Pulse APRM 2012

PULSE

The IFMSA Asia-Pacific Magazine APRM Special Edition

health in the asia-PaciFic in 2050 1

IFMSA

The mission of IFMSA

The International Federation of Medical Students’ Associations (IFMSA) is a nonprofit, non-governmental and non-partisan organization representing associations of medical students internationally. IFMSA was founded in 1951 and currently maintains 106 National Member organizations from about 100 countries across six continents with over 1,2 million students represented worldwide. IFMSA is recognized as a non-governmental organization within the United Nations’ system and the World Health Organization and as well, it is a student chapter of the World Medical Association. For more than 60 years, IFMSA has existed to bring together the global Imprint medical students community at the local, national and Editor-in-Chief Editor in Chief international level on social and health issues.

Mariam New Zealand Omar H.Parwaiz, Safa, Egypt

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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.

Objectives:

• To expose all medical students to humanitarian and health issues, providing them with the opportunity to education themselves and their peers; • To facilitate partnerships between the physician in training community and international organization working on health, education and social issues; • To give all medical students the opportunity to take part in clinical and research exchange around the world; • To provide a network that links active medical students across the globe, including student leaders, project managers and activists, so that they can learn from and be motivated by each other; • To provide an international framework in which medical student projects can be realized; • To empower and train medical students to become advocates in leading social change.

RegionalEditors Co-ordinator Content Renzo Guinto, Philippines Helena Chapman, Dominican Rep. Jatinder Narang, IFMSA-Grenada Editors Parawiz, New Zealand Mariam Airin Aldiani, Ahmed Zaher,Indonesia Egypt Design/LayoutEditor Photography Airin Aldiani, Indonesia Bronwyn Jones, Australia Proofreading Design/Layout Mariam New Zealand Omar H.Parwaiz, Safa, Egypt Proofreading Betty Huang, Taiwan Publisher Pushpa Hossain, Egypt of International Federation Medical Students’ Associations

Publisher

General Secretariat: International Federation of IFMSA c/o WMA Associations Medical Students’ B.P. 63 Secretariat: General 01212 Ferney-Voltaire, France IFMSA c/o WMA Phone: +33 450 404 759 B.P. 63 Fax: +33 450 405 937France 01212 Ferney-Voltaire, Email: gs@ifmsa.org Phone: +33 450 404 759 Fax: +33 450 405 937 Homepage: www.ifmsa.org Email: gs@ifmsa.org Homepage: Contacts www.ifmsa.org publications@ifmsa.org

Contacts

publications@ifmsa.org Printed in Ghana.

Contents Message from Regional Coordinator

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Editorial

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Say Hello to Our New RC

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Health in the Asia-Pacific in 2050

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Taking ACTION Everyday The Taiwan Experience

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Asia-Pacific Moments AM 2012 India

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30 Years From Now A Story of 2050

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What’s Up Asia-Pacific?!

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Health in the Asia-Pacific in 2050 Challenges and Recommendation

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Call for Regional Team 2012-2013

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Standing Committee Updates from Asia-Pacific!

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R.G. is your RC!

Message from the Regional Coordinator

Asia-Pacific is in the Heart In the past three Pulse issues this term, I wrote articles exploring various themes related to health – social determinants of health, sustainable development, and universal health care. Interestingly, despite these topics being heavily technical, I was able to finish my articles in a short span of time.

I was even able to submit them way ahead of the deadline set by Mariam and Airin – my dynamic duo in charge of Publications!

But for this issue, writing my final message to the region was a struggle. It took me days to organize my thoughts and temper my emotions as well. Until now, I cannot believe that the end of my term as Regional Coordinator is fast approaching!

The job of the RC is definitely a challenging one. For the past year, I made sure that all e-mails are being replied to within 24 hours at most – but sometimes it is frustrating to wait for an important response for a week or two. Of course, I faced many difficulties during the term – but I also am grateful for having been given with such an experience.

The work of an RC was a test of resourcefulness and creativity, patience and endurance – qualities that I believe are very much needed for global leadership in the 21st century. IFMSA is indeed an 4

amazing school for such rigorous preparation and education.

Moreover, the experience of an RC is certainly exciting, worth enjoying, and absolutely fulfilling. It enabled me to get to know better my sisters and brothers in the Asia-Pacific region – all of you! And what I discovered is that our region is a treasure chest of ideas, talents, idealism, activism, passion, innovation – and of course, fun! Being the Asia-Pacific RC probably is one of the best jobs in IFMSA – you always get invited to the funniest, craziest, and happiest national parties in every General Assembly!

The year that passed is marked by outstanding achievement. We have recruited more NMOs, gave special attention to global health advocacy and education, greatly improved our regional sessions during GAs and the Asia-Pacific Regional Meeting (not to mention the big turn-out of participants, making this APRM the biggest so far in IFMSA history!), published informative and entertaining Pulse issues, and much more! There are so many reasons for us to celebrate and walk proud for!

All these accomplishments are ours, and would to share yourselves to the world – the people of have not been achieved if not for all the great Asia-Pacific are all waiting for you! Thank you for women and men of IFMSA Asia-Pacific. To the fol- all your support and cooperation! lowing, I convey my heartfelt and sincerest thanks!

