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Bulletin de Santé Mondiale — Global Health Newsletter

Volume 6 Numéro 4 Mai 2013

Bulletin de Santé Mondiale - Global Health Newsletter

Premier génocide du 20ième siècle

Laura Patakfalvi Éditrice en chef Bulletin de santé mondiale

C'est un fait : la douleur a fait perdre la raison à beaucoup de victimes ; et ceux qui les ont torturées ont bâti leur carrière sur leurs souffrances. En tant que médecins du futur, nous devons reconnaître le passé de notre profession. De nombreux médecins qui ont planifié et qui ont agi en tant que complices actifs ou passifs de génocides constituaient l'élite du corps medical. Connaitre et comprendre les enjeux du passé est la première étape qui contribuera à prévenir d’autres crimes contre l’humanité. Voici un bref résumé de l’historique du genocide Arménien, premier genocide du 20ième siècle . L’ébauche du génocide Aux premiers siècles de son existence, l'empire ottoman était une empire cosmopolite où chrétiens et musulmans coexistaient en paix. À la fin du XIXe siècle, l'empire ottoman comptait environ 2 millions d'Arméniens sur une population totale de 36 millions d'habitants. Dans les années qui précèdent la Première Guerre Mondiale, puisque l'empire ottoman est en plein déclin, le sultan Abdul-Hamid II attise les haines religieuses des musulmans contre les chrétiens afin de consolider son pouvoir. Entre 1894 et 1896, un million d'Arméniens sont dépouillés de leurs biens et quelques milliers sont convertis de force à l’islam. Des centaines d'églises sont brûlées ou transformées en mosquées.

Ces massacres planifiés donnent un avant -goût du génocide. L'Américain George Hepworth enquêtant sur les lieux deux ans après les faits, écrit: «Pendant mes déplacements en Arménie, j'ai été de jour en jour plus profondément convaincu que l'avenir des Arméniens est excessivement sombre. Il se peut que la main des Turcs soit retenue dans la crainte de l'Europe mais je suis sûr que leur objectif est l'extermination et qu'ils poursuivront cet objectif jusqu'au bout si l'occasion s'en présente. Ils sont déjà tout près de l'avoir atteint». En 1909, un nouveau parti politique, les Jeunes Turcs prennent le pouvoir et avec leur devise « Liberté, Égalité, Fraternité » laissent espérer un avenir meilleur aux minorités de l'Empire. Cependant, leur idéologie finit par emprunter un nationalisme encore plus étroit appelée «touranisme». Cette idéologie prône l'union de tous les peuples de langue turque, de la mer Égée aux frontières de la Chine (Anatolie, Azerbaïdjan, Kazakhstan, etc). Dès 1909, soucieux de créer une nation racialement turque, les Jeunes-Turcs multiplient les massacres des Arméniens. On compte ainsi 20 000 à 30 000 morts dans la région d’Adana le 1er avril 1909. La Turquie dans la guerre de 1914-1918 Le sultan déclare la guerre le 1er novembre 1914 et l’empire ottoman entre dans la Première Guerre Mondiale en joignant la coalition constituée de l’Allemagne et de l’Autriche-Hongrie. Les Jeunes-Turcs profitent de l'occasion pour

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Pendant l'été 1915, les deux tiers de la population arménienne sous souveraineté ottomane disparaissent, soit 1,5 millions Arméniens. accomplir leur dessein d'éliminer la totalité des Arméniens de l'Asie mineure. Ils procèdent avec méthode et brutalité. L'un de leurs chefs, le ministre de l'Intérieur Talaat Pacha, ordonne l'assassinat des Arméniens d'Istamboul puis des Arméniens de l'armée, bien que ces derniers aient fait la preuve de loyauté dans la guerre qui s’avérait fratricide pour les Arméniens. En effet, pendant cette guerre, les soldats arméniens étaient contraints de tuer leurs frères arméniens combattant dans l’armée russe. Talaat Pasha transmet un télégramme aux Jeunes-Turcs d'Alep : «Le gouvernement a décidé de détruire tous les Arméniens résidant en Turquie. Il faut mettre fin à leur existence, aussi criminelles que soient les mesures à prendre. Il ne faut tenir compte ni de l'âge, ni du sexe. Les scrupules de conscience n'ont pas leur place ici». Dans un premier temps, les agents du gouvernement rassemblent les hommes de moins de 20 ans et de plus de 45 ans et les éloignent de leur région natale pour leur faire accomplir des travaux épuisants. Beaucoup d'hommes sont aussi tués sur place. La «Loi provisoire de déportation» du 27 mai 1915 fixe la déportation des

survivants ainsi que le dépouillement des victimes. Les militaires et gendarmes ottomans procèdent avec méthode en réunissant les femmes et les enfants des villages où il ne reste plus d’homme. Ces derniers sont réunis en longs convois et déportés vers le sud, vers Alep, une ville de la Syrie ottomane.

Dans ce numéro Premier genocide du 20e siècle Laura Patakfalvi

Genocidal Doctors Laura Patakfalvi

Automéducation médicale Claudel P-Desrosiers

Les marches se déroulent sous le soleil de l'été, dans des conditions épouvantables, sans vivre. Les marches débouchent en général sur une mort rapide.

