SCOMER Newsletter Vol. 1 Issue 5

SCOMER Newsletter Nov-Dec, 2012

Volume 1, Issue5

www.famsanet.org

| scomer2012@gmail.com Inside this Issue, …..

1. Why I may work in Africa!!!

2. Life in School of medicine (SMS) prelude….

3. Brain drain! To go or Not to go?

4. The power of medical students 5. The Ebola Fever, what is it?

6. Ethics...The lives in our hands 7. The Oath, Is it a pledge or …..

8. More about the Hippocratic Oath 9. At the World’s End 10. UCMF—Students’ Chapter report

SCOMER is one of the five standing committees under the Federation of Afri-can Medical Stu-dents’ Association (FAMSA) and functions mainly to promote medical education and research among medical students in Africa. The new team involves students from several universities across the continent.

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WORD FROM SCOMER Dear cherished reader, Welcome to the fifth edition of the SCOMER Newsletter. We would like to take this platform to thank you and all our readers for keeping the pace with us throughout the year and to this end; our last edition for the year 2012. We are glad we will chalk greater successes to share with you and a greater populace within Africa and beyond in the year ahead.

In wrapping up for the year and in this issue SCOMER takes a look at some happenings within the year. As we dissect medical ethics, palpate the Hippocratic oath, the reality of undergraduate medical training in Africa ,take a closer look at some of the medical conditions which led to the demise of some African leaders in the course of the year, the celebration of the World Mental Health Day, amongst others.

We would like to hear your views ; if you enjoyed reading any of the articles, in this issue and in any of our previous publications in the course of the year‌do let us know. ( please log in to www.issuu.com/famsanet—for previous publications ).It is the best feedback we can have to ensure that we live up to bringing you the best in medical education and research. Send your response to the editor scomer2012@gmail.com Wishing you a pleasant reading.

Enjoy !

Dorcas Naa Dedei Aryeetey - Editor

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WHY I MAY WORK IN AFRICA !!!

On the assumption that most of the current crop of medical students are youth, it is also quite alarming that very few if any view saving their respective countries and continent as a priority. So much so that a common phrase amongst the youth today goes like, ‘’build and enrich Africa, then die poor’’.

The Kenya prime minister recently stated that the reason doctors go overseas is because the government was not disbursing adequate funding for them to engage in research. Some students may already be familiar with the chain of African diseases; the diseases impact on us and we cringe. The West investigates the disease on our behalf as we watch and even find a cure for it. What makes this painful is that eventually we’ll get cures to African diseases from the west. How ironical!

Nonetheless, one important factor has not escaped most of our keen observations; everyone is in it for the money! Remember the career guidance counselors? They always said that a career in medicine called for a genuine desire to help humanity in relieving woes caused unto it by ill health. I put it unto you, aren’t such people countable in a countless population?

They say that we bombard our brains helpless for almost half of our life in the quest for education, for a better life. Now with our world, what is a good life? Mine is this; a good home, a well groomed family that eats and leisure in the best way, good medical insurance, and oh, a dream car! That’s a list that is never free along the circumference of this globe. You see? So perhaps it could be, if we wish to have a good life, justified to search for better places to make life better from.

Perhaps one of the things that many people will agree to, is that Africa is an enigma in every sense of the word.

Most of the dynamics that easily apply to other regions seem not to have footing in our beloved continent; and neither do our principles seem buyable elsewhere.

Yes, we need this but I wish it would be that easy; for it is a nightmare depriving ourselves of so much in the quest for what counts to make life a comfortable zone. And of our negative trends, the brain drain remains a somuch –spoken-about, yet still little done to prevent it- or worse still it persists at a level that is no longer of interest to anyone, by virtue of the little that is apparently yielded, from this music that has been played in as far back as our sophisticated brains can recall, brain drain is ruining Africa.

No one can afford to sit on the fence in this. I believe that most of us know why some of the best professionals go for greener pastures. Perhaps it is even upon these ideas- whether real or imaginary, true or false; that most of our future seem lit towards.

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It would be imprudent to say that no one should go away from Africa; for everyone has a right to their own free will. Let’s reason together. With so many health problems around, some (or more) even more complex, who will solve them, with all specialists trooping to already developed countries with their health problems mainly of consequence of lifestyle (I understand it is a price to pay for abundance, just like Africa pays for inadequacy!)?

How will research ever be an institution that keeps us interested, if the minds good enough to carry out research are lost in money making schemes? Tell me, how good will the doctor-population ratio be, with some countries doubling their population every 15 years?