After a year of serving the medical students of the To my beloved Regional Team, for the devotion Asia-Pacific region, I could humbly say that the fuand hard work… and the friendship that flourished ture is so overflowing with positivity and promise. after a year of working together (not to mention, I am fully confident that the next Regional Team, for enduring the countless e-mails from your RC, under the leadership of the RC-elect Dr. Vincent ensuring that we meet our deadlines! )… I look Khor Wei Sheng of Malaysia, will build on our colforward to more collaboration with you beyond lective successes.I even pray that they surpass IFMSA! them as we strive to reach the goal of a “healthier Asia-Pacific,” which has been my mantra since To our NMOs in the Asia-Pacific region, especially Day One. our NMO presidents, for bearing with the tons of email reminders, surveys, and online discussions Finally, even though I am ending my term as RC – all aimed to make sure that we keep the connec- this September 30, it is not totally goodbye for me tion and that your voices are truly heard! It was a from Asia-Pacific and especially from IFMSA. From pleasure and privilege serving you.

RG is your RC, DG – Dr. Guinto – will now meet the DG – the Director-General of the World Health To the Organizing Committee of the Asia-Pacific Organization! I feel blessed to have been elected Regional Meeting under the leadership of Vincent as the next Liaison Officer to the WHO – another Khor Wei Sheng, for standing up when no one else tough job with lots to offer especially in the arena could, and for the dedication and determination to of global health. I pray for your continued support make APRM 2012 the best regional meeting in as I begin another chapter in my IFMSA life, and IFMSA ever! Hats off to all of you!

I will certainly continue keeping an eye on the region, providing my support to the next RC and his To my many friends from across the Asia-Pacific Regional Team, and lending a helping hand to anyregion, sorry if I cannot list all of you here – I don’t one who will need my assistance and guidance. want to miss names, but of course, you know who you are – those who sent me a sweet Facebook For this final message, I chose my photo in front message, or served as my listening ear in times of of Taj Mahal to accompany this page. I am sure frustration, or gave me advice or encouragement, that you all know the story behind this magnificent or entertained me during night parties and lunch building – a lasting monument dedicated by an breaks and free times during GAs! Let’s keep the emperor to his beloved wife.If I will be given the fire of our friendship burning! marbles and the land, I will do the same for the region that I love so dearly and deeply.

To my fellow IFMSA officials, for sharing your expertise and showing your concern for the Asia-Pa- In the meantime, I will house all the good memocific region. We spent so many unforgettable mo- ries and the unforgettable friendship within myments together – from simple yet mind-boggling self. Asia-Pacific is, and will always be, in my heart. and emotionally-charged e-mail discussions to the crisis experience that dramatically transformed our lives and the life of our Federation. Congratulations to us all, graduates of the IFMSA leadership school class of 2012!

Renzo

And to all the beautiful members of IFMSA Asia- Ramon Lorenzo Luis R. Guinto, MD Pacific, you are the inspiration behind the sleep- Regional Coordinator for the Asia-Pacific less nights and sweat and tears. You made this International Federation of Medical personal journey worth taking. Now, it’s your time

Students’ Associations

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Editorial Pulse is your magazine and we value your contributions. There are many ways you can be a part of us.

You can write an article for us, or help us as part of the editorial team, or you can contribute to our segment called ‘What’s Up Asia-Pacific?!’. We want to hear from you and find out what is happening in The theme for this issue is the same as the theme your part of the region. As always, please feel free for the APRM – Transitions 2012: Doctors-in-train- to email us! ing changing the global health landscape of AsiaPacific. You may remember the Essay Competition Also, as this is the end of our term, you can apply that the Organising Committee had earlier this year to be the next DA for Publications and Communicafor people to attend APRM for free. In this issue tions. The job requires good editorial and design of Pulse, we present you the three winning essays. skills and can be a lot of fun. The work commitCongratulations to the three winning authors! She- ments are very manageable and you get to work la, Subash and Zhen Qiang present to you their with an awesome Regional Team. Applications are views on Health in the Asia-Pacific in 2050. Read open for all the DA positions – there are job descripmore about their thoughts, and if you have some tions for all the roles towards the end of this issue ideas of your own, you can share them with the rest of Pulse. Have a read, have a think and then apply of the Asia-Pacific family by getting them published for one of the positions! We strongly encourage it. in Pulse.

We have really enjoyed working as your DAs for PubWe love hearing your thoughts. Our new initiative lications and Communications. It’s been a great for this term was ‘What’s Up Asia-Pacific?!’. This is pleasure for us, best of luck to everyone and we an informal way to share your ideas and opinions hope we meet some of you at APRM! with the rest of the Asia-Pacific region. This initiative has been quite successful and you can read Hugs, what students are currently thinking in this issue Mariam and Airin of Pulse.

Welcome to the final issue of Pulse for the 201112 term! We are very excited to present to you the September issue of Pulse. The launch of this issue coincides with the Asia-Pacific Regional Meeting (APRM) happening in Malaysia this month.

Thanks to our contributors: Subash Bastakoti, Nepal Shela Sundawa, Indonesia Goo Zhen Qiang, Malaysia Joanna Choa, Philippines Greco Malijan, Philippines Motoko Kametani, Japan Renzo Guinto, Philippines Berthari Abianti, Indonesia Ida Ayu Narayani, Indonesia

of you ll a to ks n a th l a ci pe s d n a Asia-Pacific Family!!!

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Mariam Parwaiz

Airin Aldiani

Development Asisstants for Publications & Communications

da.pub.ifmsa.asiapacific@gmail.com

Disclaimer: Pulse is the official magazine for IFMSA Asia-Pacific. Opinions shared in Pulse are not necessarily those of the Editorial Team or of IFMSA.

Say hello to our new Regional Coordinator

DR. VINCENT KHOR WEI

M.A.D. TEAM

Make A Difference, Together Everyone Achieves More Hello, 你好, こんにちは, 안녕하세요, สวัสดี, नमस्ते my beloved Asia-Pacific family!

First and foremost, I would like to take this opportunity to express my sincere gratitude to all NMO Presidents and all Asia-Pacific medical students for giving me the opportunity and trust, to serve you as the Regional Coordinator for the 2012-13 term. Thank you so much.