Global Health Diplomacy Christian Kraef

Compassion Fatigue Omid Zahedi Niaki

Des jeunes femmes et des adolescentes sont enlevées par les Turcs pour être vendues comme esclaves ou converties de force à l'islam et mariées. Au total, pendant l'été 1915, les deux tiers de la population arménienne sous souveraineté ottomane disparaissent, soit 1,5 millions Arméniens.

They were blue Debra-Meghan Sanft

Home Palliative Care Vanessa Martelli

La réaction de la communauté internationale Les informations sur le génocide émeuvent le public occidental, mais le sultan se justifie en évoquant la nécessité de déplacer les populations pour des raisons militaires. Le gouvernement allemand, allié de la Turquie, censure les informations sur le génocide. Après la guerre, c'est en Allemagne que se réfugient les responsables du génocide, y compris Talaat Pacha.

Mon petit patient, mes 1e larmes 14 Soumia Senouci The reciprocity of caring Mali Worme

Des nouvelles d’IFMSA-Québec Conseil exécutif 2012-2013

L’année en images Conseil exécutif 2012-2013

Negociating better global health 22 Freya Langham Retour à la réalité Jouhayna Bentaleb

Les nazis tireront les leçons du premier génocide de l'Histoire et de l’occasion perdue de juger les coupables... «Qui se souvient encore de l'extermination des Arméniens ?» a lancé Hitler en 1939, à la veille du massacre des Juifs.

Bulletin de Santé Mondiale - Global Health Newsletter

Le génocide arménien et la Turquie C’est seulement dans les années 1980 que l'opinion publique occidentale a retrouvé le souvenir du génocide, surtout grâce aux efforts des arméniens de la deuxième et troisième génération. Le gouvernement turc actuel maintient une position ferme de refus de la reconnaissance du génocide et condamne toute reconnaissance du génocide par des gouvernements ou parlements étrangers. En effet, la reconnaissance du génocide impliquera des enjeux financiers et territoriaux importants pour la Turquie. La Turquie sera contrainte à restituer des territoires à l’Arménie et à payer une indemnisation pour les préjudices humain, moral et matériel comme l'Allemagne a dû le faire après l’Holocauste. En effet, aujourd’hui, en Turquie, de nombreux citoyens sont conscients de l’existence du génocide. Beaucoup de Turcs sont ainsi troublés de découvrir qu'ils descendent d'une jeune chrétienne d'Arménie arrachée à sa famille et à sa culture. Ces derniers préfèrent

Seul un Arménien sur 3 habite les terres de la République d'Arménie

cacher leur descendance arménienne pour ne pas être victimes de discrimination. De plus, l’article 301 du code pénal turc trouve coupable quiconque qui « insulte l'identité turque ». Ainsi, de nombreux journalistes et auteurs qui évoquent le génocide sont condamnés et emprisonnés. Prenons l’exemple d’Orhan Pamuk, journaliste d’origine turc, récipiendaire du Prix Nobel de la Littérature. Ce dernier a fait l’objet de sérieuses menaces contre sa vie pour avoir admis dans une interview qu’entre 1915 et 1917, « un million d'Arméniens et 30 000 Kurdes ont été tués sur ces terres, mais personne d'autre que moi n'ose le dire » et a dû comparaître en justice pour cette insulte délibérée à l’identité turque. Citons également Hrant Dink, journaliste arménien vivant en Turquie, qui s’est focalisé sur les questions des droits des minorités. Il fut assassiné le 19 janvier 2007 et fut pour les arméniens du monde entier la 1,500,001e victime du génocide. Les arméniens de la Diaspora La diaspora arménienne désigne les communautés arméniennes installées hors des territoires de l’actuelle République d’Arménie. Sur une population arménienne mondiale estimée à 11 millions de personnes, seuls 3,2 millions résident en Arménie. En effet, seul un Arménien sur trois habite les terres de l'actuelle République d'Arménie. Malgré ce fait, les arméniens ont pu s’intégrer aux pays qui les ont accueillis tout en préservant leur culture. C’est grâce aux efforts des arméniens de la troisième génération que de nombreux pays reconnaissent le génocide arménien comme un fait indéniable de

l’histoire. Les pays ayant reconnu le génocide arménien sont :

Plusieurs pays ont pourtant refusé de considérer les massacres arméniens comme un génocide. Sans remettre en cause l’atrocité ou l’ampleur des faits, ces pays veulent essentiellement préserver de bonnes relations avec la Turquie. Cependant, le Québec a été un des précurseurs de la reconnaissance du génocide. Elle a reconnu en 1980, soit 24 ans avant le Canada. Les Arméniens au Québec Au total, 37 500 Arméniens habitent au Canada. Le génocide et la peur de l'extinction complète de la nation ont incité les Arméniens à redoubler d'efforts pour préserver leur héritage ethnique au Canada. Chaque année, le 24 avril, journée commémorative du génocide arménien, les Arméniens se rassemblent à Ottawa devant le parlement turc pour protester et rendre hommage aux martyrs du génocide. Les centres communautaires, les églises et les trois écoles arméniennes (l’école arménienne Sourp Hagop, l’école Notre-DameDe-Nareg et l’école Alex Manoogian) jouent un rôle important dans la préservation de la culture et de la langue. Atom Egoyan, cinéaste canadien d’origine arménienne, a réalisé de nombreux films sur le génocide, comme Ararat (2002).