So much so, that I pose this, should personal fulfillment man our lives at the expense of the continent’s advancement; it being a fact that within it lie those that we love, those that have educated us so far reside in it.

It’s an enigma that will always haunt us, and we’ll still pose unto ourselves the question why Africa lags behind in health care services and availability of specialists ever so necessary for development in our health systems to pass.

For the decisions that form our individual destinies ultimately shape the destiny of mama Africa.

QUOTE: It is the tension between creativity and skepticism that has produced the stunning and unexpected findings of science- CARL SAGAN

By Kevi Makori MBchB –V Kampala International University -Western Campus

Life in SMS (School Of Medical Sciences) prelude……

To the outsider who sees through the telescope of prestige, being in the medical school is like riding on the crest of a wave. Preying on the assumption that doctors are rich, he is more than inclined to have ideal perception about life in the medical school (most even forget that you are no doctor without going through the medical school).

Most of us had this ‘misconception’ until fortunately or unfortunately we found ourselves swimming in this hot stream which we hitherto thought was at worst, lukewarm. Indeed, he who feels it knows it. If I had my father tell me about the stress and palpable tension in SMS ( School Of Medical Sciences ) , I would have played it down. Perhaps, I would have among many thoughts, convinced myself that ‘his time has passed’. But one thing that you will sooner than later realize when you are admitted to SMS is that the standards never change! From the daughter of the koko seller to the son of that business magnate trail is trail and repetition repetition.

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Life in SMS prelude…… (Continued) Whether you were admitted with ten or six A’s has no bearing on your survival. It is either you adapt or die or better still, cram or trail. There is no intermediate. The survivors therefore are those with the tendency to evolve quickly. If you have a hard shell and find yourself in an environment with a high temperature, you would have to find a way of dissipating the heat in your system else your demise is certain. So it is with SMS. In the times of examination, the heat in the system is enough to bake your brain! No matter how much you read, you are never certain until you see your results. The part where brave men tremble and beautiful ladies hide their faces is when the results are being pasted. The suspense that is associated with it can best be described as a miniature of the judgment day.

While some are wildly celebrating, some are disappointedly crying (on the inside for the sake of their reputation). Then comes the resit. The resit itself is not something out of the ordinary except for the terrifying fact that if by any means your name does not appear on the list, you are made to assume a stationary position for a whole year!

Ironically, all these ‘tortures’ are the fun side of SMS. Take them out and SMS becomes a snake without venom which even a child can wrap around his wrist. The challenges make us appreciate the gravity of our profession and most consoling of all; gives us a bank of memories from which we can draw inspiration in the face of adversity.

Samuel Akotiah….MBCHB 1 KNUST– Ghana

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"To go or not to go?" The puzzle in the mind of many Medics They have left their home countries with good intentions: to search for a better wage, better working conditions, to easily acquire new skills in their profession as they advance careers in different settings or even to raise their growing families in places of better social amenities. However, immigrant health workers have drained the human resource base of Uganda; a country that spends a lamp some on funding its public medical schools.

In 2006, South Africa employed over 250 Ugandan doctors from a nation where less than 200 doctors were graduating annually and when the doctor to patient ratio in Uganda was 1:12,500. 2009 saw 13 senior surgeons leave Uganda for Rwanda. The following year Uganda’s leading daily The New Vision, 6th April, 2010, put the doctor to patient ratio at 1:24,725. Other countries such as Australia, the UK, USA and Canada are employing numbers totaling to more than Uganda’s doctor population. The National Development Plan of 2010 declared that the nation lacks policies to increase the number of professional health workers and measures to ensure their retention when recruited.

The lack of doctors has worsened the health situation in Africa where there is only 3% of the world health workforce in Sub Saharan Africa; harboring a 24 percentage of global disease burden. Although nearly all child deaths occur in developing countries, Africa is affected most. A baby born in Sierra Leone is three and a half times more likely to die before its fifth birthday than a child born in India. Same baby is more than a hundred times more likely to die than a child born in Iceland or Singapore. The Kampala Declaration and Agenda for Action adopted in March 2008 during the first Global 7 Forum of Human Resources for Health set out a vision that all people everywhere shall have access to a skilled,

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motivated and facilitated health worker within a robust health system.

MESAU is meeting a goal in increasing medical education in Uganda and in a way will sooth the gaps left behind as Doctors immigrate to newer fresh lands without Uganda lacking the labour it desperately needs. MESAU has gone further to enhance collaboration between the super powers of science from Universities like John Hopkins and infant Medical Institutions like Gulu University. This will in a way also help the developed World to harvest labor products that have been trained to International standards. There are also individual Western Universities like Baylor Teaching Hospital, Case Western, UCLA, George Washington, Harvard or YALE, Swedish and Netherland Universities, that are patterning with local Universities in Uganda to offer opportunities for elective student exchange programs and research work.