M.A.D. has been my principle in everything I do since high school. My friends and my family members have always thought of me as a MAD person, because I always did something different or extraordinary from my peers. For example, all my colleagues wondered how did I managed to cope with the stress of facing the final MBBS exam while organising APRM 2012 at the same time. While they were working hard revising for the exams, I was working hard replying to emails and travelling. These are all possible, not because I am smarter than others, but because I have the belief and passion in myself, to Make A Difference in my life!

The Asia-Pacific region is one of the largest regions in the International Federation of Medical Students’ Associations. We have many active NMOs doing very excellent jobs in the Federation. However, in terms of representation in IFMSA-International and projects, I believe we still have much more room for improvement.

Hence, I would really love to see the Asia-Pacific members, from junior members to the leaders, be M.A.D.!!!

Believe in yourself; believe that you can do more than what you are doing now. Each and every one of us in the region should make good use of the excellent platform provided by IFMSA, to voice concerns about healthcare, to make an impact to the local and international community by organising projects, and to train and develop the healthcare leaders of tomorrow. I hope that the members of Asia-Pacific will be more actively involved in all IFMSA activities and projects, be it at the local, regional or international level, in the coming fiscal year.

My vision for the next fiscal year is to see the rapid development of the Asia-Pacific region. I will work hard with the incoming Regional Team members to expand the IFMSA membership to countries like Fiji, Brunei, Singapore, Cambodia etc. We will also assist the NMOs in development through various training programs and assist the candidate members to become full members of IFMSA. All these visions and works are impossible without an effective and dynamic team! I sincerely invite all passionate medical students in the Asia-Pacific region, who believe they can Make A Difference, to join the Regional Team for fiscal year of 2012-2013! As one of the million medical students in the Asia-Pacific region, I strongly believe that we still have enormous untapped potential and strength that will bring our region to a new horizon in the next 20 years.

The key to success is that ALL of us have to work TOGETHER as ONE TEAM, helping each other, learning from each other with the spirit and mindset of “TOGETHER

EVERYONE ACHIEVEs MORE”

Last but not least, my heartiest congratulations to the current RC Dr Renzo Guinto, his wonderful regional team, all the NMO Presidents and all Asia-Pacific members who had done a great and excellent job in fiscal year 20112012! Under the leadership of Dr Renzo and the dynamic Regional Team this fiscal year, many ground-breaking initiatives like Asia-Pacific Think Tank, Health in Asia-Pacific Primer, Regional Yearbook, APRM 2012 have been put into action successfully. ASIA-PACIFIC IS GROWING! We will be continuing all your hard work, and making Asia-Pacific stronger than before! I will also be taking one year off from my clinical training, to serve you as the RC for 24/7.

For the next fiscal year, I really hope to have more connections and interactions with the NMOs and local medical students. I hope to attend all the National GAs or medical students meetings by all NMOs in the coming one year!

Let us all be more active in IFMSA and show the MADness of Asia-Pacific to the world!!!

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38 years from now

A Story of 2050 by: Dr. Subash Bastakoti Walking down the stairs of the Operating Room (OR), heading towards the changing room, I noticed how old and fragile my face had become as if it was a burden to the shiny mirrors on the wall. I drove home through the alleys of newly built roads of Kathmandu; traffic was busy and I reached home late. I was feeling drowsy as the clock struck eleven. My eyes were closing off to sleep as the news on the television aroused me. A bad hurricane had shovelled the coastal areas of South-East Asia affecting millions of people. It was the cruellest mishap that happened in the month of June 2050.

The next morning I got an email from Medecins Sans Frontieres requesting my services as a volunteer. I called my family in the United States and informed them that I was going to Malaysia to help the victims of the hurricane.

was under control and no longer a threat to the world. Newer strains of viral infections could now be easily diagnosed and very few cases posed diagnostic dilemmas. Although there had been many levels of achievements, global warming continued to alarm the world, and tornadoes and hurricanes were often the headline stories on television news.

Commitments were shared by participants of the meeting and entry to a new but challenging world was the farewell message to the audience.

As I wiped my glasses and looked through the airplane window, there was an announcement from the aircraft crew that we were about to land. A helicopter flew us to the calamity site from the airport. There were thousands of paramedics and volunteers there.

It was a miserable scene.The situation was not completely under control. However, newly developed rescue robots and underwater medical teams had helped bring down the number of mortalities.

There were only two central hospitals left after the event and the victims were referred there from As the plane took off, many thoughts began to fly the first aid stations in the emergency camps. Fire across my head. This event reminded me of the In- proof areas had been designed and the rescue site ternational Affairs of Health meeting that had taken was fully under satellite supervision. Hundreds of place last year in Geneva. It was probably the larg- people were being rescued from the sea by superest gathering amongst the medical professionals. sonic underwater ambulances. Rescue helicopters The issues regarding global health were empha- were seen trailing up to the horizon. Other helisised. Overall, the health scenario was out of hand copters from various organisations were continuas bioterrorism in Africa and the Middle East was ously humming the sky with food supplies, medicadiscussed. The special procedure to develop lethal tions and volunteers. virus strains had been hacked and a few scientists had been kidnapped by terrorists. As the result of It was about to rain when we reached the hospital the microbiological bombing, millions of people had where I was to be posted for the next two weeks. suffered.

There was a list of fifteen cases to be operated New advancements in genetic screening and foetal genetic analysis to prevent or modify diseases were also presented. It had been ten years that HIV/AIDs 8

on. Most of them had pelvic fractures. They were on self-monitoring epidural analgesia and were brought to us in support cabins by medical volun-

After being brought to the third zone of the OR, we received the first patient. He was a seven yearold boy and had sustained a grade four epiphyseal injury of the right knee. Anaesthesiologists monitored and assessed the child and as we set to work fixing the injury.