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Genocidal doctors: Remembering the Armenian genocide “There is nothing new about physicians taking part in acts of barbarism” - Robert Kaplan,

disease at that time.

Doctors have frequently been accomplices in politically motivated repression, brutality and genocide, conducting inhumane experiments on victims, participating in torture and directing programs to exterminate the enemy. For no reason other than they had the power to do it at the time, they have beaten, tortured and killed victims.

Doctors are human beings, and as members of a particular society, they are equally susceptible to that society's prevailing social climate. When a state adopts an exclusionary policy of hypernationalism, all of its citizens, doctors included, can find themselves on both sides of the divide.

Clinicide: the Sory of Medical Murder

Before Rwanda and Bosnia, and before the Holocaust, the first genocide of the twentieth century happened in Turkish Armenia in 1915, when approximately one million people were killed. Systematic participation of doctors in state terrorism began with this first genocide of the 20st century. Dr Mehmed Resid, a governor who massacred Armenians, explained: “Even though I am a physician, I cannot ignore my nationhood. I came into this world a Turk. My national identification takes precedence over everything else. Armenian traitors had found a niche for themselves in the bosom of the fatherland: they were dangerous microbes. Isn't it the duty of a doctor to destroy these microbes?” It is puzzling to realize that two doctors were among the ultimate decision-makers in the genocide of 1915 and even drew up the Ten Commandments for the massacre of the Armenians (rules and regulations on how to proceed with systematic extermination): Dr Behaeddin Shakir and Dr Mehmet Nazim. These physicians were influential in propagating the nationalist ideological justifications for this crime, as well as in organizing and leading units which killed Armerians through mass deportations, medical murder and medical experiments. The Armenian genocide provided the template for the Nazi holocaust, where Nazi doctors conducted the first experiments on twins. Morphine injections were given to Armenian children. Toxic gas was another method to kill children. Children were organized and sent to the mezzanine to kill them with toxic gas equipment. Innocent people were inoculated with the blood of typhoid fever patients without rendering that blood ‘inactive’, thus infecting them with typhoid which was a common

How do physicians reconcile their Hippocratic oath with a mandate of genocide? Like many other professional groups, doctors are simultaneously members of the social elite and public servants.

Mortality rates due to genocidal violence are far in excess of other public health emergencies including malaria and HIV/AIDS. The immediate and long-range health consequences of genocide include the sequelae of infectious diseases, organ system failure, and psychiatric disorders, conferring an increased burden of disease on affected populations for multiple subsequent generations. Therefore, primary genocide prevention should be a physician’s mandate. As we continue our medical education, I ask myself how I can navigate the moral vulnerabilities of the medical profession and remain morally intact. It is well documented that medical students become less empathetic as they progress through medical school. The genocidal physicians cast a shadow on our profession. We must escape that shadow by guarding against our own moral erosion. It is within our power to choose the path we take. The first step is to be aware of the risks and potential for harm in the profession we have chosen. The second step is to remember the genocides from our past, advocate for their recognition and remembrance, in an effort for history not to repeat itself. Laura Patakfalvi Editor in Chief of the GHN References 1. Dadrian, Vahakan (1986). "The Role of Turkish Physicians in the World War One Genocide of Ottoman Armenians." Holocaust and Genocide Studies 2:16992. 2. Baron, J. H. (1999). Genocidal doctors. Journal of the Royal Society of Medicine, 92(11), 590. 3. Kaplan, R. (2007). The clinicide phenomenon: an exploration of medical murder.Australasian Psychiatry, 15(4), 299-

Bulletin de Santé Mondiale - Global Health Newsletter

Automéducation médicale Il y a environ deux ans, je recevais ma confirmation d'acceptation en médecine. Si seulement je savais.

Claudel P-Desrosiers Présidente IFMSA-Québec president@ifmsa.qc.ca

J'ai eu la chance de présenter mon programme lors de la fin de semaine d'entrevues. De voir des centaines de jeunes, assis dans une même salle, des cœurs battant à mille à l'heure, animés par le stress et l'incertitude, ça m'a rappelé pourquoi j'avais opté pour la médecine. Mais aussi, à quel point je vivais entourée de légèreté, d'insouciance. Je n'avais aucune idée de ce qui allait m'attendre une fois dans le programme. Peutêtre bien heureusement. Des études en médecine, c'est une aventure folle qu'on commence très jeune. C' e s t un e s ur - s t im u la t io n continuelle, une quantité inimaginable de matière à ingérer dans des laps de temps limités. C'est incroyablement excitant, mais par moment épuisant. On pourrait facilement penser que ça laisse peu de place à autre chose. Faux. Un peu étrangement, en l'espace de quelques mois seulement, j'ai découvert une passion pour la santé beaucoup plus importante que pour la médecine ellemême. J'ai avalé des rapports de santé publique, des articles sur les politiques internationales de développement: je me suis créée un programme d'apprentissage parallèle, entouré de collègues aussi passionnés que moi par des enjeux que le curriculum extra chargé ne peut pas offrir. Je me suis automéduquée. Le problème dans toute cette histoire, c'est que j'ai réappris à voir la société, dans ses forces comme ses faiblesses.