The countries that are hiring cheaply trained African doctors would also pay back to where they are educated from.

It is no wonder countries like Cuba and China are making large export earnings from human resource.

KIU School of Health Sciences as a private institution was timely started at such an apt moment. It would raise the number of graduating doctors from the three government medical institutions annually and admit students meeting optimum entrance requirements stipulated by Ministry of Education and Sports so as not to compromise the quality of candidates to be trained. Seven years down this road, it is winning. Biggest setback in Uganda’s eye is that the 1st graduates who were able to maneuver chal-

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lenges of a baby Medical School performance and finances, were largely foreigners – so contributed little to the shortage of Doctors in Uganda specifically. The Ugandans themselves are to take some of this blame.

While they were in their caucuses wishing KIU should not be registered or chattered for training Doctors in Uganda, Kenyans and Tanzanians were clapping hands for such a cheap facility for training Health workers in East African. Against all these odds, this year Uganda will realize a bigger harvest of native doctors out of KIU. The KIU curriculum competency of taking students to clerk patients in Health Centre IVs during their COBERMS (Community Based Education Research Management and Services) is another step in the direction of training and retaining Doctors who are ready to work in hard to reach neighborhoods in line with MESAUs vision.

These efforts need embracing by the central government of Uganda. The Ministry of Health’s policy of delayed recruitment for interns after completion somewhat defeats these purposes. The lack of post internship training as a bridge to curb this redundancy is another disillusion. It takes long spells of time for Doctors to wait for advertisements from District Service Commissions, Ministry of Health or Public Service Commission to run adverts for Medical Officers yet for some of these facilities, that is all the human resource they need.

If Uganda cannot borrow a leaf from other equally economically disadvantaged countries like Swaziland where nurses have had more than double salary raises to stay on their jobs or Zambia where doctors in upcountry centers have had free education for their children, it is going to be hard to convince health workers not to go. Uganda’s Public sector is known in East Africa to be the least paying country in terms of salaries for health workers yet among the best for providing adequate training in the same region. Medicine is a rigorous discipline requiring at least 5 years of tertiary training in Uganda.

These policies will take a political muscle of Uganda’s policy makers. Against all odds, apart from very few MPs excluding the Workers’ MP in Parliament, Hon Dr. Sam Lyomoki, most MPs are not medical doctors or have no health workers’ background. For a doctor who spends 24 hours on the Ward, to earn less than 1/10 of a salary of an MP who required only an A-level certificate to contest and win his post, is but a slap in the face.

Paul Kibenge, MB Ch B V, KIU Western Campus (For other publications by the same author on the internet by search words: Paul Kibenge)

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MEDICAL STUDENTS AS ADVOCATES FOR HEALTH DEVELOPMENT THROUGH HEALTH ACTION MEDICAL CAMPS (HAC).

Objective: The purpose of this camp was to provide free medical care to the low income population of Butenga and Kitanda Health Centre IV and III respective catchment areas.

Background: Health Action Camp is an integral part of health delivery system especially in the disadvantaged communities, by bringing free health services closer and strengthening other aspects of health like health education.

Bukomansimbi is a new district having been created by the act of parliament in 2010 with no district hospital, its major Health Centre is Butenga Health Centre IV which is under-staffed. It’s equipped and funded to oversee the activities of the other few Health Centres in the district , so on many occasions the patients are forced to seek health care from other health providers like private clinics due to lack of drugs in these Health Centres.

Methodology: The camp was a preventive, diagnostic and treatment type conducted at Butenga and Kitanda health center IV and II respectively in Bukomansimbi district, targeting a population of 350 health seekers at each site.

Activities carried out included: treatment of the common illnesses like malaria , health education on the commonest causes of morbidity and mortality in the area , HIV counseling and testing , and Young Child Clinic ; Vitamin A supplements and dewormers.

Results: Most of the patients who attended the camp were socially and economically disadvantaged.

A total turn up of 659 patients was realized at both sites. Most of the children and young adults were diagnosed of malaria, respiratory tract infection, urinary tract infections, skin conditions and gastro intestinal disorders especially peptic ulcer disease(PUD) while chronic illnesses like hypertension, arthritis and heart conditions were more common in the elderly.

A total of 250 patients went for HIV counseling and testing, only 4% were positive, as reported by TASO Masaka Branch.