Being from an underprivileged country like Nepal, it has always been confusing for me to work in such sophisticated environments. If a calamity like this had struck my country, millions would have lost their lives. At night, from the balcony of my room I could hear the screams of people lost in the sounds of the sea waves. I was not able to sleep as the faces of the victims continued to flash before my eyes. This reminded me of a man I had met on my way back. He was the father of the boy who had been operated today.

teers. I came to know that most of the orthopaedic cases post-disaster were simple fractures and were discharged from the camps themselves.These mobile camps had facilities for portable imaging systems, laboratories and conducted minor surgeries. A computer-based triage system was functioning on-site and quick-scanning medical monitoring robots delivered the fastest results. Those who needed operations were sent to the hospital; these were the complicated ones and some of these required grafts, which could take several hours.

The OR was divided into five zones and the most severe cases were operated in the fifth zone. Samples from the OR were sent to the laboratory through automatic sample devices along with the patient details through pipelines. Results were displayed on the patients’ monitors. Then they were brought to the OR in negative pressurised chambers to prevent infections.

Dr Subash Bastakoti NMSS - Nepal Subash is an intern at the Institute of Medicine at the Tribhuwan University Teaching Hospital in Kathmandu, Nepal. This essay was written with the view of the consequences and calamities of improper actions by humans in the name of development. It is a fictional story of what might happen in many years from today and the role of the doctors and health care delivery systems at that time.

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What’s Up Asia-Pacific?!

Health in the Asia-Pacific in 2050

How do you see Asia-Pacific in 2050?

Jumpei Shibata IFMSA-Japan Nagoya University

Our collaboration within Asia-pacific is more tight and strong. But I have a hunch that we won’t organization EU, which aim to unite the Europe. That’s why our Asian members are too specific.

What is the biggest issue that make a worse impact on Health in the Asia-Pacific in 2050?

Non-communicable diseases, Climate change, Rapid population growth From your perspective as a medical student, what is your role in addressing this issue?

As a medical student, I would like to make systems which solve these issues. We can make use of our IFMSA connection and make difference to the World.

How do you see Asia-Pacific in 2050?

Universal health-care system, Research based medicine, Health insurance for all, Quality health care providing team, Universal health policy for Asia-Pacif ic.

What is the biggest issue that make a worse impact on Health in the AsiaPacific in 2050?

Yameen Hamid BMSS - Bangladesh Shaheed Suhrawardy Medical College, Dhaka University

Weakening health care system, High levels of pollution, Climate change, Political rigidity From your perspective as a medical student, what is your role in addressing this issue?

Motivating among young medical students, Building research oriented study, Motivating mass people about modif ied health care system.

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How do you see Asia-Pacific in 2050?

In dark MD Anwarul Quadir BMSS - Bangladesh National Officer of Public Health Bangladesh Medical College

What is the biggest issue that make a worse impact on Health in the Asia-Pacific in 2050?

Non-communicable diseases, Climate change From your perspective as a medical student, what is your role in addressing this issue?

I am trying my best........

How do you see Asia-Pacific in 2050?

Better in certain aspects and worse in some more. A few countries would be advancing in the fields of science and technology while some would be deteriorating in terms of health conditions and environment. But that’s often the neglected sector of the society since people are so busy pampering the nation’s good. So from general prospect, Asia Pacific would be at it’s best (In all ways!) given the kind of attention we’re receiving already!

What is the biggest issue that make a worse impact on Health in the Asia-Pacific in 2050?

Suranjana Basak MSAI - India Director of Communications MGM Medical College, Navi Mumbai

Rapid population growth, Poverty, Political rigidity From your perspective as a medical student, what is your role in addressing this issue?

Making a difference by spreading the word and doing good in the smallest possible way by communicating with those we face daily (Educated people who are still falling prey to the lifestyle diseases, maids, shopkeepers , people smoking on streets, beggars etc).

Building policies, working on large issues, delivering talks to intellectuals is a rather long and extremely ambitious. Realistically speaking, “AC T ING at the local level” is all that will stay!

How do you see Asia-Pacific in 2050?

Kana Morimoto IFMSA-Japan University of Tokushima

I think healthcare for poor or disabled people is not enough. We need to make more effective system to save these people, include social welfare program. In addition, each countries need to cooperate more not only to improve medical skill for every healthcare workers, but also to develop medical technology in whole Asia-Pacific.

What is the biggest issue that make a worse impact on Health in the Asia-Pacific in 2050?

Weakening health care system, Rapid population growth From your perspective as a medical student, what is your role in addressing this issue?

As a physician scientist, I want to improve medical technology cooperating with other Asia-Pacific country. I also want to help to make more effective social welfare system.

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Health in the Asia Pacific in 2050 Challenges and Recommendation

by: Shela Sundawa

Nowadays, Asia-Pacific countries are in different stages of economic development as well as in health statuses.

Some countries are still fighting high maternal mortality rates while other countries have succeeded in declining it. The condition of the health systems also varies amongst the Asia-Pacific countries. For some countries, especially low-middle-income countries, outreach of adequate basic health care services is still the challenge, while for other countries resource allocation and public-private interventions are the main issues.1 However amongst all these countries, there are some similar specific health issues which are becoming emerging cases. By 2050, Asia-Pacific will be home to most of the world’s elderly people. About 998 million people aged 60 and above will be living in the Asia-Pacific region by 2050. Census bureau of the United States of America (USA) predicts that Singapore will have the most dramatic change with regards to the proportion of population over 50 years of age, which is set to increase from 23% of the population to 50% over the next 25 years.2

By 2050, outdoor air pollution (particulate matter and ground level ozone) is projected to become the top cause of environmental-related deaths worldwide based on the Organisation for Economic Co-operation and Development (OECD) Environmental Outlook Baseline.3 World Health Organization (WHO) Air Quality Guideline reported that air pollution concentrations in Asia are already above acceptable health standards.

