PeriSCOPE

PeriSCOPE

Official magazine of the Standing Committee on Professional Exchange

Spain

Japan

Ghana

Peru

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Indonesia

8 Emergency Medicine in Peru - 10 Cardiac Surgery in Spain - 12 Plastic Surgery and Internal Medicine in Japan - 14 Primary care in Chile 16 Internal Medicine in Indonesia - 18 Internal Medicine in Austria 19 General Surgery in Taiwan - 21 General Surgery in Ghana

IFMSA

The mission of IFMSA

was founded in May 1951 and is run by medical students, for medical students, on a non-profit basis. IFMSA is officially recognised as a nongovernmental organisation within the United Nations’ system and has official relations with the World Health Organisation. It is the international forum for medical students, and one of the largest student organisations in the world.

is to offer future physicians a comprehensive introduction to global health issues. Through our programs and opportunities, we develop culturally sensitive students of medicine, intent on influencing the transnational inequalities that shape the health of our planet.

Imprint Editors in Chief Amine Ardhaoui, Tunesia Pablo Vega Rojas, Chile Content Editors Yusuf Dursun, Turkey Rouba Abdennour, Lebannon Samuel Sinaga, Indonesia Pierre-Antoine Juge, France Nadya Nakova, Bulgaria Ionas Gektidis, Greece Design/Layout Madelein van der Stouwe, The Netherlands Proofreading Laura Bertani, USA Charley Peal, UK Aaron Schembri, Malta Ann Farrugia, Malta Daniel Vella Fondacaro, Malta Special thanks to Mousa Azer, Egypt Magrit Jarlsdatter Hovind, Norway Publisher International Federation of Medical Students’ Associations General Secretariat: IFMSA c/o WMA B.P. 63 01212 Ferney-Voltaire, France Phone: +33 450 404 759 Fax: +33 450 405 937 Email: gs@ifmsa.org Homepage: www.ifmsa.org Contacts publications@ifmsa.org Printed in Canada.

Contents ifmsa.org

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Editorial

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New opportunieties for SCOPE

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SCOPE - A glimpse of the past

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Emergency Medicine in Peru

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Words from the Editors in Chief

Message from the Liaison Officer for Research and Medical Associations

Word of the third SCOPE director

From Switzerland to Peru

Cardiac Surgery in Spain From Malta to Spain

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Plastic Surgery and Internal Medicine in Japan

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Primary Care in Chile

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Internal Medicine in Indonesia

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Internal Medicine in Austria

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General Surgery in Taiwan

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General Surgery in Ghana

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Subregional Training

From Bratislava to Tokyo

From Brazil to Chile

From Oslo to Semarang

From Chile to Austria

From Tunisia to Taiwan

From Spain to Ghana

Uprising of the exchanges

PeriSCOPE - Edition 2, August 2010

Editorial Getting back on track

ifmsa.org

It is with great joy and pride that we hold in our hands the second edition of the Standing Committee on Professional Exchange’s magazine.

Being the first standing committee in the international federation of medical student’s associations (IFMSA), and providing one of the largest students exchange programs in the world, SCOPE is still not sufficiently known by medical students worldwide and the larger public. For this reason a dedicated group of medical students, members of the SCOPE family, have decided to bring this wonderful committee out of the shadows, and share their love for their committee with you!

We have chosen to put the spotlight on the various protagonists of this complicated but solid system, starting with the words of the liaison officer for the Research and Medical Association. This will give you a better overview of the cooperation we are trying to achieve with various organizations in order to increase the quality of the exchanges and offer new programs to students.

IFMSA is turning 60 years old next year and we are really proud to be a part of this wonderful organization. In order to understand how we became the largest student exchange program in the world it is first necessary to understand the history of this organization. For this reason we contacted Dr. Per Bergsjø from Norway, a former director of the committee from 1953, who told us a bit about how he became the director as well as some stories from his term, which was marked by the years following the second world war.

A tour through some of the wonderful Sub Regional Trainings (SRTs) has been a wonderful opportunity for the exchange officers from different countries to meet and share their ideas, as well as receive trainings to increase the quality of the program.

The most significant aspect of this magazine consists of the students’ thoughts and experiences.

How could anyone describe the exchanges better

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than the students themselves? We have chosen many articles written by students in various countries, from Ghana to Chile, who have had the opportunity to take part in an exchange program organized by the IFMSA; these students have shared with us their thoughts, joys and memories and we hope that their words will encourage our readers to take part in these once in a lifetime opportunities.

Although vastly different in many aspects, this stories share a crucial theme – these exchanges have all somehow, albeit at different levels, changed the lives and broadened the minds of those who have experienced them. Whether you are studying medicine in Peru or Switzerland, these experiences are all unique, yet similar in many ways, and it can be enriching to share these stories with students from all over the world – students who will later become really close friends.

Working on PeriSCOPE was an exchange in itself; from Tunisia to Chile, through Turkey, England, Egypt, Norway, Malta, The Netherlands and the U.S.A. these articles have been concocted, collected, edited, selected and reborn in a delightful design. We hope you enjoy reading it, and we would be pleased to receive any comments or questions.

We are looking forward to seeing you on the team for the next edition!

exCHANGE the world!

Amine Ardhaoui & Pablo Vega PeriSCOPE is an IFMSA publication © Portions of PeriSCOPE may be reproduced for non political, and non profit purposes mentioning the source provided.

Notice: Every care has been taken in the preparation of these articles. Nevertheless, errors cannot always be avoided. IFMSA cannot accept any responsibility for any liability. The opinions expressed in this PeriSCOPE are those of the authors and do not necessarily reflect the views of IFMSA. Some of the photos and graphics used are property of their authors. We have taken every consideration not to violate their rights.

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New Opportunities for SCOPE Word of the Liaison Officer to Research and Medical Associations Remco Kruithof, IFMSA LORMA 2010-2011

Dear SCOPE friends, In the last 59 years, the numbers of exchanges and the number of countries taking part in the IFMSA exchange program have increased constantly. Nowadays, more than 8’000 exchanges are organized each year in more than 83 countries all around the world. This is the largest exchange program run by students in the world.

The exchanges are very well known inside the IFMSA, since SCOPE is one the first standing committees and has been very active since the beginning. This renown is based upon the huge structures to support the exchanges, the organization and motivation to make an unforgettable experience for each incoming student.