L'éducation médicale, c'est notre outil le plus puissant pour transformer des futurs professionnels de la santé en agents de changement.

Et j'ai le goût plus que jamais de partir à la découverte de ce monde qui m'entoure. De le comprendre dans toutes ses subtilités. Malheureusement, cela ne se fait pas les salles de classe, ni à l'hôpital. Ça se fait à l'extérieur de l'enceinte universitaire. L'éducation médicale, c'est notre outil le plus puissant pour transformer des futurs professionnels de la santé en agents de changement. C'est elle qui peut nous faire comprendre ce que ça signifie d'orner son nom des lettres MD. C'est elle qui peut nous faire voir à quel point nous avons le pouvoir de changer le cours des choses, pour le mieux, au nom de la santé de nos patients. Mais lorsqu'on considère que notre patient, c'est une ville, un pays, un monde, cette définition prend d'autant plus importance. Deux ans plus tard, ai-je pris la bonne décision? Oui. Même si je déroge peutêtre un peu de l'étudiante typique en médecine, je ne regrette aucun des choix que j'ai faits jusqu'à présent, des nuits passées mettre en place des projets, des heures investies à tenter de comprendre des enjeux de santé mondiale, des fins de semaine passées à l'extérieur pour des conférences et congrès de toute sorte. Sans oublier que j'ai fait les plus belles découvertes. Je peux vous le confirmer: vos futurs médecins sont exceptionnels. Il faut passer une semaine, un mois, avec ce groupe un peu hétéroclite d’étudiants pour comprendre ce qui les motive, ce qui les passionne. Eh oui, ils savent parler d'autre chose que de la médecine. Ils sont talentueux, ouverts d'esprit, allumés. Est-ce que je veux être médecin? Oui. Est-ce que je veux pratiquer la médecine? Je préférerais faire de la santé ma pratique courante. On s'en reparlera dans 3 ou 4 ans.

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Global Health Diplomacy In a globalized increasingly complex and interdependent world health has been found to be a critical factor for success in foreign affairs. In the following we will look at some definitions of Global Health Diplomacy, analyze characteristic examples for interactions of health and diplomacy and discuss the challenge of how to best bring together interests in the fields of foreign policy, development aid and health. 1. Global Health Diplomacy – a term gains momentum After his reelection in November 2012 President Obama made a quite indicative move by creating a new position at the State Department – the Office of Global Health Diplomacy. In December last year the Office was set up and described its main task as “to guide diplomatic efforts to advance the United States’ global health mission to improve and save lives and foster sustainability through a shared global responsibility.” Ambassador Eric Goosby, already U.S. Global AIDS coordinator, was appointed to lead the new office. The need to maintain and foster the Global Health efforts of the U.S. government as one of the biggest in the field is widely accepted. Nevertheless, one might argue that adding offices and fancy names to already vast bureaucratic structures will just complicate efforts of already existing institutions, plans and initiatives. However, such assumption falls short of profound analysis. While the term Global Health has been used and defined for decades by institutions mainly dedicated to health such as the World Health Organization, the creation

inside the state department and the addition of the word “diplomacy” mark a shift in paradigm. In fact the field of Global Health Diplomacy is increasingly establishing itself as a pillar of “traditional foreign affairs” with its own institutions, researchers and policies. Countries as diverse as Switzerland, Japan, Norway and UK have agreed on national Global Health strategies and partly set up specialized offices. In order to understand better what mutual bene fits Global He alth Diplomacy brings to the world of international relations it might be helpful to look at the origins of the term. Global Health Diplomacy has been defined by Ilona Kickbusch, professor a t t h e G r a d u at e In s t i t ut e fo r International Development studies and one of the most prominent scholars in that field, as the “multi-level and multi actor negotiation processes that shape and manage the global policy environment for health”.

Christian Kraef 4th year medical Student University of Munster (Germany)

The implementation of health as a key element of foreign policy was reinforced by the Oslo ministerial declaration – global health in 2007, which was written by the seven ministers of foreign affairs of Brazil, France, Indonesia, Norway, Senegal, South Africa, and Thailand. It aims at “broadening the scope of foreign policy”, more precisely it emphasizes that “life and health are our most precious assets.” Then it states: “There is a growing awareness that investment in health is fundamental to economic growth and development. It is generally acknowledged that threats to health may compromise a country’s stability and security.” The process of globalization has lead to an increase in interdependencies and helped bring this approach to the