These two issues in Asia-Pacific - ageing population and outdoor air pollution - contribute to another challenge that is being faced and will continue to be a bigger chal-

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lenge in the future of this region, non-communicable diseases (NCDs). Of the 57 million global deaths in 2008, 36 million, or 63%, were due to NCDs.4 NCDs in AsiaPacific has been known to be a major killer since 2002.

About 60.1% of deaths in the region are caused by NCDs while communicable diseases account for ‘only’ 29.9% of deaths.

It is widely understood that NCDs will continue to rise due to increasing life expectancy, and in the future Asia-Pacific which will host most of the ageing population in the world who will likely be fighting the highest NCDs burden in the world. Not to mention, outdoor air pollution which is higher than the acceptable amount in some Asia-Pacific countries already will also contribute to increasing deaths due to NCDs. Diseases like Chronic Obstructive Pulmonary Disease (COPD) and cancer are example of NCDs which are highly correlated with outdoor air pollution. Therefore integrated action from government along with the private sector and society will need to be done to reduce the impact from these two toxic combinations.

The first thing that should be done is to reform the health system. Governments have the primary responsibility in ensuring good public health as it is the lawmaker and the caretaker of people.1 However it does not mean that the government should act alone in this matter. Health care can be delivered by the government as well as the private sector to ensure more people are reached. A good example is what happens in Malaysia – with their pragmatic approach towards the development of public health services.

Another problem in health delivery is its inequity between rural and urban areas. For most countries, the rural population is dominating the urban population, whereas the availability of health care in the rural areas is less than that in the urban areas. India has developed a good rural health system. They have outreached rural residents by employing a social worker from the local community; this

is named ASHA (accredited social health activist), and by building a community health centre they have succeeded in specifically increasing the number of attended births to 95%.5 India’s concept of rural health system can be applied to other countries to reach rural communities especially in the matter of NCDs. Many of the ageing population in rural areas are asymptomatically suffering from hypertension or diabetes and are unable to seek any help. Therefore having a health activist in their area to bridge these people with health care providers will be beneficial.

The second thing that should be highlighted in providing better care in the future in Asia-Pacific is increasing physician-to-population ratios as well as their quality. Countries like Indonesia, Cambodia, Bhutan, Bangladesh have a very low physician-to-population ratio raging from 16 to 29 physicians per 100,000 while other Asia-Pacific countries have much higher ratios, for example Singapore has 162 physicians per 100,000.1 Medical doctor training also needs to be shifted from being urban oriented to being more rural oriented. Most of the medical students study in tertiary hospitals with modern tools to help diagnose patients. However, general practitioners are expected to serve in primary health care with limited tools and devices. The result of this teaching style could be unconfident graduated medical students who are hesitant in diagnosing illnesses and prescribing medications. A study by WHO SEARO showed that two-thirds of fresh graduates felt that their skills in medicine needed improvement for them to operate independently.5 Thus, medical curricula should be developed based on the health system needs, and be rural oriented and community based.

Thirdly, governments should incorporate health sector policies with other sector policies such as transportation and industry. As mentioned above, outdoor air pollution is predicted to continuously rise in Asia-Pacific and will contribute to adding more suffering. Therefore, action is needed in reforming transportation and regulating better industry arrangements.

New York City in the USA has started its way in fighting NCDs by regulating a better transportation system.

The Department of Transportation of New York City has refined public transportation and increased parking fees to encourage more people to use public transportation

instead of their private cars. The size of the sidewalks has also been widened to make it comfortable for people to walk.6 By promoting public transportation, the city will be able to curb outdoor air pollution and by widening sidewalks, many people will choose to walk which is beneficial for their health as it will increase their physical activity.

As it is widely known, lack of physical activity is one of the major risk factor for NCDs. Starting now, every country in the Asia-Pacific region should be getting ready for the future health burden and should be preparing their fight against the burden. Unless serious action is taken, the burden of ageing population, air pollution and NCDs will reach levels that are beyond the capacity of all stakeholders to manage. Reforming the health system and medical education as well as incorporating health policy with other sector policy are suggestions that need to be started from today.

References: 1. Bandara A. Emerging health issues in Asia and the Pacific: implication for public health policy. Asia Pacific Development Journal.

December 2005; 12(2).

2. Watson W. Ageing workforce 2006 report: Asia Pacific [internet].

Available from: watsonwyatt.com 3. Organisation for Economic Co-Operation and Development. Environment outlook to 2050: the consequences of inaction. 2012.

4. World Health Organization. Executive Summary: Global report.

2010.

5. Kishore J. National Health Programs of India: National Policies & Legislation Related to Health. 8th Edition. 2009. New Delhi: Century Publications.

6. Rozes M. Launch of wellness week in the Americas. In: PAHO’s Director Newsletter. 2011; 12.

Shela Sundawa CIMSA - Indonesia Shela is a fourth-going-on-fifth year medical student at Universitas Indonesia who has passion for global health. She has worked with American Cancer Society as their ‘Global Cancer Ambassador for Indonesia’ to bridge civil society’s ask and the government’s will on NCDs since last year. She also served as the Marketing, Campaign and Advocacy Director of CIMSA Indonesia during 2011-2012. She wrote thie essay during her visit to India to observe the major rural health problem as well as their health system delivery there.