Outside the IFMSA, just a few people know about the tremendous work done by student to provide their pairs with clerkships, but every time SCOPE is presented to external organization, they are impressed. At first by the number of exchange, and even more when they see the complexity necessary to insure the clerkship. Until now SCOPE didn’t use a lot of external help, but a lot of potential lies in collaboration with other organization for the future.

A great potential lies, for example, in the collaboration with international organization like FIGO, UICC, WONCA or WFN(1) on the quality of our exchanges. As a student, it is hard to know what is important in a clerkship to be learned or what are the important skills for each department. At the moment, we are working with all the mentioned organizations and a few others on checklists that could be included in the handbook every student going on exchange will have to take with them. Also, having the support of these organizations will encourage tutors to take our exchange program seriously and provide the students with good learning supports.

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Another type of collaboration is with WONCA, on primary health care clerkships.

Primary care is an important part in every health system, but clerkships in this field are not common in the SCOPE exchanges.

With the help of WONCA, we will be able to support those who are willing to organize this kind of clerkship and also make the necessary promotion to have students doing this kind of exchange.

Because the position of Liaison Officer to Research and Medical Associations is new, a lot more exploration should be done to see all the possible opportunities for medical students. But there is obviously a large potential for this exchange program to improve and offer new and better opportunities to all medical students. SCOPE has now the opportunity and the capacity to become the best opportunity for student willing to experience another way of medicine.

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Abbreviations FIGO: International Federation for Gynecology and Obstetric UICC: International Union Against Cancer WONCA: Global Family Doctor Organization WFN: World Federation for Neurology

PeriSCOPE - Edition 2, August 2010

SCOPE - A glimpse of the past Message from the third Standing Committee Director

Per Bergsjø

The Standing Committee on Professional Exchange was set up in 1951 and it was the first committee established in IFMSA along with the beginning of the Federation. The first director of the committee in 1951 was Henrik Wulff from Denmark, followed by Sven Oseid from Norway in 1952 and later Per Bergsjø in 1953. The role of SCOPE-D, which is to coordinate the progress of each country and facilitate discussions during our sessions in the General Assemblies, is very important in the federation; it also serves as the link between external organizations and other sources that are willing to collaborate.

“1953. Airline tickets were expensive, unless you got a free flight from Oslo to Hamburg with one of the Air force DC3s that supported the Norwegian occupation forces in up-state Germany after the Second World War.”

By the year 1953 ,when Mr. Bergsjø became the director of SCOPE, he was the chairperson of the Travel Secretariat for Medical Students in Norway and a medical student in his third clinical year.

The Federation had assigned SCOPE the job of establishing a body for facilitating the exchange of medical students who wanted to spend a semester or a summer holiday doing voluntary work in hospital laboratories or other departments in foreign countries.

Traveling abroad was not as common back then as it is today, due to financial as well as other constraints. Airline tickets were expensive, unless you got a free flight from Oslo to Hamburg with one of the Air force DC3s that supported the Norwegian occupation forces in up-state Germany after the Second World War. The common means of transportation included a ship from Denmark or Britain, and by train through the continent. It was almost out of the question for medical students to travel to the Unites States at all. Bergsjø was an exception since he had been invited to be the “Camp Doctor” in Camp Rising Sun, a scholarship camp near New York in the summer

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of 1953. Brief sojourns to hospitals at Johns Hopkins in Baltimore and Harvard in Boston incited him to promote international collaboration among medical students.

A historical fact to be remembered is that these were the early years of the Cold War between the Soviet Union and their satellite countries in Eastern Europe on one hand and the Western democracies dominated by USA on the other.

IFMSA was an offshoot of the Western alliance, while medical students with communist about the author sympathies had their own international association with a handful of members from Norway and meetings behind the “iron curtain”.

The Committee used to gather from time to time and work on some contributions that were really helpful later on; even today many countries think of these as being novel ideas, such as the dictionary of standard terms in English to be used in applications for temporary hospital tenures, which was implemented in the report on “Professional Travel and Exchange 1953” (known today as evaluation forms). It also aimed to achieve development of more merchandising material with a brochure titled “Do you want to go abroad, summer 1954?”, which listed international summer courses for medical students approved by IFMSA. It is important to remember that during those years internet did not exist, thus every document and application of the students was sent by regular mail; if the students had any questions regarding these documents, this exchange occurred via post or phone calls rather than with skype.

Dr. Bergsjø is an intercultural person who grew up in this environment. He was motivated to become the SCOPE Director by his desire to meet people of his own age-group from other countries, a novel experience after five isolated years of war in an occupied country. Personal contact breeds understanding and friendship, as well as fostering new thoughts and ideas. He wanted to facilitate the international exchange of medical students who could then experience the

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fascination he had felt upon being confronted with foreign places and strange cultures, which after a while became neither foreign nor strange.

This experience has had a real impact on Mr. Bergsjø’s life. Throughout his ensuing fifty-six years he has had numerous contacts with physicians and other health workers from foreign lands, many of which have became his personal friends.

In the early nineteen-fifties there was an ethnocentric tendency among medical students in Norway; however, he eventually came to realize that there was a world outside of Norway where some things were better and others worse, and that it was important to go out and see for oneself as well as attempt to remedy the bad and promote the good, at home and abroad.

“It is important to remember that during those years internet did not exist, thus every document and application of the students was sent by regular mail; if the students had any questions regarding these documents, this exchange occurred via post or phone calls rather than with skype.”

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about the author

Per Bergsjø (1932-), Professor emeritus, obstetrician/gynecologist, formerly head of the Department of Obstetrics and Gynecology at Haukeland University Hospital in Bergen, is presently a guest scientist at the Norwegian Institute of Public Health in Oslo, Norway. He has been a consultant to the Medical Birth Registry of Norway and is presently Co-coordinator of the Medical Birth Registry at Kilimanjaro Christian Medical Centre (KCMC) in Tanzania.

He has also served as a temporary advisor to the World Health Organization on a number of shortterm contracts.

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PeriSCOPE - Edition 2, August 2010

Emergency medicine in Peru From Switzerland to Peru

Cindy Bouvet

about the author Cindy Bouvet is a 5th year medical student studying in Geneva, Switzerland

A few months ago, I was in Peru. Why this country? Well, I’ve been on other exchanges (Mexico, Ecuador) and I really enjoyed the atmosphere and the culture of South America, so I wanted to see some more of this continent The advantage of participating in a SCOPE program is that you are at the heart of the culture, in a hospital where you mix with different people All the people around you know that you are a foreigner (I’m blond with green eyes…so imagine me in the middle of latin people!), and that makes this experience even better. Well, let me explain from the beginning my experience with SCOPE. In 2004 and 2005, I went on pre-clinical exchanges. The first year it was in Guadalajara, Mexico, in emergencies. The second time my exchange took place in Ecuador in Quito, in emergencies and pediatrics. These experiences gave me motivation for my studies, so I was looking forward to doing a clinical exchange. And then, at the end of my 4th year…Peru.