Conclusion We regarded the camp highly successful as portrayed by the high turn up of patients. Inadequate finance and time were the challenges.

Ssemusu Moses: ssemusum@gmail.com College of Healthy Sciences Makerere University Kampala (MUK)

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THE EBOLA HEMORRHAGIC FEVER According to CDC, Ebola Hemorrhagic fever (Ebola HF) is a severe, often fatal disease in humans and nonhuman primates that appears sporadically since its initial recognition in 1976. The disease, popularised then by a newspaper ‘the Hot Zaire’ first appeared simultaneously at Nzara (in South Sudan) and Yambuku (in Democratic Republic of Congo). The later is a village near river Ebola from which the disease got its name.

In Uganda, it was identified in Rwot Obilo village in Aswa county, Gulu district in September, 2000 though several cases and deaths had occurred in the communities until a month later when suspected cases where reported to Lacor and Gulu hospitals (both in Gulu district). The ministry of health confirmed the outbreak on 8th October, 2000 and in less than three months, 426 cases and 172 deaths (including the medical superintendent of Lacor Regional Referral hospital, other health workers and medical students) were reported by the ministry.

Since then, several outbreaks have been reported in the different districts in the western part of the country with the most recent one being in August, 2012 when 24 cases and 17 deaths were confirmed.

Ebola virus and Marburg virus (also causing hemorrhagic fever) are the only two viruses belonging to the filoviridae family. They are considered to be among the most virulent pathogens that infect man.

There are five subtypes of Ebola virus; Ebola Zaire, Ebola Sudan, Ebola Ivory Coast and lastly Ebola Reston (which does not cause mortality in humans).

PATHOPHYSIOLOGY The virus targets endothelial cells, phagocytes and

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hepatocytes where it secretes glycoproteins which bind to the endothelial cells in the blood vessels causing loss of vascular integrity as well as coagulopathy.

The replication of the virus overwhelms that of the infected cells and the neutrophil activation is inhibited thus impairing the host defense system. The white cells even transport the adhered viruses to the lymph nodes, liver, lungs and spleen where they further destroy the cells. The damaged cells release cytokines (IL-6, IL-8 and TNF) causing inflammation and fever SIGNS AND SYMPTOMS Sudden onset of fever, general malaise, myalgia, arthralgia,headache and a sore throat, cough, dyspnoea.

These are followed by vomiting, diarrhoea, rash, impaired kidney and liver functions and internal and external bleeding.

The cause of death is usually not hypovolaemia but rather, multiple organ failure as a result of fluid redistribution, hypotension, disseminated intravascular coagulopathy and focal tissue necrosis.

PREVENTION STRATEGIES There is no definitive treatment or vaccine for this disease thus patients are managed on supportive therapy (fluid replacement and electrolyte balance) Avoid direct contact with the infected persons as well as the bodies of the deceased (blood, secretions).

Therefore, all health workers normally have protective gadgets including gloves, face masks, gowns and boots all the time during the outbreak.

Isolation and screening of all suspected persons and monitoring of all the other people they’ve been in contact with.

By Kisangala Ephraim Medical Student in Uganda & Chairman SCOMER 2012-2013

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ETHICS, THE PATIENT'S REQUEST, THE DR'S DECISION… AND THE LIVES IN OUR HANDS The patient was a two week old male lying in the incubator and on oxygen, severely asphyxiated from birth though delivery was recorded as normal and without complications. He had been on admission since birth and taking him off the oxygen supply resulted in cyanosis or in layman’s terms the baby turning blue...a request for an Ambulance to transport the patient to Korle - Bu after three days was still pending as...a thousand and one reasons! We had just finished ward rounds and the Dr we were with was finishing up with changes on some of the patients’ treatment sheets.

I cast a glance in her direction of the patient’s mother (looked middle aged) and did not need much evidence to tell that this woman was struggling to make ends meet for her family. I peeped into her son’s folder, and they had no health insurance. I checked the demographics and she is a trader and has 4 children already; now this new member of the family her fifth child and another mouth to feed! We were approached by this mother who now looked hopeless, tired, and almost in tears, she asked (translated from Twi to English here ) ‘’emmh Dr...since we can’t even afford the bills here, even if we are able to transport my child to Korle - Bu i can't pay the bills...and this child is so sick...i already have 4 children am struggling to take care of...i think you should just give me my child to send home......

After several discussions and questions, and trying to reconcile the mother's decision and the state of the child the Dr asked....... and what if, right after getting home you lose this child?