Bulletin de Santé Mondiale - Global Health Newsletter

The field of Global Health Diplomacy is increasingly establishing itself as a pillar of “traditional foreign affairs” with its own institutions, researchers and policies. overarching field of foreign affairs with its various policies. The signing countries of the Oslo declaration have realized that most health threats do not stop at political borders and play a crucial role in all policies and sectors of society, including security. Political instability can cause health disasters but moreover a fragile public health situation can be a hazardous threat to stability of countries and regions. A vivid example is the devastating effect of the HIV/AIDS epidemic that destroys whole communities and destabilizes huge areas in sub-Saharan Africa. The 2003 SARS outbreak which put Hongkong into recession, terrified the world for months and made American Chinatowns become “ghettos” as no one dared to enter is another example in case. During the 2010 Pakistan floods Islamic extremists took over as main suppliers of aid and thus strengthened their public standing and recruited new members. And just recently typhoid outbreaks in the rebel-held zones of Syria marked the headlines and reminded us of similar threats like cholera outbreaks in Haiti or many refugee camps around the world. While death and human suffering are still a central concern we can

also identify major impacts on trade and development. Furthermore pressing contemporary issues such as the rise of extremism and migration are accelerated and mark the connection to questions of security policy. Hence, the 2007 Oslo ministerialdeclaration aims to “increase awareness of our common vulnerability [...] by bringing health issues more strongly into the arenas of foreign policy [...] reinforce health as a key element in strategies for development and for fighting poverty [..]and strengthen the place of health measures in conflict and crisis management and in reconstruction efforts“. 2. Interactions of health diplomacy – some meat

and

Looking at some examples of how states make use of global health measures, one realizes that health is already a well-used factor in international affairs. a) It is well known that China has vast interests in Africa. Mostly food and other resources let them engage in deep political cooperation with a

number of African states. An integral part in these endeavors is, next to e.g. infrastructure projects, medical collaboration. According to a 2005 article in China Brief Magazine China has deployed over 15,000 doctors to more than 47 African countries and treated approximately 180 million Africa patients since 1964. While without doubt millions have profited it also helped China gain prioritized access. b) Health programs do also aim at improving global perception of super powers. The start of the US President’s Emergency Plan For AIDS Relief (PEPFAR) in 2003 coincides suspiciously with the beginning of the Iraq war. Widely perceived as a public relations act to let the US appear to be a good global citizen it in the end turned out to be a majorly successful program nonetheless. Infection rates were reduced significantly and millions of lives have been saved, adding some sort of humanitarian legacy to the presidency of George W. Bush. c) According to the UN Food and Agriculture Organization, North Korea faces a food deficit of 414 000 tons this year. A situation which leads to severe chronic under- and

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malnutrition of large parts of the population and is to some extend caused by international sanctions and the fact that food is used as a commodity in anti-proliferation negotiations. South Korea stopped almost all food supplies to the North in 2008 when Lee Myun-bak ended the “sunshine policy”. This could be seen as an example in which a public health threat is used or at least tolerated by security policy and nations when it comes to power-play.

when trade considerations trump health; health can be used as an instrument of foreign policy in order to achieve other goals; health can be an integral part of foreign policy; and foreign policy can be used to promote health goals. These approaches cannot always be sharply differentiated and are better visualized as a continuum“.

d) Another, more recent example of the entanglements of health and (trade) diplomacy is the Trans-Pacific-Partnership negotiation, which basically aims at establishing a free trade regime among major pacific nations. Repeatedly concerns have been raised that this treaty could, by affecting intellectual property and patent laws, reduce the affordability of important pharmaceuticals to millions and hence favor trade considerations over health – an example that could also proof crucial in any developments towards a Trans-Atlantic-Free-Trade Association. A positive outcome in this regard on the other hand has been achieved by the World Health Assembly resolution on public health and intellectual property (WHA 61.21).

It is evident that the path that should be taken to create win-win situations for all involved in Global Health Diplomacy is narrow. Just recently Doctors Without Borders criticized the German Minister of Foreign Affairs in an open letter for citing humanitarian aid as a tool in the Mali conflict. Not unfoundedly it is argued that entangling humanitarian aid missions in military interventions compromises the neutral role of NGO’s and endangers staff and mission.

These examples make it hard to distinguish mean and goal. Does foreign policy serve the improvement of health or is health just another conductor of foreign policy? As so often the answer can get more complex. Ilona Kickbusch identifies four ways in which foreign policy and health interact: “Foreign policy can endanger health when diplomacy breaks down or

3. How to create win-win situations?

But the first and probably broadest challenge is the extreme diversity of actors in that field. Multilateral institutions, national interests, the private sector, NGO’s and academia in health politics, development politics and foreign affairs need to be brought together in terms of technical language, patterns of thinking and interests. A second question concerns the platforms that such diverse stakeholders need to be most fruitful. The WHO will probably, amid all its problems, still be the place where a lot of frames in terms of health will be set. But as lined out above others like the WTO, the World Bank, the G8/20/77 and private funds like the Global Fund to Fight AIDS, Tubercu-

losis and Malaria (GFATM) or forums such as the World Economic Forum are also crucial places for conduction of health diplomacy. In fact, ideally, health should be an everyday issue in embassies around the world, wherever stakeholders of different nationalities or interests meet or whenever decisions that frame the world we live in are made. In that context, the U.S. state departments office on global health diplomacy serves a prime example on how to make health a key-stone element in diplomacy. The US state department as the most powerful, best-endowed and already most comprehensively involved department taking the lead for development and health efforts will create mutual benefits for U.S. foreign policy and the global strive for a better world. Bibliography

