, extreme tiredness, hearing loss etc.

According to some information hydropower which is made for the reservation of water is blocking the migration of fish from their feeding place to breeding place i.e. ocean to river and vice versa impacting the number of fish impairing the whole ecosystem. So, in doing every activity we need to think of nature.

Poisoning due to heavy metals like mercury, lead which are hazardous to health due to drinking of unsafe water. The drainage from the industrial cities containing these pollutants will mix into oceans taking lives of huge masses of fishes and other aquatic creatures.

We need not afforest haphazardly which will also impair the ecosystem like we shouldn’t plant trees in tundra biome, grassland, desert because these places have their own ecosystem and these trees will be alien species in this area which may not support pre pre-existing ecosystem of that area. Some countries like china, Saudi Arabia are planning to make so called green great wall to afforest desert. Well that would lower the content of carbon from atmosphere and improve precipitation of the land. What about our oceanic bed or coral reef which are major contributor to carbon fixation. We are deteriorating that flora of bed by damping poison. Fishes survive by eating aquatic flora also aquatic flora sustain due to fish. Other examples, grazer survive due to grassland and also grassland exists because of grazer. If we kill all grazer from grassland then it would turn to forest. Likewise when we are impairing fish numbers ultimately aquatic flora also get impaired and what about carbon fixation? The hazards due to the deterioration of the environment will affect both the health of the human as well as the flora and fauna of the whole world. Various carcinogenic factors are growing. We are conscious of our health but we don’t care about the wildlife. Global warming which has been elevating the temperature of earth because of which icy landscapes have melted down. The North Pole has depleted in area. The wild life in these territories is vulnerable to extinction because of threat to their dwelling place. Number of penguins in the South Pole is decreasing due to global warming. Forest fires have been reported in many places like California Dixie fire, Australian bush fire, Russian wildfire, Siberia wildfire has taken lives of thousands of wild lives cause of these types of wildfire there are many but humans are responsible. Possible cause may be. Heat waves in Canada have put the lives of many people in danger. 500 people died because of the heat wave in Canada and uncounted death of animals.

Taking into consideration all of these incidents we should march our footsteps to the measures to conserve nature and assure our environmental protection.

PROSPECTIVE IMPLEMENTATION OF A ONE HEALTH FRAME WORK INTO THE CURRICULUM: A Perspective Look From Past Indonesia’s Approaches WRITTEN BY:

Muhammad Mikail Athif Zhafir Asyura Universitas Indonesia AMSA-Indonesia Muhammad Afif Naufal Universitas Indonesia AMSA-Indonesia

During the mid 19th century, a series of cholera outbreaks occurred. John Snow, the father of modern epidemiology, observed that most of the infected lived in proximity to the Broad Street water pump. Knowing this, he then persuaded the local authorities to disable the pump, which resulted in the outbreak diminishing in due time. This simple recount demonstrated two valuable lessons;

(1) human health depends heavily on their environment, and (2) involving other sectors is paramount in putting the bigger picture into the equation.1 The second point briefly describes the One Health Approach, which consists of people, environment, and animal health. Despite the seemingly straightforward concept involving the three different sectors, implementing a One Health approach has been

Reflecting on a commentary by Chatterjee et al., Pathogen emergence originating at the human-animal-environment interface has caught many health systems off guard, especially in countries situated in Asia, Africa, and Latin America, the projected hotspots of such epidemics to occur. Considering this article was made in 2016, Chatterje and their colleague were not far off in predicting the current situation we are in, the COVID-19 pandemic. Originating from the lack of surveillance and attention to the animal-environment framework, the pathogen managed to zoonosis its way through the country’s health system and what came after that was history.2

Now enter Indonesia. Brimming with biodiversity and a bustling society, it is one of the biggest developing countries. Situated in the tropical hemisphere, stable climate and ‘perfect’ weather are usually present. Despite its nurturing environment, Indonesia still faces a plethora of public health problems, one of them being Neglected Tropical Diseases (NTDs). Diseases such as leprosy and Soil-transmitted helminth infections are still commonly found, despite efforts from the government to eradicate them. Reflecting from Dr. John’s story, environment (and fauna) plays a pivotal role in disease transmission. This motion was wellreceived by the government, which is now spending 3.8 billion dollars on sanitary programmes especially in lower-hygiene regions. However, even with a constant decline in prevalence, Indonesia has failed to meet its eradication target, indicating inefficiency.3

Inefficiency in the system was predominantly caused by the minimal efforts in instigating cooperation between experts of different disciplines and delegating those responsibilities to people in power. To truly adopt the One Health System, interprofessional collaboration should be more emphasised. Although, credits should be given as Indonesia has started to move towards that goal, with the most recent action being the implementation of a One Health response to combat the pandemic. For a long time, collaboration to that extent has never been publicly seen, as experts in health, animal health, and environmental health congregate to formulate multiple mandates to tackle the spread of COVID-19 from various perspectives.3,4

Even though the efforts were definitely appreciated with long-standing results, one might wonder whether the formation of such a task force was too late. Hypothetically speaking, if a better human-animal -environment model existed before the pandemic began, the spread of the pathogen might potentially be prevented or minimised to the very least. One might even considr the introduction of such a framework as early as possible, or in this case since undergraduate studies, is imperative in instilling the seemingly complicated concept4. Ironically, this consequential mindset has not yet been included (or even considered) in our medical education curricula.