What care should be given?....and…this was the care - taker's decision...in medicine...the choice of the patient counts (in this case a minority; her 2 week old son who could not take the decision himself… ethical analysis...to allow this decision to be taken for another life...setting in a place where getting a higher authority to take custody will be like chasing after the wind... euthanasia or '' mercy killing'' - put in a nicer way has not been legalised...and the Dr's decision to deliver the best.

Ethical analysis (or moral reasoning) is the process of thinking through ethical problems and reaching a conclusion. It helps the decision-maker to grow personally and professionally, allows communication of the process by which a decision is made, and permits the process to be constructively criticised. It can be used systematically: for example, in retrospective review of difficult cases. When, in everyday

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practice, time for reflection is limited, knowledge of methods of moral reasoning provides a useful background and aid for decision making and is often employed in ways analogous to those of ‘the novice – expert shift’. Some approaches that are applied in ethical analysis are as follows A Principles Approach – This involves analysing ethical problems in terms of the principles of respect for autonomy, beneficience and non-maleficence (benefit and risk), and justice. If all of these principles support a particular course of action, then that course of action is probably correct and there may in fact no longer be an ethical problem.

A Casuistry Approach – this uses precedent as a guide to what to do. A case is recalled or imagined which is similar to that under discussion but where the right choice of action/ behaviour was obvious.

A Perspectives Approach – This involves considering the views of all the stakeholders: the patient, the family or carers, the health- care team, the health service and the society.

The Counter –argument Approach – A particular course of action is chosen and the best ethical arguments against it are then marshalled and evaluated.

Application of rules – In certain common and clearly defined situations, externally imposed rules (including the law) may require, or guide towards, a specific course of action. This does not obviate the need for ethical analysis.

While all these approaches may be useful, it is important to remember that none of them removes the need on the hand for the exercise of judgment, and on the other for good communication and consensus decision – making. No less is the requirement for all of this to be based on sound and shared information about the clinical and human facts of the case.

In this case, further discussion of the relevant issues with the mother and other members of the health care team led to a concordance. The patient was maintained on the oxygen supply and miraculously a day after this reported incidence the baby was able to survive without the need for artificial ventilation.

By Dorcas Naa Dedei Aryeetey , School Of Medical Sciences (KNUST) - Ghana ( Editor – SCOMER )

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A pledge or one of those things?

Among the oldest binding documents in history, the Hippocratic oath is widely believed to have been written

by Hippocrates, the father of modern medicine although the oath emerged a century after his lifetime. The Hippocratic Oath, contrary to widespread perception is not sworn in most medical schools possibly because its requirements are for the most part, impractical in the modern medical environment. Among these are the requirement to swear by gods and goddesses the new physician has no fear nor owe any allegiance to and it may also be contrary to the religious beliefs of the new doctor. The oath also requires a very burdensome obligation to one’s tutor which may be impossible to fulfill in this age. The oath also essentially prohibits cutting a patient with a knife which implies abandoning the entire surgical practice which forms a vital part of the modern medical discipline. These make the classical oath obviously outmoded and it’s not surprising that the medical schools that swear an oath swear a modern version of the oath such as Lasagner’s version.

These modern versions attempt to bring out the core values that are entrenched in the classical Hippocratic oath and streamlining these values with modern medical practice. The classical oath speaks of following a system of regimen that is beneficial to the patient as well as avoiding harm and injustice. It also states that visits are to be for the benefit of the sick and entreats doctors to remain free from intentional mischief and sexual relations with patients. All these standards are captured in the modern oath and have been fine tuned to the necessities of the practice today.

Hippocrates

So do doctors really care about this oath? Is it just some tradition handed down or a sacred commitment?

Either way, it appears the oath is not a legally binding document and one’s desire to keep it depends on his or her conscience. Since the oath serves as a moral guide, society should decide what morality entails and work to impart these values in the course of training the individuals rather than waiting till they are on the brink of graduating and expecting them to suddenly follow an arbitrary set of dos and don’ts. Doctors are also human who would struggle (just like everyone) else to put the needs of others above their own and society ought to recognize this human nature and how to curtail its effect in the work of the doctor.

Swearing an oath doesn’t automatically give you the capacity to fulfill it especially when there is no absolute stand on certain issues like euthanasia and abortion. The doctor’s decision is then based on his personal view and until these dilemmas are sorted out and society decides what its moral fabric entails, the pledge to do no harm will be ambiguous. When what is morally right is clear, a more binding ‘Hippocratic oath’ can be drafted in the conscience and heart of the doctor, otherwise any oath would end up being ‘one of those things’.