It was in July 2009, winter in Lima. I had chosen this city because I’ve got some friends there who I wanted to spend some time with. So I was in a small hospital of Emergencies. You might have noticed that I like emergency departments. That is

With the Peruvian medical students

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because I think it’s a really good way to discover a country, if you speak the native language of course. You’re in contact with so many different people! I was living with a Peruvian family with 6 children, and one of them was studying medicine. My house was not far from the hospital but I had to go by bus to the hospital, which is an experience itself in Lima! The buses are small, and they are really fast and you have to say where you want to stop. Also you have to be sure of the price Otherwise as you are not Peruvian, and they can see that, they’ll charge you more! So make sure you have the exact amount of money before getting on a bus!

So each morning I went by bus to my hospital in Lima. The hospital was the Casimiro Illoa.

In the emergency department I was stationed in surgery so I was waiting for the fracture, the wound, the burn… I was with the interns, who are the Peruvian students in their last year of studies. We spend a lot of time talking about medicine in their country, how are their studies, and the differences with Europe and Switzerland.

It’s a rewarding experience to discuss with medical students in another country, it’s an easy way to learn a lot and become open-minded about your own ideas.

I was spending 6 hours a day at the hospital; if there was nothing to do in the emergency room I was going to the surgical unit to see some operations. That was also very interesting, to see the aseptic conditions in another country!

Alternatively in the ER, I spent a lot of time suturing because in Switzerland you don’t have a lot of opportunity during your 4th year to do that and I wanted to practice.

At the end of my working day, I was going back to my house, to see if I could do something with my family. Otherwise I was visiting my friends in Lima. Your host family is also central in your knowledge concerning the culture of the country.

You can see how people live from inside, hear about their occupation, their hobbies, their jobs… and also you can discover the food! The advantage of being in a family is that you are part of it, that you feel at home after few days and it’s a really pleasant situation. My host family

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The hospital Casimiro Illoa, the front of the hospital: my little bus n°19 to go back home!

After your exchange, you keep in contact with them and you know that if one day if you return to that country, they’ll be there for you. It’s a strong feeling.

Apart from the hospital and the family, a social program was organized by the people from PeruAPEMH. This is also an important point in a SCOPE exchange: the social program. It is the best way to meet others students coming from all around the word: Canada, Poland, Greece, Spain… when we met each other, it was the time to share our experience at the hospital. As I was the only one in my hospital I was able to hear how it works in others hospitals of the city, and we shared our funniest anecdotes! One night we had a small Food and Drinking Party, exactly as the one during the General Assembly of IFMSA. During the week-ends we organized some trips out of Lima, to Huacachina, Nasca, Arequipa, Huaraz…it was a great opportunity to discover a new country and travel with people who I didn’t even know a few days ago, it was such a great experience.

At the end of my clerkship I still had one week of holiday, so I went trekking for a week and went to Machu Pichu.

This was my third SCOPE exchange, but each time it’s different, getting better because you become more open-minded, you know how to act inside a hospital as a foreigner, you know the way of thinking of the Latin people. Each time it’s an amazing experience and you bring home the best of your experience: motivation for medicine, new friends, and unforgettable memories.

As I’m a NEO, I really like seeing how the exchange program is organized in others countries, the social program, etc. I think that SCOPE is very helpful for students who want to go abroad for

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a clerkship and don’t know how to get in contact with the hospital they want to go. Here, a LEO organizes your clerkship, finds a place at the hospital for you, finds a family, organizes a social program, so what possibly can be better?

Each experience is something new for you, and each experience will help you become a physician aware of the world around you, aware of the disparities between the countries, aware of how lucky you are that you saw all these as a medical student.

So I want to thank SwiMSA Exchanges and PeruAPEMH for the great moment I had in Peru this summer.

Dinner time

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PeriSCOPE - Edition 2, August 2010

Cardiac Surgery in Spain From Malta to Sevilla Jessica Sant

about the author Jessica Sant is a medical student living in Malta.

We had been warned! The southern Spanish city of Seville is known to be one of the hottest cities in Europe during the month of July. Being used to hot and dry Maltese summers, I did not think much of this warning, but upon arrival I certainly felt the difference! Siesta time is best spent napping and eating lunch at 2:30 p.m. needed some getting used to.

Nothing, however, was going to spoil my experience in southern Spain. Seville - the artistic, cultural and financial capital of Andalusia - was all that I had expected and more!

The city of Seville is over two thousand years old. The passage of the various people and cultures is instrumental in its growth, and this has left the city with a distinctly unique flavour, together with a large and well-preserved historical centre. The city is heavily influenced by Moorish culture, which one may find reflected in the city’s most famous monuments and locations.

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My weekday mornings were spent in the Cardiac Surgery Department of the largest hospital in the city – the Virgen del Rocìo University Hospital.

Afternoons were spent exploring the city, whilst weekends were reserved for visiting other cities in Andalusia such as Granada, Córdoba, Càdiz, Jerez and British Gibraltar.

Malta is no longer the centre of the world. This becomes even more apparent when you find yourself explaining over and over again what, where and how amazing Malta is! What is even more special about such an experience is that for that month the city you are in becomes your home away from home.

After those first few days you don’t feel like a tourist any longer and you would have the opportunity to explore a different society from its heart.

I will miss dearly those evenings by the river which passes straight through the heart of Seville

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– the Rio Guadalquivir! The legendary Calle Betis on the river bank came to life during the week celebrating the feasts of Saint Ann and Saint James, better known by the Sevillians as La Velà de Santa Ana. Joie de vivre of the people from el Barrio de Triana (Triana neighbourhood) - the other side of the river - was at its best! This river bank is said to have been discovered by Astarte, the Semitic goddess of fertility. It is here where she took refuge after fleeing the amorous persecution of Hercules. Here you find patios tiled with locally hand-painted ceramics, orange trees and everything that is typical of southern Spain; it is the home of the Gitanos.