However, The recent introduction of Interprofessional education (IPE) has been a successful addition to our curriculum. IPE is a “curriculum approach in which students from various backgrounds collaborate in one setting.5 To some extent, IPE could be considered as a kindle for One Health, but in retrospect, the potential to improve and expand is there. There are very

few known examples of IPE which incorporated other sectors connected to health such as agricultural and environmental studies. Although one might argue about the difficulty of executing such collaborations at an undergraduate level, several points should be considered, with one of them being the prospective future of these undergraduates growing into future leaders in healthcare.

In conclusion, the One Health system is monumental in tackling several global health issues. A sufficient focus on the One Health approach has been initiated, although with varying results. The introduction of One Health via education is considerably lacking, thus raising the importance of non-healthcare collabo-

rations within these modules. Hence with this approach, we are investing in the possibility of future ‘John Snows’ to tackle more complex healthcare issues.

REFERENCES 1. Tulchinsky TH. John Snow, Cholera, the Broad Street Pump; Waterborne Diseases Then and Now. Case Studies in Public Health [internet]. 2018 [cited 2021 Aug 26]:77–99. doi: 10.1016/B978-0-12-8045718.00017-2. Epub 2018 Mar 30. PMCID: PMC7150208. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7150208/ 2. Chatterjee P, Kakkar M, Chaturvedi S. Integrating one health in national health policies of developing countries: India’s lost opportunities. Infect Dis Poverty [internet]. 2016 Oct 3 [cited 2021 Nov 22] ;5(1):87. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047123/ 3. Biro Komunikasi Publik Kementerian PUPR. Pagu Anggaran Tahun 2020 Sebesar Rp 120,21 Triliun : Pembangunan Infrastruktur Dasar Permukiman Menjadi Prioritas Kementerian PUPR (Bagian 3) [internet]. Indonesia: Kementerian Pekerjaan Umum dan Perumahan Rakyat; 2019 Aug 30 [cited 2021 Aug 25]. Available from: https://pu.go. id/berita/pagu-anggaran-tahun-2020-sebesar-rp-120-21-triliun-pembangunan-infrastruktur-dasar-permukiman-menjadi-prioritas-kementerian-pupr-bagian-34. Ramadayanti E. COVID-19 dalam perspektif one health approach dan law enforcement [internet]. Bandung: Universitas Padjadjaran; Mar 26 [cited 2021 Aug 25]. Available from: https://fh.unpad.ac.id/covid-19-dalam-perspektif-one-health-approach-dan-law-enforcement/ 5. Findyartini A, Kambey DR, Yusra RY, Timor AB, Khairani CD, Setyorini D, Soemantri D. Interprofessional collaborative practice in primary healthcare settings in Indonesia: A mixed-methods study. Journal of Interprofessional Education & Practice [internet]. 2019 Dec [cited 2021 Aug 25]; 100279. Available from: https://www.sciencedirect.com/science/article/abs/pii/S2405452619300035?via%3Dihub

WHO defines the concept of One Health as “an approach to designing and implementing programmes,policies,legislation and research in which multiple sectors communicate and work together to achieve better public health outcomes”(1). It solidifies the irrefutable fact that planetary health is closely interlinked and tied to human,animal and environmental well-being.This also functions as a call to action towards the conglomeration of the different sectors in the fields of human,animal and environmental health so as to form a common infrastructure which emphasizes on the coordination of action and responsibilities.As the One Health approach places a higher priority on planetary health,it differs,from governmental policies, by focusing on how competing interests such as agricultural productivity,animal health and the health of populations far removed from the farm must be balanced over time (2). This presents as difficult governance and implementation challenges as imminent health catastrophes are seldom discernable at the pre-epidemic stage when immediate action is most needed.

The SARS-CoV-2 virus has proved to be a deadly foe on the social,economic and healthcare front,leading to huge losses in terms of human lives and livelihood.This ongoing pandemic has threatened global health and thus has indirectly reinforced the requirement of One health principles for the prevention of such future disruptions. COVID-19 is a zoonotic disease which demonstrates the terrifying ability of other such hidden pathogens residing in the bodies of livestock who can overcome the species barrier anytime,thus precipitating the beginning of another deadly pandemic(3).And in this era of increased air travel and easy accessibility across continents and countries,such zoonotic diseases spell disaster on specific communities along with specialized vulnerable groups of people who might be predisposed to severe illness due to their physiological constitution.The only enduring method available at the moment is intervention at the human-animal interference via the adoption of cost-effective and sustainable One Health practices.

One Health seeks to tackle the emerging problems of antimicrobial resistance and the transmission of deadly pathogens from animal to human beings,as well as the effect of environmental health on the dynamics of the complicated relationship existing between the two. The three-pronged approach of One Health policy can be broadly classified under prevention,action and control and the identified outcomes of One Health policies were subdivided into three definite patterns: institutional coordination and collaboration, OH in action/ execution, and extended One Health (i.e. a perceptible entanglement with the environmental domain).Systematic literature reviews of the three coronavirus outbreaks, i.e. SARS, MERS, COVID-19 have shown that the most common identification of One Health was found to be in action/execution; while the least cited identification was One Health in its extended meaning. It was also found that there was a marked, periodic increment in the use of both One Health as institutional coordination and collaboration, and One Health in its extended meaning(4).