Raymond Kwame Amoah (thextremerey@yahoo.com) Kwame Nkrumah University of Science and Technology (KNUST) - Ghana

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Palpating The Hippocratic Oath ‘’ I swear by Apollo the physician, Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgement, I will keep this Oath and this stipulation. – to reckon him who taught me this Art equally dear to me as my parents, to share my substance, and to relieve necessities if required; to look upon others in the same footing as my brothers.

I will use treatments for the benefit of the ill in accordance with my ability and my judgment, but from what is to their harm and injustice I will keep them I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

With purity and with holiness I will pass my life and practice my Art. While I keep this oath unviolated, may it be grated to me enjoy life and the practice of the Art… Should I violate this Oath, may the reverse be my lot. ‘’ (excerpts from The Original Version of the Hippocratic Oath – 425 BC) Written nearly 2,500 years ago by the father of medicine, the Hippocratic Oath traditionally taken by newly graduated physicians to observe the ethical standards of their profession, specifically to seek to preserve life.

It is one of the oldest binding documents in history. Perspectively we take a closer look at what Hippocrates put together, pause to ponder and question the Hippocratic Oath – a meaningless relic or an invaluable moral guide in our times? Perusing the oath which is to be sworn to gods and goddess unknown to us through to its concluding part ‘’ should I violate this Oath may the reverse be my portion‘’; the student in training or the doctor on the field in the medical profession may be caught up thinking of differentials and with a high index of suspicion say that Hippocratic must have been merely quaint when he put this oath together. Paralleling medical practice and its challenges when he put the oath together 425 BC and 2012 AD down the lane, one in our generation and on the African soil where doctors encounter insurmountable difficulties or obstacles ,government health polices, hospital administrative challenges, lack of resources, ignorance, poverty the list is endless in having to often improvise ways and means to save lives – the celebrated Greek physician may seem better off a saint further away on his island of Cos in practicing to the letter this very oath! Then again it strikes us that inspite of the encumberance in the practice of medicine in his days he deemed the people or society worth all the reverse of the implications of his undertaking on him!

Written in antiquity, today, most graduating medical-school students swear to some form of the oath, usually a modernized version. At the end of the first five or six years of medical education we take this Oath step out into the reality of the working field. The question then is how do we keep the oath? Subconsciously what may linger on years after medical school and after the oath swearing is the truth that – we take this oath and practice not because we are doctors but because sooner or later we are all patients, or people close to us may find themselves in our consulting rooms or with our colleagues. Below is one the modern versions of the oath. The British Medical Association’s Revised Hippocratic Oath 2010 AD ‘’ I promise that my medical knowledge will be used to benefit people’s health. Patients are my first concern. I will exercise my professional judgment, uninfluenced by political or religious pressure, or the race, sexual orientation, social class, wealth, or celebrity of my patient. I will not put profit or my own career above my duty to my patient. I will do my best to keep myself and my colleagues informed of new developments, and ensure that poor practices are exposed to those who can improve them. I will respect each of my roles, as expert, communicator,

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scholar, partner, manager, teacher, professional, and health advocate. I will promote fair use of health resources and try to influence positively those whose policies harm public health.’’

and cannot not apply in certain instances but rather play its role adequately to the better of both parties.

From this point the conflict of interest ensues when we are faced day in and out practicing on the African soil or finding ourselves working in areas where there only seem to be barely a glimmer of hope despite all the breakthroughs medicine has evolved through the centuries ; arduous it is upholding the Hippocratic oath and drawing the line where the oath thrives or dies in such systems!

‘’While I may continue to keep this oath unviolated, may it be granted to me to enjoy life and the practice of the Art, respected by all, in all time.’’

Indeed, a growing number of physicians have come to feel that the Hippocratic Oath is inadequate to address the realities of a medical world that has witnessed huge scientific, economic, political, and social changes, a world of legalized abortion, physician-assisted suicide, and pestilences unheard of in Hippocrates' time. Some doctors have begun asking pointed questions regarding the oath's relevance: In an environment of increasing medical specialization, should physicians of such different stripes swear to a single oath? With governments and health-care organizations demanding patient information as never before, how can a doctor maintain a patient's privacy? Are physicians morally obligated to treat patients with such lethal new diseases as AIDS or the Ebola virus?

Other physicians are taking broader aim. Some claim that the principles enshrined in the oath never constituted a shared core of moral values, that the oath's pagan origins and moral cast make it antithetical to beliefs held by Christians, Jews, and Muslims. Others note that the classical Oath makes no mention of such contemporary issues as the ethics of experimentation, team care, or a doctor's societal or legal responsibilities. (Most modern oaths, in fact, are penalty-free, with no threat to potential transgressors of loss of practice or even of face.)