Triana is sometimes credited with the invention of flamenco and both are well and truly the heart and soul of Seville. Here everyone knows the steps to the joyous and passionate Sevillanas. There was no place for miserable faces… my only wish was that I knew how to dance - I was missing out on half of the fun! The smell of fresh fried sardines and all sorts of other sea food filled the festive air and glasses were flowing with tinto de verano (which literally means red wine of summer and is roughly equivalent to red wine with lemonade) to quench everyone’s thirst!

For us Maltese, no summer feast is complete without nougat-sellers and fireworks and what could have made our Sevillian fiesta better than finding the same thing on Calle Betis?! In Spain, however, nougat is known by a different name: turrón!

nurses alike to communicate with me in English, a language which does not come that easy to them.

I was given the opportunity to scrub up and assist in several open heart surgeries from which I learnt a lot. Not being a particular wiz at learning new languages, I can say my Spanish vocabulary goes as far as surgical instruments and that is about it! Certainly, the highlight of my surgical experience was touching patients’ hearts in asystole, fibrillation and normal sinus rhythm. This exhilarating feeling surely echoed throughout my month spent feeling the heart of Andalusia. Te quiero Sevilla para siempre!

I would like to thank my colleagues Roberto Corso and Luke Sammut for their contribution to this article and their marvellous company.

Whether you fancy the ritual or not, la Plaza de Toros de la Real Maestranza (the bullring), is one of the most beautiful, oldest, as well as one of the most significant, in the history of bullfighting. A traditional Spanish bull fight ends when the matador stabs the bull through its aorta or heart. Walking through the ‘Prince’s door’ is the most desired achievement of all the bullfighting figures since this privilege is reserved for the real champions.

Although I did not see an actual bullfight, entering the ring through the Prince’s door and a visit to the museum certainly put me into the scene.

Spending hours in such a special work place as a cardiac surgical theatre, where I could not understand most of what was being said, was certainly a unique experience. Although some might think of the language barrier as a setback, I felt it gave me the opportunity to focus on other things that go on in a surgical theatre that require acute observation.

Certainly I must agree with whoever wrote the song “Spanish eyes”. Whatever color they may be, they are certainly deserving of a beautiful song! Theatre staff greeted me every morning with smiles in their eyes to the sounding of a cheery “Hola Jessica!”, so it did not take long for me to feel part of the team.

I dearly appreciated the efforts made by doctors and

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PeriSCOPE - Edition 2, August 2010

Plastic Surgery And Internal Medicine in Japan From Bratislava to Tokyo Alexandra Haššová

about the author Alexandra Haššovádicine is studying medicine in Bratislava, Slovak Republic.

I had a dream… Japan is my all time favorite country. With my high school friend, we used to watch anime and read manga when nobody in Slovakia even knew anything like Japanese pop culture exists. We learned cool words like kawaii, sugoi and ganbate!!! (cute, perfect and try hard!), to be able to fully describe our everyday normal life as teenagers. We read books on samurais, fascinating Japanese history, got an asymmetrical Japanese bow and learned to shoot from it and killed several poor plants trying to make them representative bonsais. I’ve always wanted to visit this country, so I guess this opportunity was really a gift from somewhere above, if I can call it that way.

Arrival to Japan, getting around and first impressions If you need any information upon arrival to the Narita International airport in Tokyo it’s no problem. Fortunately, the information kiosks are available everywhere and the employees speak good quality English. Be aware though, because this is probably the last place to enjoy these fluent English speakers. Japlish is a slang word, which totally represent most of general spoken English in Japan. It means that if you want to ask a stranger for directions, you most probably will get them, but with a very strong accent. It’s quite cute though.

In Japan everything’s neat, organized and clean! It’s funny to think, realize and state this, because if you take a look for example from the 10th floor of the university hospital, you’ll notice that buildings are not assembled on streets in an organized manner at all. It’s about the same with the masses of people moving in every kind of direction at any speed. I guess you could really call it an amazing organized chaos. Murphy would have “loved” this country of paradoxes and contraries.

His rules don’t work here at all. You can’t really surprise this system in any way; it’s prepared for almost everything. Nobody really knows how, but it functions perfectly and that’s the point.

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School, hospital and staff Toho University is a private medical university.

This means several major things in Japan. First of all, it is newer. Secondly, the equipment and supplies this medical center uses are almost brand new and there is always enough of them!

Which makes a totally big difference compared to for example my little country.

I worked in the Plastic surgery department, which usually meant assisting at the operating table. The operational wing was huge. There were about 20 operation rooms, everything was wireless, touchless and there were a whole lot of sensor which always knew what kind of soap you want to have pumped.

The Internal medicine department was supplied by newest examining technology and no patient was ever confused where to go or what papers to take, since all information is shared online via hospital electronic system connected to every other hospital in Tokyo.

Moreover, the doctors are well paid, so they actually enjoy working here and teaching students, which sometimes may take up all the time of their day. They can work as long as 20 hours a day, literally. Personally, I consider this a workaholic behavior, in Japan it is called devotion to your personal life purpose. In any case, it is definitely admirable.

My experiences with both departments are very good. I saw procedures I’ve never thought of seeing before. Assisting at operation on a hepatitis C positive patient made me realize all the additional steps that need to be taken to protect ourselves. I tried my first operational intervention and reposition of maxillary complex fracture alone!

Social program, travelling, sightseeing There is plenty of sightseeing things available to see in Tokyo and its surroundings. If you’re a history freak, go see Meiji jingu shrine, Imperial palace, museums in Ueno park. Gardens are all over the place and Tokyo is surprisingly green sometimes. Go to Tsukuji market, the largest fish market which creates one third of world’s export.

Have you had enough of city life? Take a one

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hour train trip to Hakone area and try out the traditional tee houses and onsens (hot springs) in Japan. Mount FUJI is available for climbing in summer too.

At night, life gets even better. You can go dancing to Roppongi or try Karaoke places in Shinjuku or just party in Harajuku. Only the transport at night is problematic - there are no trains. So if you decide to stay out, you stay out. Or pay horrible money for a taxi.

Considering the university activities traveling and social program were pretty good in here. Every Saturday, there was a bunch of people gathering in the clubroom and we always went to different place for sightseeing and good lunch. It’s fun to spend some time with the local students and even more fun to try to talk to them. You laugh, when

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“I saw procedures I’ve never thought of seeing before. Assisting at operation on a hepatitis C positive patient made me realize all the additional steps that need to be taken to protect ourselves.” they are trying their baaad English and they laugh when you are trying your even worse Japanese…

Anyways, trying to write about all the exciting places in Tokyo and other cities would take me too much time to write and you too much time to read.