Should be the proper establishment of a coordinated network for serving as a security checkpoint against zoonotic diseases. The primary establishment of a separate body responsible for the collection and analysis of data on the occurrence of infectious diseases in both humans and animals in of the utmost necessity. This involves a coordination and partnership among government officials,veterinary doctors and policy-makers for the timely identification of alarming symptoms of a new disease among animals, collection of living samples,if needed and proper transportation to well-funded testing facilities. This can serve as base data which can be further subjected to analysis and interpretation into a model to identify potential zoonotic threats along with surveilling the entry of new strains into a country via animals.It is necessary to establish a near real-time and easily usable surveillance system of the spatio-temporal distribution of sporadic cases for determining the nature and extent of spread of the disease.

Not only is a collaboration necessary,it also provides for a cost-effective alternative via the interlinking of laboratories and mobilization of resources for the common good(5).This is all the more welcome in the aftermath of the COVID-19 pandemic which has already led to a tight constraint on the financial front for many countries. The further steps which can be implemented involves an independent model powered by Natural Language processing(NLP) and Machine Learning (ML) to identify local outbreaks and their potential threats on the social networking sites. Appropriate measures can be further taken by governmental bodies in order to judge the authenticity of the news,determine the nature of the infectious disease,measure the general response of people and also to quell any signs of public panic.It is also necessary to acknowledge the role of environmental health as migration routes due to various causes,environmental included,can serve as a potential silk route for the introduction of novel diseases in different regions. There also presents the hidden threat of antimicrobial resistance,a serpent still skulking in the dark and ready to lash out with full force at the opportune moment .Only when there is a coalition led by the government,various stakeholders and responsible citizens to educate the public about the future dangers revolving around the indiscriminate use of antibiotics coupled with general awareness sessions regarding the possible routes of transmission of pandemic-potential diseases can we fully strive to realise the full utility of One Health with respect to general well-being and planetary health.

REFERENCES: 1.https://www.euro.who.int/en/health-topics/health-policy/ one-health#:~:text=’One%20Health’%2 0is%20an%20approach,animal%2C%20human%20and%20environment%20 interface. 2.https://pubmed.ncbi.nlm.nih.gov/27321961/ 3.https://pubmed.ncbi.nlm.nih.gov/18288193/ 4.https://www.sciencedirect.com/science/article/pii/ S2352771420302718 5.https://tropmedhealth.biomedcentral.com/articles/10.1186/ s41182-020-00257-0

ONE HEALTH OR NO-ONE HEALTH? “He who has health has hope and he who has hope has everything.”

ne health is a concept that deals with the fact that human health in term is intricately associated with animal and environmental health. The concept of one health was introduced a long time back but came into light in recent years. It is formally defined as a collaborative as well as corroborative and interdisciplinary approach to achieve optimal health care at a national, regional and local level while considering that human health is comprehensively related to animal and environmental health. It points towards a more holistic approach rather than a piecemeal approach.

Written by:

NOVONIL DEB AMSA India North Bengal Medical College and Hospital

The world population is facing an exponential increase in the past few years. This has led to colonisation of new geographic areas and more frequent interaction with animals and the environment. Due to this intimate contact, there is a chance of disease transmission from animals to man. Going in similar lines, the global climate change due to deforestation and global warming, has led to disruption in the natural habitat of animals, thus making them more vulnerable. The rapid spread of zoonotic infection can also be attributed to scaling up of international travel and trade. Animal health can sometimes serve as an indicator for a potential illness, thus proper identification of these warning signs is crucial to control fatality.

One health concept covers a broad range of issues like food safety, food security, antimicrobial resistance and vector borne diseases. Recent studies has also portrayed the importance of one health model in the fields of chronic disease, mental and occupational health. The concept is popular in the United States and is also serving globally as a tool to tackle public health issues. Effective monitoring of animal and environmental health as well relevant sectors helps in assessing incoming threats and disease transmission. Human health professionals like doctors, nurses must work in close collaboration with Animal health professionals like veterinarians and environmental health specialists in order to achieve successful interventions.

ONE HEALTH AND COVID-19 The global menace caused by the COVID-19 has underpinned the concept of one health to a much broader scope. The 2019 strain of the virus supposedly originated from the wet markets of China. In addition to devastating effects on mankind, the virus has also infected many animal species. Reports suggest that more than 200 species of animals across 29 countries have been infected after contact with infected humans. However, no evidence of transmission from animal to man is found. Thus, implementation of one health model is important to prevent transmission of deadly pathogens like Zika and Ebola. A comprehensive, holistic approach along with meaningful integration is crucial in attaining optimal health outcomes.

For the past few decades there is an increased talk on One Health to create a sustainable future. Here we are going to present the concept of one health, its applicability and how it can pave the pathway for a sustainable future.