But the oath may not just remain in the dusty confines of a book, neither should it lay dormant to all and sundry only to be used against health professionals in the heat of strike actions but rather should serve every chance of influencing every action both internally and also with the powers that be in not subverting and coming up with brilliant excuses as to why the oath does

As stated both in the old and revised Hippocratic Oath

Paradoxically, addressing the realities and pegging a line from the revised oath ‘’While keeping within this framework, I will not be discouraged by failure, and will try to continue in the spirit of practical and rational optimism. ‘’ but to all practicing and those yet to be welcomed into the fellowship may Hippocrates creed not die or thrive but the health ( as defined by WHO ) of both doctors and patients prevail.

Complied by Dorcas Naa Dedei Aryeetey , School Of Medical Sciences (KNUST) - Ghana ( Editor – SCOMER )

AT THE WORLD’S END The older you grow, the more deaths you hear of. So there is a tendency to think… It was at this juncture that I was invited to pray over a dead man of 24 years, as is the Muslim custom, before burial. Before I was called, I was still thinking of how this article should go. Now, the course is clear after being initially blurred.

Like I was saying, we are all more likely to hear of deaths now than years before, not just because we are medical students attending to the sick, some of whom will inevitably die, but also because we are more aware of our environment now. It is also true that older people are more likely to die. With these, life simply appears shorter or death appears closer.

Death is an everyday event taking place by the second, yet when it involves the rich and/or famous, it makes news.

Consider the man I just talked to you about. Would you have heard of his death if I hadn’t mentioned it? Of course not.

Was he not important? Definitely not. By this, I am setting the stage for a discussion of the death of prominent people in Africa.

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AT THE WORLD’S END (continued) “It's rare for the leader of a country to die in office. Since 2008, it's happened 13 times worldwide - but 10 of those leaders have been African…” This is according to a BBC report. What about Africa predisposes our leaders to die while in office. We can all speculate as to the cause.

Former Ghanaian President, John Atta Mills

The debate as to how much of a presidential candidate’s hospital record should be kept personal and from the view of the public rages on. On the one hand there are those who posit that since public funds are used to cater for the health needs of Presidents, there is no such thing as privacy of health records. ‘Don’t we deserve to know how sick you are before we worsen your health with the stress of providing for our needs?’ they probably are asking. On the other hand there are those who think it doesn’t matter what the health status of the candidate is. After all, you could be cleared by the best doctor today, told you have never been healthier, contest an election, win and die in a car accident on your way to cut the sod for a project. So the healthy die, and the sick live. The equation is too complex to be explained with simple logic.

I am Ghanaian, so I will speak about our Ghanaian situation.

For the 3 other deaths that occurred this year in Africa, namely Ethiopia’s Meles Zenawi, Malawi’s Bingu wa Mutharika, Guinea Bissau’s president, M B Sanha, little will be heard about them on this platform. No offence, but I have a dearth of knowledge of the events preceding their demise.

It had been widely rumored that President Mills, then as candidate Mills was ill. Indeed, these rumors initially emerged from competitors in his own party to the effect he wasn’t fit to lead their party. Obviously, there were denials. Then he was elected to lead his party. It then became a campaign issue between parties. This unsubstantiated claim was again vehemently denied. The health issue didn’t die down even after he became president. It was during the period of seeking re-election that his untimely death was reported.

In our African context, certain issues are taboo topics, including the health of our elderly. Is this then the basis of the secrecy of our leaders’ health statuses? Or is it just the certain knowledge that if it were made known that they are battling one chronic illness or another their opponents will have a potent arsenal against them? The latter proof seems to hold a lot of weight. Or do our leaders simply not know their health statuses? Don’t they go for regular medical check-ups. The vehemence of their denials when the rumor of their ill-health gains centre stage seems to support this last claim.

Rumors as to the cause of Ghana’s late president death were rife. The wheels of speculation were well lubricated by the paucity of information. Top on the list was cancer. Nobody knew for sure if it was true, and nobody knew which cancer it was, if the ‘cancer’ hypothesis was true. Ghanaians were in the dark. Amazingly while Ghanaians we still grappling with how to come to terms with the demise of our truly humble leader, BBC posted on its website that his cause of death was throat cancer, without a shred of uncertainty. It still amazes how they got that information. But is

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it as big an issue as I am making it seem? Please ignore my pettiness.