So if anybody is interested about anything concerning traveling to Japan, please contact me.

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PeriSCOPE - Edition 2, August 2010

Primary Care in Chile From Brazil to Chile: flavor of wine and smell of adventure

Lourielthon B. Gualda de Souza

about the author Lourielthon Gualda de Souza is studying medicine in Maringa, Brazil.

My exchange in Chile was simply amazing. My name is Lourielthon B. Gualda de Souza; I’m from Maringa, a city in the South of Brazil. In January of 2010, I underwent a SCOPE exchange in Primary Care in Santiago, capital of Chile. My objectives were to better understand the way that the Primary Care in Chile is organised, Chilean’s culture and gaining the maximum knowledge that I could in the fields of: practical medicine, patient care socio-cultural and professional development. I can say that I was very surprised with this wonderful experience.

Firstly, I chose an exchange abroad because I personally think that a change from the ordinary daily routine to a new experience is a very positive and beneficial experience. We’re used to seeing everyday life through a prism, but when we put it in another perspective it contributes to creating a concept closer to the world’s reality. Not that Chile was so different than Brazil. Unfortunately, both have poverty, but in Chile I could see another way of social care organization working together within the healthcare organization. In my opinion, Chile has the best social organization system of South America, because, at least, what I noticed is that generally everyone has access to food, which is different from Brazil.

things with them and also encountered patient cases that you don’t find in books. I established a friendly relationship with my tutors and I felt very comfortable to ask questions and to practice. This environment led to my superb learning and put my tutors as another good reference as real doctors, not just people graduated in medicine, but people whom we can proudly call: Doctor, A model of doctor one should try to achieve in medical formation.

The opportunity to learn more about the structure of the Primary Healthcare system and at the same time make new friends, gain new experiences and live new exciting things, changed some of my previous concepts, in other words, changed my

Furthermore, it is interesting to note the formation of the population and culture of this nation.

Chile has an incredible social diversity from other countries of South America mainly Peru, Bolivia and Ecuador. I felt there was an interesting union between Chilean culture and the culture of the other countries. I see that the Latino music, books, art, TV programs and other things are mixed in a common knowledge and get part of the general culture of the country. It is such a thing, that we don’t have in Brazil with the other countries of South America, maybe because of the language or the colonization.

Regarding the SCOPE exchange, the doctors that I trained with were excellent; I learned many

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perspective of Chile and also my perspective of the world. Chile is a wonderful country, which rose

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above my expectations.

Chile has many charming perspectives – for example; • The Language: The attempt to learn their fast way of speaking was really funny and their peculiar words like “Ueon”, “Bacan” and others put me in some humorous situations.

• The Food: Oh it’s “esquisito !”. Their fish and wines are the best, but their avocado (“la palta”)…, Oh dear God, they love it too much and some hot dogs came with that… Oh my God I will not have any more “palta” in my life.

• The Culture: The people are very kind, friendly and hospitable, and they have the warm hearts of the South Americans and the education of the Northern Hemisphere. Their nightlife and traditional parties are very exciting even for me; a Brazilian.

Chile is a very organized country, having a secure and an effective public transportation system, mainly the subway. Regarding the places, Chile is a country with a lot of diversity and has everything one would look for, for an adventure!

• Desert - Go to North - I knew that in our trip I would see amazing skies and unbelievable lakes, and so I did!

• Mountains and volcanoes with snow - Go to Pucon - I climbed Villa Rica’s volcano, it was terrific.

• Wines - Go to the Road of Wine – They have unbelievable vineyards with a smell of history.

• Fish and a peculiar Culture – Go to Valparaiso and Viña del Mar – It has the true flavor of Chile, in my opinion, and the best Salmon with wine that I ever tasted. And also you can understand why one of the greatest poets of the world, Pablo Neruda, had so much inspiration!

• Adventure – Go to the South – Visit the wonderful and unimaginable sights, I could feel the terrific sensation while trekking in Torres del Paine, one of the 10 most famous trekking circuits around the world, with their inhospitable ice cold winds, lakes, and the unbelievable and enormous mountains - no words can describe this exciting experience.

But if you want to know of any beaches, I didn’t come across any good beach. Yes, Pacific Ocean was beautiful but too cold.

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My eternal gratitude goes to all the crew of IFMSA Chile – mainly their SCOPE team - to propitiate this experience and my tutors to propitiate one of the best experiences ever. I don’t have words and ways to show my gratitude for all the knowledge I gained, the friends I made, that were not only the people that I knew, but they were people who left an impact in my life! I will never forget them. They were not just acquaintances, but real friends! That will be part of the wonderful nostalgic memories of my experience in Chile, for the rest of my life. Thanks a lot.

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PeriSCOPE - Edition 2, August 2010

Internal Medicine in Indonesia From Oslo to Sumatra Yassin Almassy

My name is Almassy, Yassin. I am currently a 5th year medical student at the University of Oslo in Norway. My baseline motivation for going on an exchange was the desire to expand my horizon and to get an understanding of global health and healthcare issues in the world today. I’m seeking to get new perspectives and understand the challenges from different points of view, and the best thing to do is to get a firsthand experience on these realities. I looked upon the IFMSA exchange program as a golden possibility to do so. about the author Yassin Almassy is a 5th year student, studying in Oslo, Norway.

I underwent 3 weeks (15.06.09 - 04.07.09) of training at the department of internal medicine at M. Djamil Hospital, in Padang on West

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Sumatra, Indonesia. I chose Indonesia as my destination partly because of its location and its diversity with lots of interesting cultural and environmental differences, but also because I wanted to see and get a hands on experience on tropical infection diseases such as malaria, dengue fever and so on that we hardly come in contact with at home.

Boarding, lodging and the hospital days I was with 3 other friends and medical students from Norway and we were kindly placed in two different but really nice host families with great hospitality and love. I shared a room with Adam,

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infection we examined, together with the residents’ help.

“I was able to see many sub departments of internal medicine such as gastroenterology, tropical infection, haematology, neurology, cardiac ICU and outpatient clinics.”

my study colleague from Oslo and we were provided with a really nice traditional breakfast every morning with sate, nasi goreng. Our hosting NEO was in the same department as us. We were quite happy about this, and also about the fact that we all had the same schedule and same driver to hospital which was a 10min drive from the house. I really appreciated the fact that i was living in a host family which gave me an amazing experience with the way of life, culture and people of West Sumatra, also known as ancestors of the Minangkabau culture.