Humankind is a part of something bigger. We are interconnected with everything around us and cannot neglect that the evolution and progression of our planet depends on the mutual relationship between humans, animals and the environment we share. With the rapid advancement in science and technology, industrialisation, and international trading, we humans are being self -centered ignoring the fact that our health and survival depends on animal and environmental health and not just on human medicine. This has called forth many health issues, conflict, climate change and poverty leaving the world dire with increasing zoonotic disease crises that critically require expeditious and efficacious global health remedies as well as need of comparative and evolutionary medicine. With regard to this, we need some holistic proposal to meet the current and future health needs which is provided by One Health concept. This emphasises an integrative approach with the aim of restoring the biological system from all scales including human, animals and environmental health. It focuses on transdisciplinary and interdisciplinary collaboration and generates solutions to the complex global health challenge of modern times. One Health is such a vague topic that sometimes puts a question mark on its applicability. When we talk about animal health, there comes the ethics as we do not count much on nonhuman animals and sectoralised them from human health. We come in contact with domestic, farm and wild animals in our day to day life. This close contact increases the chance of pathogenic transmission between human and animal. Due to this, the emergence of a pandemic occurs. We can also get some diseases by consuming plant products, which have increased these days, due to increased use of insecticide, pesticide and environmental pollution. Globalisation in food supply has increased the risk of outbreaks and spread of foodborne pathogens and also for the emergence and spread of novel antibiotic resistance genes. One health approach supports global health security by improving coordination, collaboration and communication at human-animal-environment interface to address such shared health threats.

‘Roadmap to a one health: Agenda 2030’ throws light on

Today’s approach to reach sustainable future A paradigm shift is urgently required to desectoralise human, animal, plant and ecosystem. Sustainable development goals.

These all are possible when we realise that we are not only one creature on this planet and respect and reconnect our natural past and work within our ecological niche. One health intervention like communication, education and capacity development, participation, prevention through structural changes (development, agriculture etc.), reducing risk and integrated action amongst health services ( laboratories, epidemiological units, etc.) has seen to be beneficial to meet the need of present and future health issues of human, animal and environment at once.

Operating One Health will require an integrated animal and human health system including surveillance, robust modeling efforts that use big data. For this, effective participation from government sector, veterinary, public health sector, ecologists to ensure their coordination, collaboration and communication to reach the aim of One Health. Many countries, particularly developing countries, have taken up the principles of One Health and applied them to extend their capabilities and capacities. These countries are using their resources in such a manner that can somehow safeguard sustainability. Implementing one health principle in day-to-day life reduces the chance of disease emergence due to the human-animal-environment interface. Collaborative multisectoral effort for the equity in the distribution of health facilities, foodstuff, with a consciousness of people on animals and environmental health as well will probably take us to a better future. One Health approach will be most successful to prevent disease outbreaks before they are recognised as a problem by public health and funding agencies; thus preventing the future disease outbreak.

REFERENCES: 1. Atlas R, Maloy S. One health. 1st ed. San Diego: Center for Microbial Sciences,San Diego State University; 2014. 2. Destoumieux-Garzón D, Mavingui P, Boetsch G, Boissier J, Darriet F, Duboz P, Fritsch C, Giraudoux P, Le Roux F, Morand S, Paillard C. The one health concept: 10 years old and a long road ahead. Frontiers in veterinary science. 2018 Feb 12;5:14. 3.Amuasi JH, Lucas T, Horton R, Winkler AS. Reconnecting for our future: the lancet one health commission. The Lancet. 2020 May 9;395(10235):1469-71.

The environment sector plays an essential role in public health, yet, to date, it has been an under-utilized partner for health in most countries. While authorities of human and animal health and environment sectors may not be aware of the benefits of collaboration of these units together as a “ONE HEALTH” concept, which will hopefully be able to achieve its full potential at local, national, and global levels. Because animals and humans have shared risks to health and changing environments, it seems logical to expand the perspectives of public health beyond a single species to detect and manage emerging global health threats. Mitigating the effects of climate change, emerging pathogens, toxicant releases, and changes in the built environment requires a retooling of public health resources and capabilities across multiple species.

While the whole world still lags in coming up with efficient regulation based on the development versus environment database, there is an increasing awareness in the global arena that climate change needs to be checked to control its effect on the environment. So, the solutions to these global environmental issues require efforts at international issues. Animals and people often can be affected by many of the same diseases and environmental issues. Some diseases, called zoonotic diseases, can be spread between animals and people. More than half of all infections people can get can be spread by animals- a few examples include rabies, Salmonella, and West Nile virus, due to environmental issues like harmful algal blooms or lead contamination, which affect the public health in common terms. Of these, approximately three-quarters emerged from wildlife, such as HIV/AIDS, SARS, and Ebola. Antimicrobial resistance is another emerging threat to the health of people and animals, and resistant germs often spread through our shared environment.