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Health

in the Asia-Pacific

in 2050 by: Goo Zhen Qiang

A majority of the Asia-Pacific region consists of developing countries. Developing countries contain 84 percent of the world’s population and 93 percent of the worldwide burden of disease, but account only for 18 percent of global income and claim only 11 percent of the world’s health spending. The governments in the developing world face serious challenges as they have limited resources and administrative capacity while their countries have strong underlying needs for services. The gap between rich and poor nations appears even more marked when the distribution of disease burden is included in the picture.

Different from developed countries, the current burden of healthcare on the economy of Asia-Pacific is mainly due to communicable diseases and injuries.

Asia-Pacific has a high under-five mortality rate. This is mainly due to poor effectiveness of the maternal child health programs and low educational attainments amongst girls in the region. Our responsibility is to close the gap between developed and developing nations, but how is this possible with the resources constraint in developing nations? Everyone knows that the health problems in Asia-Pacific in 2050 would be skewed towards the direction of non-communicable diseases. Are we ready for 14

the change? It would be disaster if these spectrums of diseases storm Asia-Pacific. We have to learn to deal with them accordingly.

The healthcare system in each Asia-Pacific country varies. They are all struggling to produce a healthcare act that is balanced between quality and cost of healthcare services. We currently have various methods of funding the healthcare service. These include general taxation, social health insurance, private health insurance, out-of-pocket payments and donations. Most nations have adopted more than one methods of funding their healthcare services.

However, it is very difficult to achieve a balance in terms of quality of healthcare services and the healthcare expenses no matter which method a nation practices. President Obama with his Affordable Healthcare Act (AHA) does not seem to be solving problems. For decades, a big nation like the United States of America could not solve the mystery of funding their healthcare system. Instead of creating problems to solve a problem, we can anticipate that there would be a conjoint board of healthcare act in Asia-Pacific in the year of 2050.

Let us be honest with it, healthcare is NOT expensive. It is us humans who made it expensive. The patency of drugs and intellectually property laws that protect the greedy merchants make it worse.

Seventy percent of healthcare expenses are spent on it. A doctor in South Africa innovated and made his hospital a CT scan machine which cost only one thousand US dollars. When Jonas Salk discovered the first safe oral polio vaccine in year 1955, he was asked by the media, ‘Who owns this patent?’

Salk said, ’No one, can you patent the sun?’ Even if Salk patented the polio vaccine, it would not be a problem as we can still mass produce the vaccine if no company owns the sole distribution right. They key to the funding of the healthcare service is not by

in only 38 years. Eric Topol, MD in his book “The Creative Destruction of Medicine� stated that innovation is difficult in medicine. Besides the reluctance of and resistance of physicians to change, the life science industry and government regulatory agencies are in near paralysed state, unable to break out of a broken model of how their products are developed or commercially approved. Despite all these negative perceptions, we must work hard together and innovate to improve the healthcare system in Asia-Pacific by the year 2050. developing a funding method to further complicate all things, but to demolish all the greedy merchants who have monopolised all healthcare products. I hope the Asia-Pacific region would be matured enough to realise this by the year 2050. We should not commercialise the healthcare system.

The healthcare system is a simple system yet complicated by human greed. Everyone wants to monopolise and get a share from the healthcare sector.

Occasionally some Good Samaritans try to restore the human faith, but fail miserably. A baby needs to crawl before he can walk. It is just like healthcare in Asia-Pacific, we need to solve the core of the problem before we can try to improve the healthcare system. If Asia-Pacific is a patient, the deficiency in healthcare is only one of the presenting symptoms.

It is not wrong for us to treat it symptomatically. At least it gives the patient a temporary relief. Maybe, in the year of 2050 we are able to find the diagnosis for her.

It is near impossible to make a huge change to the conservative healthcare system in Asia-Pacific by year 2050. One would be deemed foolish if he wish for an improvement in the healthcare system

References: 1. G Schieber, A Maeda. Health Care Financing and Delivery in Developing Countries. Health Affairs. Vol 31, No 6. June 2012.

2. P C Rockers, M E Kurk, MJ Laugesen. Perceptions of the Health System and Public Trust in Government in Low- and Middle- Income Countries: Evidence from the World Health Surveys. J of Health Politics, Policy and Law 2012 Vol 37. No 3: 405-437.

3. K H, A M C Laude, A Huibin: Towards a Comparative Analysis of health Systems Reforms in the Asia-Pacific Region. Asia Pac J Public Health. Jan 2002. Vol 14 no 1 9-16.

Goo Zhen Qiang SMMAMS - Malaysia Goo Zhen Qiang (wolf) is a final year medical student from International Medical University, Malaysia. He aims to transform the healthcare industry and his interest is in plastic and reconstructive surgery. Zhen Qiang is the founder/CEO of PaceMaker Sdn Bhd and also the current president of the IMU Surgical Society.

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Taking ACTION Every Day the Taiwan Experience by: Joanna Marie D. Choa

Taipei, Taiwan – With the heat of the summer sun beating, more than 50 delegates took ACTION in preparing and battling hydrological disasters and relief management in Taipei, Taiwan.

ACTION, which stands for Asian Collaborative Training on Infectious diseases, Outbreaks, Natural Disasters and Refugee Management, is the only transnational project of IFMSA that has been running for the past six years, pioneered by IFMSA-Japan.

This year, participants from nine countries from all over the Asia-Pacific region took part; these included Japan, China, the Philippines, Indonesia, Malaysia, Thailand, Australia, New Zealand, and Taiwan. The entire conference-workshop was hosted

by IFMSA-Taiwan who coordinated with their national Disaster Management Assistance Team (DMAT) to conduct outdoor field activities for all the enthusiastic delegates. The making of the theme and the entire programme was guided and advised by the International Organizing Committee (IOC) headed by this year’s project coordinator, Ayaka Ishihata from IFMSA-Japan.