The days at the at hospital started formally at 7.30 AM with all the doctors, residents and some students gathering for an academic lecture session and discussions given by a couple of residents.

This was mostly done in Bahasa Indonesia, occasionally in English. The lecture was about interesting reviews and discussions on different internal medicine cases such as chronic viral hepatitis, cerebral malaria, complications of poorly controlled diabetes that we seldom see in Norway.

Warm and traditional lunch was provided by the local committee at the hospital cafeteria. The days often ended at 2 PM at the cardiac ICU with our resident friends Fadil, Yanni and Ronny where we examined, discussed treatment and management of patients with acute MI and CHF with the attending.

We were each given a doctor as a supervisor and a schedule for the clerkship by the head of the department. It gave us the chance to see many sub departments of internal medicine such as gastroenterology, tropical infection, haematology, neurology, cardiac ICU and outpatient clinics.

We got the chance to follow student clinical discussions and did a presentation for the students and our supervisor about patients with a tropical

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I was truly amazed by the way the doctors were practising medicine with less or no use of advanced medical technology or imaging. It gave me an idea of the similarities and differences with Norway’s way of practicing medicine and treat patients. The bed-side teaching with students and the daily practice of medicine at the hospitals was with no doubt a valuable experience for me as a future doctor. I got to know their perspective aboutpatient’s treatment, community acquired conditions, nurses and physicians cooperation, medical decision making and the challenges with a less advanced primary healthcare system. I really enjoyed the way everything was organized for us and the time spent on acquiring more theoretical knowledge and practical skills.

Social and cultural experience Unforgettable moments! The local committee in Padang were fantastic. They were organizing different trips for us in Padang but also in the more touristic places around the west coast of West Sumatra like Bukittinggi, Batusangkar and Sikuai Island.

Our host family’s doctor had scheduled a 1 day call on Mentawai Island (a malaria endemic area of Indonesia). We had alot of fun, taking a ferry over and spent the day at the only and newly built hospital on the island of 40.000 inhabitants. It was another great way of seeing the diverse medical conditions and diagnostic workup for minor and complicated internal medicine cases.

Adam and I were selected to play on the resident’s soccer team so we played a match. I scored a goal and we spent a couple of amazing days together. In addition we became very good friends with the residents Fadil and Yanni with whom we spent a lot of time together both at the hospital and also on social activities with their friends and families.

As a student of medicine you get your basic knowledge on the healthcare system you work in. In order to enrich your perception as a healthcare provider in an area of globalization you’ll have to get out and experience other healthcare realities.

Indonesia is a fantastic diverse, colourful country with an exciting culture and together with the great hospitality and friendship we met in Padang, I would warmly recommend it as an exchange site for both academicals and social reasons! =)

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PeriSCOPE - Edition 2, August 2010

Internal Medicine in Austria From Chile to Austria Andrés Justiniano

I decided to go on an exchange because I wanted to have a medical experience outside my country. I also wanted to gain additional experience apart from my curriculum, and get to know a foreign culture.

I chose to apply for Vienna because I wanted to go to a place where I could speak English, and given the choices available at the time, this was the best alternative to a primarily English speaking country. about the author Andrés Justiniano is studying medicine in Chile

My clerkship was great. I learned a lot of things that I did not know prior to the trip. In Austria, the doctors have many responsibilities that in Chile are done by nurses. For example: taking blood from a patient, giving antibiotics, measuring blood pressure, etc. The hospital where I completed my clerkship was a private hospital. It was similar to a “clinic” in Chile; it was very well organized and clean, people were nice and they had all patient information entered into a computerized system.The main difference between my country´s healthcare system and the Austrian one is the organization and

the use of technology. The hospital where I went had an intranet where they could see the information of all patients that were in the hospital. During my clerkship, I observed endoscopy of a patient with Osler’s disease. I don´t know if I will ever see that again in Chile.

There are many cultural differences between Chile and Austria. Austria is a country with a long history that Chile lacks. More than a century ago, Austria, along with Hungary, formed the larger Austro-Hungarian empire (there were many beautiful buildings and parks as evidence of this time period) while Chile was just beginning to develop as a country. Also, there are only 8 million people living in Austria, as opposed to our 16 million in Chile. Austria has an extremely efficient public transportation system, and a very high standard of living. As a people, even, there are many differences in the mannerisms and lifestyles between Austrians and Chileans. Overall, however, I found it very enriching to experience these differences first-hand.

Life in Vienna was very amusing, in the evenings I could go to a museum, an opera, or ice skate in front of the city hall. I will never forget the party the hospital threw to celebrate a European clinical certification they had just received. It was great; there were many delicious things to eat, as well as a disco music band that played for around two hours with many doctors dancing in the courtyard.

“In Austraie, the doctors have many responsibilities that in Chile are done by nurses. For example; taking blood from a patient, giving antibiotics, measuring blood, etc.”

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General surgery in Taiwan Clerkship in the beautiful Island Aslam Hentati

Last year, I had the chance to participate in the IFMSA professional exchange program. It was, at this point in my life, one of the best opportunities to discover another countries. I wanted to live for a short time in an exotic country where I understood neither the language nor the culture, and try to adapt to it. Moreover, I was looking for a new experience for my clerkship. Medicine is a science but it is also an art, and it is bounded by cultural background and economic norms. For all these reasons, I chose to go to Taiwan.

I had heard very few things about this island before my clerkship. I simply knew that most of the toys I played with in my childhood were “Made in Taiwan,” and most of my friends in Tunisia knew as little as I did. Therefore, the question was: why Taiwan is so unpopular in my country? A very short review of Taiwan’s history should give us the answer.

Taiwan is a small island in the western Pacific Ocean in East Asia. It has tropical and sub-tropical vegetation and a lot of mountains. At first, it was populated by the Austronesian people that are considered the Taiwanese aborigines. In the 16th century, Portuguese sailors discovered Taiwan and called it Ilha Formosa: the beautiful Island. It was the island’s first contact with the Europeans. In the 17th century, the Dutch colonized Taiwan for about 40 years. It was also colonized by China until the end of the 19th century and by the Japanese for 50 years until 1945. During the 20th century there was a civil war in Mainland China between the capitalists (the republic of China), and the communists (the people’s republic of China). As the capitalists lost the war, they fled to Taiwan and set up their government there. This led to a lot of economic and political improvements in the small island. It became a developed country where people have freedom of speech. Taiwan, however, has maintained a complicated relationship with mainland China, which still considers it a province. Taiwan, however, has kept more friendly relations with Japan and the

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United States of America.