As Earth’s population grows, our connection with animals and the environment changes: people live close together, travel more often around the globe, alter the environment and have different relationships with animals and the environment for companionship, education, food and various purposes. At the same time, the environment represents an important for human exposure to polluted air, noise and hazardous chemicals. In their report on preventing diseases through healthy environments, the World Health Organization (WHO) estimates that environmental stressors are responsible for 12-18% of all deaths in the 53 countries of the WHO Europe Region. Improving the quality of the environment in key areas such as air, water, and noise can prevent diseases and improve human health. Air pollution is the single largest environmental health risk in Europe and is associated with heart disease, stroke, lung disease, and lung cancer. Exposure to air pollution is estimated to result in over 400,000 premature deaths in the EU each year. Noise exposure from transport sources and industry can lead to annoyance, sleep disturbance, and related increases in the risk of hypertension and cardiovascular diseases. The properties of certain hazardous chemicals cause them to persist in the environment and bioaccumulate in the food chain, which means there will be considerable time lags before reductions in emissions translate into reduced exposure. This raises concerns about the health effects of exposure to mixtures of chemicals over our lifetime, in particular during vulnerable life stages, such as early childhood, pregnancy, and old age. The impacts of climate change also pose immediate threats to health, in terms of heatwaves and shifts in the patterns of infectious diseases and allergens. A growing body of evidence suggests that environmental risks are not evenly distributed across society, but rather disproportionally affect socially disadvantaged and vulnerable population groups.

An individual’s socioeconomic status influences their exposure to environmental stressors since poorer people are most likely to live in degraded environments. Socially disadvantaged people may be more sensitive to the impacts, not environmental stressors due to pre-existing health conditions, poor nutritional status, and specific behaviours, such as smoking or inactivity. They may also face constraints in adapting to and avoiding environmental risks. Therefore, “One Health” can be a beneficial initiative to tackle the web of interlinked health issues. By utilizing data, expertise, and management approaches in the environment and natural resources sector, we can enhance our understanding of the root causes of diseases, better account for the complexity of environmental factors, and ultimately encourage the protection of resources to benefit health terms. Data that should be our prime importance are climate forecasting to detect climate-sensitive vector-borne diseases, water quality monitoring of every kind of private and public localities, checking upon dynamics (ecological) and drivers (anthropogenic) that leads to vector-borne and zoonotic emergence, sentinel monitoring of wildlife to identify diseases before potential spillover to other components of the ecosystem, and so on. Involving environmental and natural resources professionals can result in a comprehensive picture of the factors that affect community health as a wholesome unit. The environmental sector plays a key role in early warning, detection, and identification of diseases risk as well as in response. So, environmental authorities controlled strategies to balance threats that cause harm to the ecosystem can be a checked measure. It may also detect and monitor diseases in wildlife that do not pose a direct threat to humans. However, even non-zoonotic diseases may have implications for the health and functioning of ecosystems in ways that can indirectly affect humans, such as pest control, pollution, and many more. Expertise and infrastructure from environmental services are the need of the hour as valuable components of health security and should be included in natural resources to maximize the protection of public health.

In 2014, parties to the United Nations Convention on Biological Diversity agreed to recognize “the value of the ́ONE HEALTH ́ approach to address the cross-cutting of interconnected biodiversity and human health, as an integrated approach consistent with the ecosystem approach (decision V/6) that integrates the complex relationships between humans, microorganisms, animals, planta, agriculture, wildlife, and the environment.

So, a global approach is needed to promote the environmental sector as a valuable contributor to the population health and well-being, particularly in “health security” efforts to prevent and prepare for endemic, epidemic, pandemic threats.”

GOOD NEWS ver. 35. 21

Hey! What’s good? Bisma Arif - AMSA Pakistan Chapter Representatives Pakistan’s cricket team has won 3 consecutive matches in T20 world cup!

Macy - AMSA United Kingdom Chapter Representatives Over 86% people over 12 years old have received at least 1 dose of the Covid vaccine!

Tania Chan - AMSA Hong Kong Chapter Representatives Hong Kong authorities will likely approve the use of BioNTech vaccines for children aged five to 11 “very soon” :D

Nashita Nowshin - AMSA Bangladesh Chapter Representatives COVID-19 cases are decreasing in Bangladesh!

Kirsten Tsan - AMSA Australia Chapter Representatives Associate Professor Michael Bowen from the University of Sydney received the Australian the Prize for New Innovators for the development of a potential new treatment for opioid addiction, KNX100. Phase 1 clinical trials for the new drug begin in 2022!

Hey! What’s good? Nur Hasanah - AMSA Malaysia Chapter Representative Malaysian volunteer learns Bengali & Urdu to communicate with foreigners at Covid-19 vaccination centre :)

Florentia Amanda- AMSA Indonesia Layout Designer Huening Bahiyyih finally debut under Kep1er despite of little screen-time by Mnet in Girls Planet 999!

Celestina Salvador - AMSA Phillipines Proofreaders Team Faceshields are no longer mandatory!

Samneet Singh - AMSA India Chapter Representatives Despite a slight reduction in neutralisation antibody titres, the Covaxin vaccine remains effective against the Delta, AY.1 (Delta Plus) and B.1.617.3

Priscilla Sayogo - AMSA Indonesia Chapter Representatives We started hybrid learning a.k.a going offline!

Hey! What’s good? Lloyd Anicier B - AMSA Phillipines Chapter Representative

Journalist Maria Ressa becomes the first Filipino Nobel Peace Prize laureate for “efforts to safeguard freedom of expression.”