In the end, whether our elected leaders know they are sick or not, whether they reveal their health records to us or not, the point has to be made that since in the emergency situation it is those same doctors, nurses, et al that they probably ignored in their tenure who will give them oxygen, administer their medications, measure their Blood Pressure and monitor their progress before they are flown out, if they live long enough, it will be in their interest to keep them motivated. The hospitals too must be equipped. May they be reminded that, as they make their beds so shall they lie on them.

Everyday people die. I don’t know the statistics, but I am pretty sure that more deaths were recorded centuries ago, per populations than they are recorded now for apart from wars which have now become sophisticated and indiscriminate, the plagues of the past are no longer with us, yet .

By Abukari Yakubu , MbCHB 3 School Of Medical Sciences — KNUST (Ghana) gubliyakubu@gmail.com

REPORT FOR THE UGANDA CHRISTIAN MEDICAL FELLOWSHIP (UCMF) STUDENTS’ CONFERENCE Date: 26th- 28th October 2012

Venue: Gerenge FOCUS Centre and Lweza Training Centre

Attendance: Medical Students in Uganda Introduction: This conference was organized as part of the end-of-year activities of the UCMF. The conference was intended to sensitize students about the UCMF as a vital step in launching the UCMF Students’ chapter.

UCMF is an umbrella body that brings together christian medics (Doctors, nurses, radiographers, pharmacists etc) in Uganda. It strives to promote envangelism, social networking, social justice through advocacy and spiritual growth among the medics in the country.

It is affiliated to International Christian Medical and Dental Association (ICMDA) and Fellowship of Christian Unions (FOCUS).

Why the students’ chapter: We brainstormed on why there need for a students’ chapter and some of the reasons include the following: Medical school years form the foundation for UCMF membership hence the need to pay special focus to medical students.

There is need to create a sense of belonging for students within the UCMF hence encouraging their full participation in all UCMF activities within Uganda and beyond.

Improving opportunities for networking between medical students from various universities within Uganda and beyond on aspects including mentorship, medical evangelism, medical missions, academics, fellowship, social interactions, sup-

VOLUME 1 ISSUE 5 porting those in needs, etc. All of these are emphasized within the UCMF. Student in Ministry by Dr. Bernard Kikaire He emphasized that a Christian Doctor /student should do more than just treating patients as God has given them something extra that the patients can benefit from. He also shared his moving story of his life as a student (secondary and medical school) and a minister of God including the challenges he faced doing this and how he did overcome them.

Mentorship by Dr. Isaac Ssinabulya It was a very interactive session where benefits, barriers to mentorship and the solutions to the mentorship challenges were thoroughly discussed.

Currently there’s a UCMF mentorship programme through which a student (mentee) is attached to a doctor (mentor) who pledges his time and resources to guide the student through his/her years in medical school and through internship. The focus is to provide oversight in both his Christian and academic life. The other aspects addressed are agreed upon between the mentor and mentee.

RELATIONSHIPS by Dr. Richard Byaruhanga aka Ricky This was a very interesting topic and almost everybody asked questions or discussed something. Dr. Ricky adequately handled the important points to be followed as one considers starting and nurturing a relationship which may ultimately lead to marriage. In particular, he emphasized aspects such as prayerfully seeking God’s guidance, knowing the times and seasons, linking with friends to get guidance, taking time to know those you date as well as appropriately ending any relationships that ought to end in order to avoid causing unnecessary hurt to the parties involved.

SALINE SOLUTIONS By Dr. Sarah Nakubulwa This is a tool adapted from the ICMDA which guides one

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on how to minister to patients during our medical work. It has been observed that patients are very receptive to the gospel and are often very willing to listen to the medical personnel Evangelism during medical work is an excellent opportunity to win souls to the Lord, especially since some of them may be in their final hours of life and thus the opportunity should be utilized well.

MISSIONS by Dr. Richard Kagimu Dr. Kagimu, who has been closely involved with most of the recent mission organized by and through the UCMF, talked about reasons why students should be involved in missions, the different mission activities UCMF is currently involved in and benefits of missions. The whole session was spiced up with several interesting stories and life experiences.

A new executive was elected to lead the UCMF in 2012/2013 and the students ‘chapter was incorporated as a new arm of the UCMF. WAY FORWARD FOR UCMF STUDENTS’ CHAPTER Having understood the basic guiding principles of the UCMF, the students engaged each other to come up with a basic structure of the students’ chapter of the UCMF. In particular, they came up with a vision and mission statement; and a tentative leadership structure. An interim committee was elected to lead this new arm of the UCMF. I believe that the students’ chapter will have a great impact in the lives of the students in the country as they manage the patients in the hospitals.

Ephraim Kisangala Kampala Int. University- Uganda

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