1. U.S. State Department Official Blog, 2012. Strengthening Global Health by Elevating Diplomacy. Available online. [accessed: 23/2/2013] 2. Jamestown Foundation, 2005. Chinas soft power in Africa: from the “Beijing Consensus” to Health Diplomacy. Available online [accessed: 23/2/2013] 3. Kickbusch,Ilona., 2011. Global Health Diplomacy: How foreign policy can influence health. British Medical Journal 342:d3154 4. Sheryl Gay Stolberg , 2008. In Global Battle on AIDS, Bush creates legacy. New York Times, January 5. Available online. [accessed: 23/2/2013] 5. KATZ, R., et. al ,2011. Defining Health Diplomacy: Changing Demands in the Era of Globalization. Milbank Quarterly, 89: 503–523. 6. McCurry, Justin, 2012. No End in Sight for North Korea’s malnutrition crisis. The Lancet, 379 (9816), p. 602 7. Ärzte ohne Grenzen Deutschland, 2013. Offener Brief gegen Missbrauch der humanitären Hilfe Berlin, Pressemitteilung/Offener Brief, 29/1/2013

Bulletin de Santé Mondiale - Global Health Newsletter

The physician as a healer: Medical Students Essays Mark Twain once said, "The physician who knows only medicine, knows not even medicine." McGill medical students share their stories of compassion and hope, which portrays the cost of caring, the patient-physican relationship, and the physician’s role as a healer.

Compassion Fatigue Medical students, residents and physicians are no strangers to hard-work. We become accustomed to long days and grueling shifts early on in our careers.

Omid Zahedi Niaki 3rd year medical student

McGill University

Caring for patients can be physically, mentally, and emotionally demanding. We can all recall those hectic days where basic human necessities like eating or even visiting the loo were perpetually delayed in order to attend the urgent (and sometimes non-urgent) needs of our patients. Similarly, we are all quite familiar with that gnawing ache in our backs that was bound to be felt at the end of a long day in the OR. Undoubtedly, we are no strangers to physical fatigue but mentally, doctors are also pushed to their limits. With an aging population it is not uncommon to care for extremely ill patients with several comorbidities. Planning the treatment for such patients requires that we integrate all of our knowledge about various aspects of medicine which can be quite demanding intellectually. With all this, we oftentimes forget that the practice of medicine can also be quite draining emotionally and this is especially true when caring for young terminally ill patients. When all these

elements overwhelm the healer, it is dubbed as “compassion fatigue”. The AAFP describes it as a “deep physical, emotional and spiritual exhaustion accompanied by acute emotional pain.” It is a form of burnout that unwary healthcare professionals often experience and it is intimately linked with time (or lack thereof). Indeed, as clinics and wards get busier, physicians tend to eliminate the very things that revitalize them. The following is an example of how I became familiar with the concept of “compassion fatigue” and how I managed to avoid it. Very recently – as a student rotating through internal medicine – I was given the responsibility of caring for a frail and elderly lady that had been admitted for recurrent falls. Omitting the details of the case, we eventually diagnosed her with an inoperable/untreatable cancer. From the get-go, the overbearing nature of the patient’s family was quite prominent. They would frequently request to speak to me and as a good medical student I would oblige on most occasions. The patient was quite unstable and her case was complex. This meant that I was constantly monitoring her, ordering tests,

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Compassion fatigue is a form of burnout that unwary healthcare professionals often experience and it is intimately linked with time (or lack thereof). organizing procedures, analyzing results, and reassuring her family. I accompanied her in the ambulance when she had to be transferred to another hospital for a procedure, and I even went as far as to personally provide her pills as she refused to take them from anyone else. Though I never came close to feeling compassion fatigue, it wasn’t long before I came to the realization that a lifetime of such behavior would have me in the grave before my time. Indeed, it is easy to lose sight of everything else when your focus is on helping a sick (and sometimes dying) patient. As such, I began to set limits; for one, I told the family that they could no longer request me at will, I stopped accepting tasks that fell under the jurisdiction of other healthcare workers, and I started to limit the time I spent visiting the patient. These boundaries (that I eventually set for all my patients) meant that my day was more organized and allowed me to fulfill all of my daily obligations which even included enjoying a 10-15 minutes lunch break! In the end, it is important to emphasize that despite all this, medicine remains one of the most rewarding professions and that physicians can oftentimes replenish their reserves and draw strength from their relationships and the gratitude that they receive from their patients.

They were blue, the eyes of the first patient that I knew who died. It was a busy night in the emergency room, and also one of my first nights on call as a Clerk. I relished in having my pager go off, feeling able to handle the problems that were coming my way. Patient with abdominal pain? No problem. I could handle it. I arrived at the elderly man’s bedside, and immediately realized that he was in distress. Unable to answer my questions, I decided an abdominal exam would be the best next step. Crepitus. The word shot through my mind like a dagger. Feeling my heart quicken, I told the patient that I would be right back. I knew that I needed to get help. He grabbed my arm and whispered “I’m dying, don’t leave me alone.” The sad look in his cloudy blue eyes and the firm grasp he had on my arm made all of the noise in the emergency room melt away. I made a decision: I was not going to let this man die alone. I asked a nurse to page the resident, and stayed by his side.