Wendy Liu - AMSA Taiwan Chapter Representative The percentage of vaccinated citizens in Taiwan is likely to reach 70% by mid-December / Taiwanese Judoka Yang Yung-Wei is now ranked as world number one

Susmita Khatiwada - AMSA Nepal Chapter Representative Festival season of Nepal has ended without any increase in Covid 19 cases. UN has upgraded Nepal from least developed to middle income developing country

Shafira Meutia - AMSA Indonesia Proofreaders Team Cinemas in jakarta is now open! :)

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Academic Quiz Clinical Challenge

ASPIRE #35 CLINICAL CHALLENGE Submit your answer here :

Crosswords

https://bit.ly/Aspire35ClinChal

DOWN 1

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Infection caused by a bacteria that are usually transmitted to humans by eating food contaminated with animal (mostly poultry) feces (1 word) Zoonotic disease that causes uncontrollable salivation, spasms, and hydrophobia (1 word) Synonym for One Health that illustrate how human and animals develop similar health problems (1 word) Month when the annual One Health day gets commemorated (1 word) Involving many and different disciplines (1 word) Abbreviation for the World Organisation for Animal Health (1 word) Type of environmental hazard that results from your location, socioeconomic status, occupation, and behavioural choices (2 words, no space) Terminology of medicine which involves the comparison of traditional medicine based on compounds in animal and plants (1 word) The scientific method to properly handle, prepare, and store food to prevent foodborne illness (2 words, no space) Abbreviation for the international organisation on food and agriculture under the United Nations (UN) (1 word)

ACROSS

7 When an infectious disease jump from a non-human animal host to humans (1 word) 8 The person who coined the term One Medicine in 1964 (2 words, no space) 11 Affecting multiple sectors (1 word) 12 The person who was considered the father of comparative medicine and effectively launched the One Health Concept in the 19th century (2 words, no space) 14 Branch of health studying health outcomes and its distribution of a group of individuals (2 words, no space) 15 One health: “When we protect ONE, We help protect …” (1 word) 16 The terminology used in having reliable access to sufficient quantity of affordable and nutritious food (2 words, no space) 17 When bacteria, viruses, fungi, and parasite overcome prescribed drugs following overuse and misuse (2 words, no space) 19 Official terminology used to describe the relationship between health of human civilisation and the state of natural systems on earth (2 words, no space) 20 Water-borne disease that causes severe diarrhoea and dehydration (1 word)

Hobbies SECTION

MOVIE REVIEW

Coraline WRITTEN BY : Khania Inayah Aini AMSA Indonesia Universitas Trisakti

(2009)

Synopsis

hile exploring her new home, a girl named Coraline (Dakota Fanning) discovers a secret door, behind which lies an alternate world that closely mirrors her own but, in many ways, is better. She rejoices in her discovery, until Other Mother (Teri Hatcher) and the rest of her parallel family try to keep her there forever. Coraline must use all her resources and bravery to make it back to her own family and life.

Movie Details Genre : Animation, Fantasy, Thriller, Horror Director : Henry Selick Screenwriter : Henry Selick Cast : Dakota Fanning, Teri Hatcher, Jennifer Saunders, Dawn French, Keith David, John Hodgman, Robert Bailey Jr., and Ian McShane Duration : 100 minutes

Review When I was a little girl, I was not obsessed with Barbie, instead I would watch movies like Coraline, ParaNorman, Frankenweenie and Monster House repeatedly. I don’t know what it is with children’s dark fantasy horror movies that got me attached to it. How do I find comfort in such a discomforting movie? Out of all of my favourite animated horror movies, Coraline has got to be my favourite mainly because of the disturbing & frightening story it tells, which is why Niel Gaiman did such a great job writing this book. Henry Selick’s brilliant imagery for the aesthetic and the moods of this stop motion movie that are so eerie and dark along with chilling & insidious music by Bruno Caulais that were able to set the vibe to this movie.

This movie follows a girl named Coraline who moved to a big old house with her parents. With no friend, parents who largely neglected her and new surroundings, out of boredom she goes exploring the house and discovers a small door in a wall that leads to a parallel universe. This universe was nearly identical to what her reality was like, except everyone there has buttons for eyes and overall, an idealized version of her reality, or at least she initially believed. But soon Coraline begins to experience the darker side of her fantasy world and the demonic mother with the black button eyes who wants to completely possess her, her other mother’s so-called love becomes possessive, even demonic. Coraline is a “be careful what you wish for” and a “the grass is always greener on the other side until you get there” story, which left you with nightmare and conspiracy theory that up until now a lot of people are coming up with theories that explains the sinister backstory of the other mother and show her motives and dirty work to build this parallel universe to target all of her victims. It is a children’s story but it’s definitely one that will give nightmares and chills.

IMAGINE HAVIN VIDEO EDITING A What do you get when you put a pre-med student who likes anime in lockdown? An Otaku!

his is my story on how I became an AMV editor. Last year when the COVID-19 hit, my pre-med examination got postponed by six months. So I did whatever a responsible anime lover would do; I binged anime. I was so engrossed and fascinated by the world of anime that every algorithm present on the internet showed me anime, be it on Instagram, YouTube, Netflix, Google, and whatnot. That’s when I stumbled upon some anime edits. They were some beautiful Sakuga (Japanese 作画 is a term used in anime to describe moments in a show or movie when the quality of the animation improves drastically) scenes synced to some lo-fi music. And that was the start of the journey.