A welcoming party was arranged on the first night of the conference to receive the delegates for the week-long event. For the following three days of the programme, lectures were held in the National University of Taiwan (NTU) and delivered by several experts in the field of disaster medicine with topics ranging from triage, to the use of Incident Command System (ICS) and Global Positioning System (GPS), and to diseases commonly encountered during disasters. Various kinds of small group discussions and table-top trainings were also conducted, which invigorated the delegates to think and act fast during times of calamities.

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Two days of the programme were dedicated to camping out in Yi Lan and learning several skills that are useful in outdoor activities such as in camping. The delegates were taught on how to use GPS and wireless communication, the maritime satellite system, the solar panel, and the use of intraosseous access. Additional skills, like how to operate a power generator, a water purifying system, and the electronic clinic operating system were taught. The delegates were also taught how to set up emergency field tents, how to work with knots and ropes, and also how to carry out search and rescue operations during catastrophes. Under the sea of stars, the participants had a scrumptious barbecue (wherein the participants needed to know how to start their own fire and the food to be cooked needed to be searched first with the use of the GPS!) and loads of joyful conversations with each other. The second day of camping proved to be the toughest challenge for all participants as they underwent the simulation training of a real disaster with real patients (acted out by the other half of the participating group and vice versa). The participants were compelled to make immediate decisions on how to manage patients and how to handle the media and politicians during times of disasters or unrest. Everybody needed to keep in mind all the learning they had gathered during the week. It was a fun-filled time for all the delegates as well as the lecturers who supervised the entire activity as they saw how well the students were able to understand and apply all they had learnt during the conference.

After two days of staying outdoors, the whole group travelled to Hua Lien, a province south of both Taipei and Yi Lan, to hold the cultural night. Gorgeously attired ladies and gents in their country’s national costumes performed skits, sang songs, and did a lot of dancing to showcase their rich native culture. A booth was set-up for everybody to sample delicacies brought by the delegates from their hometowns. The entire conference ended with a heartwarming closing programme by the local and international organizing committees. The last day in Taiwan was spent touring the Taroko National Park and enjoying the sights beside the Pacific Ocean before the journey back to Taipei.

ACTION truly embodies the ideals of a conference combined with interactive workshops and social and cultural trips of the host country. Being the only transnational project of IFMSA running on its 7th year, the training offered by ACTION is unparalleled and valuable in the formation of a holistic and globally-competent medical doctor of the world!

Setting aside all the serious trainings, the delegates also became locals as they toured the city of Taipei. Cultural trips included a tour to the famous Taipei 101, the Chiang Kai Shek Memorial Hall, and also to the busy Shi Lin Night Market. They also travelled by rail, as the people of Taiwan do, to arrive at Yi Lan and Hua Lien. Side trips to the coast and to Taroko National Park were also included in this weeklong ACTION-filled programme.

Joanna Marie D. Choa AMSA - Philippines Joanna Choa is currently a post-graduate medical intern in Manila. She has been a writer and editor for several school publications, newsletters and magazines of various organizations. Her hobbies include animals, travelling, and philately, which allows her to explore the world and learn more about the people and their way of life. She is also currently one of the few chosen student ambassadors of Elsevier Publishing.

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Asia-Pacific Moments

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August Meeting 2012 India!

Photo credits: Greco Malijan (Philip pines) Motoko Kametani (J ap Bethari K. Abianti (I an) Ida Ayu Narayani (Indonesia) ndonesia) Renzo Guinto (Philip pines) 19

? on gi re c ifi ac P asi A le o h w e h t in t ac p im an g in ak m in d e st re Inte You can apply to become part of the next

Regional Team for term 2012-2013!

Our new Regional Coordinator for the Asia-Pacific, Development Assistant for Dr. Vincent Khor Wei Sheng of SMMAMS-MaPublications and Communications laysia, is in need of new Development Assistants who will work with him from October 1, 2012 to • Develop, edit, manage, and distribute Pulse, the official magazine of IFMSA Asia-Pacific September 30, 2013!

Coordinate with the IFMSA Publications Division Director and •

New Technologies Division Director in the management and

The Regional Team will be composed of the Regiondissemination of regional publication and other materials al Coordinator, three Development Assistants (see • Create a repository of event descriptions, articles, photos, and videos relevant to the region descriptions below), as well as Regional Assistants Assist NMOs needing help in strengthening their publications of the Standing Committee Directors and the Project • and communications arm at the NMO-level Support Division Director.

Applications for the Development Assistant posiDevelopment Assistant for tions have to be submitted to the current Regional Coordinator, Dr. Renzo Guinto, and to the Regional NMO Development Coordinator-elect, Dr. Vincent Khor.

• Assist the Regional Coordinator in communicating with existApplications for the Regional Assistant positions have to be submitted to the Standing Committee Directors and Projects Support Division Director (see their email addresses at the end of this advertisement).