Debra-Meghan Sanft 3rd year medical student

McGill University

It took hours before any family was located, and even longer for them to make a decision with respect to their uncle’s care. For the first hour I spent by his side, if I so much as shifted a foot farther from his bed, I would end up a firm grasp on my arm and another order: “don’t leave me alone to die”. Eventually, the patient became unresponsive, and his grip loosened. I had to leave his room to go see the other consults that I had been given. The next day, I found out that he passed away later that night. That evening, I walked away from the emergency room in a daze. I felt an unbearable weight in my chest. I made a promise to myself, and silently to the patient, that I would not leave him alone to die and I had not been able to keep it. The patient had asked one thing of me, the person he viewed as his doctor in the brief period he had been conscious - he

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did not want to die alone. But ultimately, he had. I look back on that experience often, wondering if I could have approached the situation differently. The truth is, I still do not have an answer. Logic tells me that I remained by his bedside for as long as I could have, given the circumstances. My heart, however, perpetually tells me that I failed the patient in the worst possible way: his one dying wish was not fulfilled. As a future physician, my role as a healer is continuously being shaped by my experiences and by cautiously navigating the grey area between what is expected, and what would be considered above and beyond the call of duty. The fundamental role of a doctor starts with knowing the limits that clinical duties, laws and society impose. What is ambiguous is the desire that patients have to connect on a deeper level with their doctor, the unwavering trust and need to be cared for. There is a discreet implication in which the physician must be able to answer the demands of a patient during their time of need. This idea then begs the question: at what point in the patient-physician relationship does the physician gain the foresight and wherewithal to both satisfy the needs of the patient and those of himself? At first, I felt as though the patient-physician relationship became nothing more than a cycle of wanting to portray the questionably naïve ideals that I clung to as I started clerkship, followed by being disappointed in how I had handled a situation. I constantly told myself that I would always make sure patients left my care feeling like people and not just like a manifestation of

symptoms and presenting complaints. I encouraged myself to remain hopeful, even when a situation appeared bleak. I was sure that I would not let myself become disillusioned as I felt some of my staff and colleagues had. Everything changed that night in the emergency room. It became all too clear to me that in order to be the healer that I have always aspired to be, I would have to look death in the eye and not be frightened. I would have to realize I could not possibly give of myself fully to each patient, or I risked perpetually leaving with that dreadful weight in my heart. I have come to grasp that though the patient-physician relationship is fundamentally centered on the patient, that there is an implicit element surrounding how the therapeutic alliance is also beneficial to the physician. I have learned that being honest with myself and with the patient serves us both well, and allows us both to heal when results are not as expected, or hopes are crushed. Providing properly for a patient is not, as I previously postulated, only about giving of myself to the patient, about imparting knowledge, or treatment plans. The patient –physician relationship also harbors the unspoken word of learning from those who come to us for care, about being able to take a step back and be the empathic person that patients need us to be without spreading ourselves too thin. Patients do turn to their physician in times of need and we have to be strong. I do believe, however, that there is a time for physicians to relish in the alliance they have created and gain strength from it to continue on a positive path of healing.

Home palliative care: the physician’s role as healer To heal means “to make sound or whole” (Egnew 2005). Wholeness does not necessarily represent physical health or cure of disease. Healing can be said to represent a personal experience, involving a reconciliation of the meaning an individual ascribes to distressing events (Egnew 2005). The following scenario, which I was exposed to, helped me understand how a physician can heal by being a comforting and empathic presence.

It was just after 5:00 p.m. and I was driving on an ill-kept country road. I had spent the day working in the family medicine clinic of this rural town. My supervisor had invited me to join him for a home visit of one of his patients and that was where I was headed. We were warmly greeted by an elderly man and his daughter. The man, who was the patient, had a large bandage around his right leg and had some difficulty walking. As we sat in the kitchen, I became aware of an odor, which

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I had smelled once before during my general surgery rotation. It was fainter than the last time I had smelled it; nonetheless, this was the odor of necrotic tissue. I listened to the interaction between patient, physician and family member. The elderly man was a widower and had two daughters. He had been living alone, with the help of his daughters, as well as with help from the Centre de santé et de services sociaux (CSSS) for wound care. He had a stage four lymphoma. He pointed to a subcutaneous mass, which was the size of a golf ball on his left forearm and gestured to the bandage on his right leg. I knew what to expect, but I still felt slightly queasy after seeing the black wet necrotic tissue beneath the bandage. The patient wanted to spend as many of his last days at home as he could. The questions, which he and his daughter asked, at first, were related to his analgesic medication. Afterwards, the patient and my supervisor began to talk amicably. The patient told a number of stories about his past. As a conclusion to most of his stories, he would say, phrased slightly differently every time: “You see, doctor, how I have lived a full and happy life, and am lucky to be surrounded by a loving family.” My supervisor listened respectfully and answered that he was in agreement with the patient. After a little more than an hour, we said our goodbyes, my supervisor having said that he would check in on the patient in one week and that he could be reached by phone if needed. This was a marking experience for several reasons. This was a patient who was suffering physically from a painful necrotic leg mass. Moreover, he was suffering mentally, losing a part of his body to his illness, this constant unsightly and malodorous reminder of

his impending death. The relief of suffering depends on knowledge about patients as persons (Cassell 1999). My supervisor took the time to listen to the patient and both he and I understood that, behind the patient’s calm exterior, there was a fellow human being who was frightened of death. His statements of: “You see, doctor, how I have lived a full and happy life”, were not phrased as questions, but, in fact, they were. His doctor, whom he trusted and respected, agreed that he had lived a full life, and this helped the patient move forward in his journey towards acceptance of his illness. I was impressed with how comforted the patient was by the interaction described, with how much a physician can contribute to a patient’s well-being by treating the person and not simply the disease. Also contributing to the patient’s well-being was the fact that he could rely on his physician to visit him and offer him pain control.