Since then, I started watching tutorials on basics, and started following prominent content creators like @94e and @azr. xsense. I started with basic syncing of clips with the beat of the songs. I began using Filmora software. Then I started learning some basic effects, colour grading, transitions, etc. I made a few edits. I even made an edit for my crush. I thought I had lost that video, but luckily I had it backed up on my hard drive, and it was this random discovery that motivated me to write this article. We all know what happens when you make an edit for your crush, nothing. So yeah, I started making sad edits. That’s when I shifted to Sony Vegas Pro. Now I could express my sadness more aptly and creatively. This new software gave me a boost. It was this software that produced the first AMV for my Instagram page. At that time, I only had a potato PC. Therefore, I could not use a heavy video editor like Adobe After Effects. I made edits, and some got an outstanding number of views.

NG AS A HOBBY But now it was time to study; there were only two months left for NEET (College entrance examination for med school in India). It was time to grind. I ground so hard that I got saturated with all the information and concepts. And at this point, editing helped me. It acted as a vent. At this moment, I realized that video editing had passed all the criteria to be called my hobby. It saved me from a lot of stress. Fourteen days before the exam, I was making PUBG mobile montage. For the next thirteen days, I studied like never before. The exam was over, and I was expecting a good rank (and I got it!). I had already told my parents long ago that after my NEET, I wanted a gaming laptop. They were reluctant. So I did what a responsible son would do. I begged for it. Luckily they bought it for me. Now it was time to level up the game. I installed After Effects. At first, it was so new and challenging for me. I already had made muscle memory for all the shortcuts and UI of Sony Vegas, so I thought of going back to Vegas. But some random dude on a random discord server explained to me that the learning

curve of After Effects is quite steep, but it is definitely worth the hard work. So I did what a child should do who just talked to a stranger online. I believed him. I again started watching tutorials online and remaking different edits. I was able to remake edits from which I used to get my motivation a year back. And now I wonder if I had this level of skill set back then, would she have stayed? Anyway, now I make dope edits, leader of a clan full of editors and artists, and study medicine. Even if it takes ten hours of editing and two hours of rendering, I would still edit and upload the thirty-second video on my social handles. Why? Because I love it.

WRITTEN BY : Harshul Sood AMSA India All India Institute of Medical Sciences, Rishikesh

CREATIVE CORNER

SANTÈ MENTALE FICTIONAL WRITING

Health. Health is a complex word. Some call it physical well being, some call it social. Some confuse it with the virtual activity of the person, those social media addicts. Not to disagree with the so-called ‘fitness influencers’, but I have a different mindset altogether. For me, health beds in one’s head. In simple words, an individual’s mental condition mends the architecture of his well being. It provides the basic foundation of one’s decisions, made either consciously or involuntarily. How one responds to stress, infections or even anger, influences his mood, and hence social health, his instagram page and likes.

No one prefers to eat when stressed, losing proteins and muscles! Savich, Hana and Gary, an avoid- whensighted trio. Chuddy buddies and partners in crime! They always went to the gym together, shared plates and even uploaded pictures together. They become a paradoxical happening for this conservative society, a self-sustaining trio! I call them paradoxical because a gang of three is always heavy and heartbreaking for one of them. Not till now in this case anyway.

But all good things must come to an end. So does their bond. Hana and Gary fell in love. They decided to take their friendship to the next level. Now some would say this story should have a happy ending. Maybe, for Hana and Gary. Just like us, they didn’t bother about Savich. With passing time, they started to see him as an add-on bottle of coca- cola with a pizza. We enjoy the fizz before the cheese and then get sick of this combination. We store the bottle elsewhere out of sight, only to forget about it later, leaving the soft drink tasteless and unpalatable. Same happened to Savich. Initially, it was exciting for him to roam with the new couple. A couple he worked so hard for. A couple he could even steal for, kill for, die

for. All his hard work and sacrifices got repaid by ignorance, abandonment and isolation. Now, one would suggest him to not feel dejected, instead find happiness someplace else. But that’s not how an introverted mind works! I’d give Savich a hundred for his attempts at combating loneliness and social isolation. He tried to make conversations with his college mates, school friends, even professors. But the feeling of betrayal, manipulation and victimization, made his desiderium for a companion go even worse. All his nights ended up crying. Using social media no longer gave him the pleasures. He feared looking at Gary’s and Hana’s pictures together, without him.

His appetite reduced. Going out to eat alone felt like carrying tonnes of metal across the sea on one’s back. Looking at his fellow batchmates laughing, tripping and studying together made him go green with envy. He even named the insects that falsely got trapped in his room. Digged his old soft teddy bear out to spend and eat with him. He reached the point in life where living alone in the woods was not a hard row to hoe. I know, emphatical souls now fear trying on his shoes. No imagination could possibly reach this level of abandonment. Savich ruined his health in all aspects post isolation. Social forsakenness sparked an Instagram fear in his mind, which grew up to a point where he could no longer look at others’ smiling faces. His appetite reduced with each passing day, until he could survive days without food. One event that

jeopardised his mental health created a vicious cycle of negative chills, ultimately leading to his overall deterioration. This does not mean that mental health is superior to other aspects of well- being. Infact, these three work together to run a person’s body properly. Obese people find it difficult to interact with their lean counterparts due to an inferiority complex they had created after multiple body shaming episodes and teasing. Similarly, people with fancy instagram, Facebook or twitter handles get self conscious after reading nasty comments on their uploads, which could even make the matters worse if they tremble before putting up stuff on their profile which they could have done without a thought. Now, let’s give Savich’s story the closure it deserves.