Development Assistant for Advocacy, Education, and Policy

ing NMOs and responding to their questions, concerns, and needs • Facilitate and improve the flow of communication on the server and in the regional Facebook page • Assist the Regional Coordinator in the task of organising and facilitating the Asia-Pacific Regional Meeting as well as the regional sessions during General Assemblies • Help prepare the agenda and minutes of Regional Team and Regional Presidents online meetings • Synthesise and summarise discussions in the server and turn them into relevant documents for future use

• Lead in the designing of regional thrusts and strategies for advocacy, education, and policy • Seek and promote regional opportunities for advocacy, educa- Please Keep in Mind the Following Requirements: tion, and policy • No violation of any IFMSA by-laws • Lead in drafting statements, interventions, policy papers, and • Be a member of a Full or Associate Member Organization educational primers on relevant health issues facing the re- • Have basic knowledge of structure, function, and relations of IFMSA gion • Coordinate region-wide campaigns within the IFMSA Asiance, skills, passion, Pacific If you believe you have the experie • Assist NMOs needing help in strengthening their advocacy, and vision for any of the three work areas education, and policy arm at the NMO-level submit your applications to rcasiapacific@ifmsa.org (cc: • Develop an online regional repository of resources for advocacy, education, and policy leo.vincentkhor@gmail.com) on or before September

25, 2012, 23:59 pm GMT. 20

Please submit the following documents: • A filled out Candidature Form, signed and stamped by the President of the candidate’s National Member Organization • A filled out Technical Data Card • Resume (up to two pages only) • High resolution photo (in .jpg format) • Motivation essay (up to two pages only) answering the following: 1. Why do you want to apply for the position?

2. Can you cite one specific experience that you think can help you execute the tasks of your desired position?

3. Special Questions for: a. DA for Publications and Communications: What improvements do we need for the Pulse, in terms of submissions, editing, lay-out, and distribution? How can we make them happen? b.DA for Advocacy, Education, and Policy: What do you think is the most important regional health issue that IFMSA Asia-Pacific should try to address this coming term? How do you think we can get involved in advocacy, education, and policy work pertaining to this issue? c. DA for NMO Development: What do you think is the most important concern or need of NMOs in Asia-Pacific today? How do you think we can solve or provide this?

Please send a request for the soft copy of the forms to rcasiapacific@ifmsa.org.

Let us all continue the unfinished work of building a healthier IFMSA Asia-Pacific!

For the Regional Assistants positions, contact:

Director of Medical Education: scomed@ifmsa.org Director of Professional Exchange: scoped@ifmsa.org Director of Public Health: scophd@ifmsa.org Director of Reproductive Health including HIV/AIDS: scorad@ifmsa.org Director of Research Exchange: scored@ifmsa.org Director of Human Rights and and Peace: scorpd@ ifmsa.org Projects Support Division Director: projects@ifmsa.org

Standing Committee Updates from Asia-Pacific!

Dear Asia-Pacif ic family, This year has been a good one for SCOME in the Asia-Pacif ic region: we have become more established, welcoming India and Pakistan to our family; new NOME and LOME positions have been created in various NMOs; and a growing number of students have been exposed to the ideals of SCOME and are now proud to call themselves SCOMEdians.

As Regional Assistant a major part of my role has involved assisting NMOs in either establishing, or strengthening already-existing, SCOME platforms. One of the ways in which this has been achieved is by providing NOMEs and LOMEs with advice and skills in various areas such as project development and team building.

Another of our foci has been on distributing medical education surveys to our various NMO members. At this stage we are still waiting for the results to be collated; but once this is done we will be able to formulate a report for distribution to NMOs and our external partner organisations such as the World Federation for Medical Education. I sincerely hope that the next Regional Assistant will be able to continue with this worthwhile endeavour.

Finally, an online database containing details of various medical education projects in our region has been created. It is hoped that this will be used to further guide and inspire students in setting up their own project initiatives in their home countries. Please keep an eye out in the coming weeks for the link to this database!

It has been a great privilege working with SCOME in the Asia-Pacific region this year. I would like to thank all those that have been involved including all of the NOMEs, LOMEs and countless others who have shared their passion for medical education. I hope that we will all continue in our quest for the best medical education possible.

With best wishes always, Bronwyn :O) Regional Assistant for SCOME Asia-Pacif ic

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Algeria (Le Souk) Argentina (IFMSA-Argentina) Armenia (AMSP) Australia (AMSA) Austria (AMSA) Azerbaijan (AzerMDS) Bahrain (IFMSA-BH) Bangladesh (BMSS) Belgium (BeMSA) 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 (ASCEMCOL) Costa Rica (ACEM) Croatia (CroMSIC) Czech Republic (IFMSA CZ) Denmark (IMCC) Ecuador (IFMSA-Ecuador) Egypt (EMSA) Egypt (IFMSA-Egypt) El Salvador (IFMSA El Salvador) Estonia (EstMSA) Ethiopia (EMSA) Finland (FiMSIC) France (ANEMF) Georgia (GYMU) Germany (BVMD) Ghana (FGMSA) Greece (HelMSIC) Grenada (IFMSA-Grenada) Haiti (AHEM) Hong Kong (AMSAHK) Hungary (HuMSIRC) Iceland (IMSIC) India (MSAI) Indonesia (CIMSA-ISMKI) Iran (IFMSA-Iran) Israel (FIMS) Italy (SISM) Jamaica (JAMSA) Japan (IFMSA-Japan) Jordan (IFMSA-Jo) Kenya (MSAKE) Korea (KMSA)

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Kurdistan - Iraq (IFMSA-Kurdistan/Iraq) Kuwait (KuMSA) Kyrgyzstan (MSPA Kyrgyzstan) Latvia (LaMSA Latvia) Lebanon (LeMSIC) Libya (LMSA) Lithuania (LiMSA) Luxembourg (ALEM) Malaysia (SMAMMS) Mali (APS) Malta (MMSA) Mexico (IFMSA-Mexico) Mongolia (MMLA) 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) Paraguay (IFMSA-Paraguay) 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) Slovakia (SloMSA) Slovenia (SloMSIC) South Africa (SAMSA) Spain (IFMSA-Spain) Sudan (MedSIN-Sudan) Sweden (IFMSA-Sweden) Switzerland (SwiMSA) Taiwan (IFMSA-Taiwan) Tanzania (TAMSAz) 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) Uganda (FUMSA) 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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