Taiwan has a very unique history that I felt aware of as I stayed there during my Clerkship. I trained in the general surgery department. Our hours were from 8:30 to 16:00, sometimes even longer. However, I was surprised that I was almost never bored or tired .The atmosphere was very pleasant in the department, the Professors were nice and the surgeons were really talented. I observed the operations with attention and curiosity. Everyone in the staff was very kind and tried to explain the operations step by step. I also noticed that there is a very high rate of gastric and esophageal carcinomas in Taiwan and it was one of the most common operations in this department. It was a good occasion for me to review some anatomy and therapeutic procedures.

The Doctors of the hospital were very nice during the training but they were also kind and friendly after work. Moreover, the secretary of the department was very helpful, she always assisted us in planning small trips for us during the weekends. I think it would have been a lot more difficult for me

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about author about the the author Aslam Hentati is a medical student living in Tunis, Tunisia

PeriSCOPE - Edition 2, August 2010

to plan them without her assistance and I’m very thankful for that. The social program was really well arranged and i was always invited to go to dinners with the other foreign students. It was a good opportunity to get to know each other and make our stay during the exchange even more enjoyable.

It was also a great opportunity for me to discover Taiwanese cuisine, which was surprisingly delightful. I became a huge fan of Taiwan food. It is very difficult for me to remember the names of different dishes because there were so many things to taste and discover. Most of the time I even didn’t know what I was eating, but it was tasty and that was all that mattered.

time, however, I was already charmed by Taiwan’s beauty and warm people.

Food in Taiwan is very interesting, but there are many other things to experience and learn about in Taiwan, especially about Taiwanese culture and education. Without a doubt, Taiwanese people are very nice and well educated. I always felt secure everywhere, even if I was lost, which it was pretty common because I don’t understand Chinese. When I was walking alone in the streets people would come up to me and help me to find my way. I was suspicious at first; I didn’t know that there were so nice people in this world. Therefore, I believe from my experience that Taiwanese people are very nice with foreigners, and are generall happy and friendly people. They always seemed to want to give a very good impression about their pretty island. By this

I left Taiwan with a very good impression of the island. I think that I will go back there some day. I like almost everything there. But there was something more important: I was always surrounded by nice people. These individuals were the contact persons of the group of exchange students, and they helped us out a lot throughout our stay. We became friends, and we still send e-mails back and forth.

This was the clerkship of my dreams in the most beautiful Island I have ever seen.

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Taiwan is incredibly beautiful. It has wonderful vegetation. I had the chance to go to many places and see breathtaking landscapes. Furthermore I visited a lot of temples all over the island, and many museums as well. Taiwan is influenced by Chinese, Japanese and American culture, thus you can find all kinds of entertainment. They also have a very interesting night life in the major cities. There are a lot of night markets, pubs and night clubs. I wasn’t expected that in a very small island with such a rich and wonderful culture.

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General Surgery in Ghana The sound of music in sub-sahara Sandra López Gordo

Among all the possible IFMSA countries, to me, Ghana was the most exotic destination. For two years I longed to go, but classmates chose it before me and in the end I wasn’t able to go. Finally, in the summer of 2009, I finally made it! I went to Ghana - a wonderful destination. I chose Ghana because I was eager to learn how medicine works in a developing country, as opposed to my native Spain or another European country.

When I arrived, what surprised me most was how kind everyone was. They were really nice to everyone, no matter the colour of your skin. They treat everyone as equals. If you are lost and you ask for any direction, they will answer you and bring you to the specific place because they truly wish to help.

If I were to describe Ghana with three words I would use the following: music, kindness and peace. As far as music, you can hear it anywhere. If you go and buy a bottle of water, the vendor is dancing by the time you get it. I previously mentioned the kindness of the Ghanaian people, and I use the word peace because Ghanaians take life easy, no matter what time it is (I’m not sure if they even use watches). The was never any rush at all. For example, when we would decide to meet around 8:00 pm to have dinner, the Ghanains would arrive one or two hours later, meanwhile the Europeans would have to wait for them.

My hospital experience was very interesting and helpful. The hospital was huge! The general surgery building alone had 7 floors! Overall, I had a very beneficial experience. There is a huge difference, however, in how students there learn medicine. In Ghana they give more importance to clinical practice and classroom teaching. When students go and learn in the hospital they are divided in groups of around 15 people and they all stand around one patient. One of the students introduces the patient and must know the patient’s entire clinical history. During rounds the doctors question all the students about the case. From my point of view, this learning

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style is a good way for the student to learn alongside the patient, although it initially struck me as disrespectful to the privacy of the patient, as they discuss the entire case in front of them. For example, if the differential diagnosis includes cancer, they discuss this in front of the patient without problem.

During my rotation I learned more than I learned in Spain for a full month of urology. My rotation in Ghana included one week in urology, one in paediatric surgery, one in general surgery and my final week in the operation room. I saw diseases and cancers that I had never seen before. For example, one patient had an inguinal hernia with all the bowels inside. In Spain, many diseases are diagnosed earlier than in Ghana, therefore here you see all the complications of severe and advanced illness.

I also did some duty at the delivery room and patients are overseen by students, who voluntarily stay there all night long. These students have an impressive knowledge about the common diseases in Ghana and how to treat them. The doctors place the students in stressful situations, so they learn how to react. I had never seen something like this! I felt very comfortable with these students.

I left my rotation with the impression that I had no knowledge of medicine! Really! I felt like I knew 100 times less than students in their third year of medical school. In the end I learned to accept this feeling; I learned that my own educational system involves hours in front of books, as opposed to the Ghanaian method of

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about the author Sandra López Gordo is a medical student living in Barcelona, Spain

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about the author

learning in front of patients. That makes a huge difference!

“In Spain, many diseases are diagnosed earlier than in Ghana, therefore here you see all the complications of severe and advanced illness.”

Those are my experiences on exchange, and if I have to say one sentence to summarize it would be: if you can, do it. Go to different countries to see how medicine works and learn as much as you can. At the same time you will have amazing experience!

Life outside the hospital was an adventure, we were always going out with local people. Public transportation is so bad, that without them it would have been impossible to get to the city center. We often had 23 incomings with 3 or 5 local people, which I’m sure was crazy for them to handle! It was so hectic to meet everybody and get to the centre, it took us 2 hours every night! We took some weekend trips as well, to the natural park, waterfalls and other natural attractions.