He could no longer handle the burden of living alone. Studying was becoming even more hectic with each semester and his mind always wandered about doing something out of the box. He started spending his time alone trying to uncover his hidden powers. Eventually, he found one in acting. He worked hard brushing up his drama skills, and soon applied at a renowned school that could recognise and appreciate his talents. Know him for what he was and what he could do. Clearing the interview for that school gave him a ticket out of his previous University. He made new friends, even a girlfriend this time, rediscovered his appetite and logged in on his social media again. Isn’t this perfect? Knowing that all we need to succeed in life is loads of optimism and dedication with spicules of memories that could be cherished for a lifetime!

Created by: Manvi Lamba AMSA India Maulana Azad Medical College

DO YOU SEE WHAT I SEE PHOTOGRAPHY You may not realise it but sometimes the thing you’ve been searching for your entire life has always been there by your side all along. You just need to know where to look.

Created by: Michelle Joshalyn Natasha AMSA Indonesia Faculty of Medical and Health Science, Krida Wacana Christian University

THE GAS LIGHT I laid my body disrobed the night it fell upon me How much you love vulnerability. As I bared every open pore and every cold sore, I pulled you in But you were stronger to take me down. Your lips were warm, but Your words were cold. But I ignored the letters from your mouth Because I know it’s a kisser I need, and not a goddamn poet. So I welcomed you in as I hushed you down I liked how I helpless opened up upon the signals From your eyes. I let you in. Slowly and terribly. I had to close my eyes because you told me The pain is normal, that it’s a natural element Of the pleasure I wanted from the start. It was not until I was completely destroyed I realised you lied. I tried to ask for help but it was too late. The stir you caused Was unbearable and too destructive it became a part of me. Yet from the start, I was already ill. Because your love Is an immutable virus I pleasantly gave permission to kill.

Created by: Lloyd Anicier Barba AMSA Philippines Far Eastern University-Dr. Nicanor Reyes Medical Foundation

POETRY

I have never been good in math. But allow me to count the times I picked myself up After countless bouts of love that had not been reciprocated Let me measure how many more seconds this heart can withstand, How many probabilities and chances there are to even survive. I once told myself, next time, I will only shed a fraction, And not the entirety of my soul and love But how do you recalibrate a heart that was programmed To love in infinitely numerous ways? But here I am again, making rough estimations Having calculated every move, yet I always still overshoot Blowing it out of proportion, the love I have in my pocket Does not equate with the one I planted between your lips. If I always get lost in words, more so in numbers Because whenever I try to utter my innermost thoughts, I always get bothered of how much liters of love I have left More so with how much rejection I can take. So when the next love gives me yet another question of math, It will not be surprising to see me falter Because I was never trained to measure How much love I can offer, How much risk I can take, Nor count how many fragments I can gather When my counting heart finally breaks.

MY FIRST SUNSET PHOTOGRAPHY Sometimes you want to go back in time not to change anything but to feel a few things twice. This picture was taken during community health diagnosis, an experience of lifetime, it depicts the beauty that lies in our rural area which we fail to see behind our glass windows.

Created by: A.D AMSA Nepal MBBS, Maharajgunj Medical Campus, Institute of Medicine.

PLACES I DON’T WANT TO TRAVEL I don’t know when I started seeing myself from the eyes of other’s I don’t know when loving myself became more of being loved by another I don’t know when I started betting my essence over the petty tattles I don’t know when I started filling my head with the flaws of another What an awful place to be What an awful thought to think. I don’t know when I started stressing over my stretch marks, And utterly ignored the sparkle in eyes. I don’t know when being pretty became more of number of validations And less of the magnificence a spirit possess. I don’t know when I started comparing my books, my looks, my popularity with a friend still a stranger. What an awful place to be What an awful thought to think. I don’t know when being loved became more of being loved by a person And less of being truly loved altogether, I don’t know when the reflection in my mirror became more of the reflection in social media and less of my own reflection. I wonder what the girl behind the mirror must be thinking What an awful place to be What an awful thought to think I don’t know the last when I truly appreciated myself with no if and whether. I don’t know when my insecurities overpowered the quintessence in me altogether. I don’t know from when I desperately tried to be happy in a circle, As if happiness was something to be shown and not to be felt. I don’t know the last when I truly smiled when nobody was looking at me I don’t know from when I have been running in this vicious circle What an awful place to be, What an awful thought to think.

Created by: Jeshika Yadav AMSA Nepal MBBS 2nd year, Tribhuvan University

POETRY

SOUL SCRIPTS Across the room, I glimpsed on thee, A blast of wind, blowing my door agape, With an espy, thy dagger pierced me, O Lord, have my dreams chiselled to shape? Long had I pined for a kindred spirit, My eyes couldn’t believe this new reality, When along came thy for an unforeseen visit, For aye, I’m indebted to this serendipity. Thine absence makes me shudder and fear, Desolation I now begin to see, Hoping that this feeling might just disappear, From this dread, O Lord, set me free. O dear, all my heart is thine to receive, Thou art Love, my unfaltering will to live.

Created by: Anveshak AMSA India 3rd year MBBS, Hassan Institute of Medical Sciences