Ghana is full of varied plant-life, animals and other natural wonders.

One of the best things about the exchange program is all the people you meet. Then you start planning meeting points around the entire world to see them again! It’s nice to know people from all around the world.

One of the most important things that happened to me in Ghana was meeting an important person in my life, who is now my partner, and soon we won’t be separated by such a distance. You never know who you’re going to meet and where!

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Sub Regional Training Rising up the exchanges Pablo Vega

Every year the standing committees from IFMSA meet on a regional level to motivate and train local and national officers, as well as to share, experience and make them feel a part of IFMSA. In the Committees of Professional and Research exchange SRTs are opportunities that are worth experiencing in order to bring in new ideas and to increase the level of our programs. All of the exchange system is run by students with collaboration from the Medical Faculties in different countries. For this reason it is beneficial to have students who have the right tools to manage everything that is required of a program almost 60 years old and with more of 8.000 participants every year.

Two of these meetings were held in the past months in Europe: one held from April 22nd25th in Barcelona organized by AECS and the other one held from May 21st-24th in Mannheim, Germany organized by the BVMD. The idea for an SRT in Barcelona came about after a motivated team of AECS attended the SRT in Czech Republic in 2009. They saw this as a great opportunity for their Organization so all of their effort was geared towards making this event a success. Finally, the start date came and they received more than 80 delegates from 15 European countries. In the SRT they gave 9 trainings in topics such as: Presentation and communication skills, contacting externals, marketing, intercultural learning, team building, leadership, project management, motivation and body language, handover and fundraising. Also there were 5 small working groups about marketing and media, social program, pre-exchange training, academic quality and emergencies in exchanges.

It was also a great opportunity to visit Barcelona and share with all the members of AECS, includinng the activities they arranged at nights.

After a hard winter for Europe the sun was finally rising and the SRT in Manheim was approaching. This was the biggest SRT organized in the history of IFMSA exchange. It gathered more than 130 participants from 17 countries.

It was also a great opportunity for SCOPH to

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experience our event since they are also offering exchanges as one of their projects. This great meeting was held under the romantic atmosphere of the old Starkenburg Castle. For the local officers of Germany it was a great opportunity since many of them were new in their position and these trainings were able to bring the international IFMSA environment to their country. This enabled them to take all their motivation with them to start a year full of work.

During this SRT the delegates could participate in 13 trainings in topics such as: leadership, new technologies, introduction to SCOPH exchanges, handover, and negotiation among others.

There were 11 small working groups that were about the structure of international SCOPE team, SCOPH exchange crosslink in Europe, Post Exchange meeting, marketing your exchanges, and many others that were really helpful to bring new ideas to SCOPE, SCORE and SCOPH. These gatherings are great opportunities not just for the delegates themselves, but for the organizing committees as well. It strengthens the bonds among the members of an organization and also raises the spirit of commitment.

In the words of the presidents of both organizing committees, Luis Ensenyat from Catalonia and Eric Suero from Germany, this was a journey worth experiencing. They feel really proud of their work and they really want to encourage other countries to hold an event like this. The outcomes of these meetings will undoubtedly be extremely useful to improve the exchanges even further.

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Armenia (AMSP) Australia (AMSA) Austria (AMSA) Azerbaijan (AzerMDS) Bahrain (IFMSA-BH) Bangladesh (BMSS) Bolivia (IFMSA Bolivia) Bosnia and Herzegovina (BoHeMSA) Bosnia and Herzegovina - Rep. of Srpska (SaMSIC) Brazil (DENEM) Brazil (IFMSA Brazil) Bulgaria (AMSB) Burkina Faso (AEM) Burundi (ABEM) Canada (CFMS) Canada-Quebec (IFMSA-Quebec) Catalonia - Spain (AECS) Chile (IFMSA-Chile) China (IFMSA-China) Colombia (ACOME) Colombia (ASCEMCOL) Costa Rica (ACEM) Croatia (CroMSIC) Czech Republic (IFMSA CZ) Denmark (IMCC) Ecuador (IFMSA-Ecuador) Egypt (IFMSA-Egypt) El Salvador (IFMSA El Salvador) Estonia (EstMSA) Ethiopia (EMSA) Finland (FiMSIC) France (ANEMF) Germany (BVMD) Ghana (FGMSA) Greece (HelMSIC) Grenada (IFMSA-Grenada) Hong Kong (AMSAHK) Hungary (HuMSIRC) Iceland (IMSIC) Indonesia (CIMSA-ISMKI) Iran (IFMSA-Iran) Israel (FIMS) Italy (SISM) Jamaica (JAMSA) Japan (IFMSA-Japan) Jordan (IFMSA-Jo) Kenya (MSAKE) Korea (KMSA)

Kuwait (KuMSA) Kyrgyzstan (MSPA Kyrgyzstan) Latvia (LaMSA Latvia) Lebanon (LeMSIC) Libya (LMSA) Lithuania (LiMSA) Luxembourg (ALEM) Malta (MMSA) Mexico (IFMSA-Mexico) Montenegro (MoMSIC Montenegro) Mozambique (IFMSA-Mozambique) Nepal (NMSS) New Zealand (NZMSA) Nigeria (NiMSA) Norway (NMSA) Oman (SQU-MSG) Pakistan (IFMSA-Pakistan) Palestine (IFMSA-Palestine) Panama (IFMSA-Panama) Peru (APEMH) Peru (IFMSA Peru) Philippines (AMSA-Philippines) Poland (IFMSA-Poland) Portugal (PorMSIC) Romania (FASMR) Russian Federation (HCCM) Rwanda (MEDSAR) Saudi Arabia (IFMSA-Saudi Arabia) Serbia (IFMSA-Serbia) Sierra Leone (MSA) Slovakia (SloMSA) Slovenia (SloMSIC) South Africa (SAMSA) Spain (IFMSA-Spain) Sudan (MedSIN-Sudan) Sweden (IFMSA-Sweden) Switzerland (SwiMSA) Taiwan (IFMSA-Taiwan) Tatarstan-Russia (TaMSA-Tatarstan) Thailand (IFMSA-Thailand) The former Yugoslav Republic of Macedonia (MMSA-Macedonia) The Netherlands (IFMSA-The Netherlands) Tunisia (ASSOCIA-MED) Turkey (TurkMSIC) United Arab Emirates (EMSS) United Kingdom of Great Britain and Northern Ireland (Medsin-UK) United States of America (AMSA-USA) Venezuela (FEVESOCEM)

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