Vanessa Martelli 3rd year medical student

McGill University

In conclusion, healing can be defined as a reconciliation of the meaning an individual ascribes to distressing events (Egnew 2005). By taking the time to get to know his patient as a person, my supervisor was able to help him accept his terminal illness. _______________________________ "I certify that this written submission represents my own original work and that, in instances where I have not used my own words, I have acknowledged the source(s). I am aware of University regulations, including penalties for plagiarism - as defined under article 15 of the "Code" in the McGill Handbook of Student Rights and Responsibilities."

References Cassell EJ. Diagnosing Suffering: A Perspective. Ann Intern Med. 1999 Oct 5;131 (7):531-534. Egnew TR. The Meaning of Healing: Transcending Suffering. Ann Fam Med. 2005 May/June; 3(3):255-262.

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Mon petit patient, mes premières larmes À vous qui nous rejoindrez bientôt dans cet univers fabuleux qu’est l’hôpital, J’aimerais vous donner l’exemple d’une expérience que j’ai vécue il y a quelques mois. J’espère que cette dernière saura vous ouvrir les yeux sur l’importance de voir au-delà de la maladie.

Soumia Senouci Étudiante de 3ieme année,

Université McGill

Plusieurs mois d’ICM m’ont permis de me familiariser avec l’univers hospitalier. Aux premiers abords, mon rôle semblait se limiter à répondre aux questions des médecins rapidement et avoir une technique d’examen physique parfaite. Après quelques semaines durant lesquelles j’ai eu l’occasion de discuter avec des patients, j’ai compris qu’il y avait beaucoup plus au rôle d’étudiant. C’est ainsi, qu’après six mois de stages j’ai commencé à être plus attentive aux patients. Pleine d’énergie j’ai commencé, en août, mon premier mois à l’Hôpital pour Enfants de Montréal. Les premiers jours furent difficiles. C’était un nouveau milieu et j’avais soudainement plus de responsabilités et moins de temps pour discuter avec mes patients. Après deux semaines je me suis adaptée, j’avais le sentiment de comprendre pourquoi mes patients étaient hospitalisés et d’avoir établi un lien de confiance avec eux. Lors du lundi de ma dernière semaine sur l’étage pédiatrique, on m’avertit que je devais m’occuper d’un patient transféré des soins intensifs. Cet enfant dont l’histoire avait fait les journaux durant l’été allait devenir mon nouveau patient. Puisque j’avais passé l’été à l’étranger, je n’avais aucune idée que ce petit patient s’était presque noyé quelques semaines plus tôt, ni que le sauveteur avait souffert de choc post-traumatique, ni que ses parents dormaient à peine la nuit, ni qu’il n’était au pays que depuis quelques temps, ni que sa mère était enceinte, ni qu’il aimait le foot et la télé comme les

enfants de son âge. Je ne connaissais rien de cette histoire qui me rend triste encore aujourd’hui. Mon premier contact fut lorsque mon superviseur m’introduit à la famille de mon patient. Dans une jolie chambre des soins intensifs était couché un petit enfant qui semblait déconnecté de la réalité. Dix minutes sous l’eau ont suffit à enlever ce petit à ses parents. Le médecin m’introduit comme le jeune docteur qui prendrait maintenant soin d’eux. À ce moment là, je n’étais pas certaine du niveau de conscience de mon petit patient. Donc je lui dis bonjour aussi. C’est donc avec le «cœur gros» que je quittai l’hôpital ce soir là après avoir lu le dossier immense de mon nouveau patient qui était apparemment dans un état «végétatif». Je savais que je devrais durant la prochaine semaine aller voir ses parents qui avaient autrefois un petit garçon parfaitement en santé. J’avais l’impression de ne pas avoir les outils nécessaires pour rassurer cette famille qui vivait quelque chose de si horrible! J’avais peur de me retrouver seule à jouer le rôle de messager entre l’équipe traitante et la famille. Je fus donc agréablement surprise le lendemain de découvrir que mon superviseur aussi était sensible à cette histoire. En effet, il venait tous les matins avec moi dire bonjour au petit patient. Nous avons tous les deux parlé à l’infirmière-chef à plusieurs reprises pour qu’une exception soit faite et que les parents puissent avoir droit à un lit supplémentaire pour dormir auprès de leur fils. C’est ensuite pour des coupons de cafétéria pour les parents que nous avons dû faire des démarches. Puis, il fut question de les aider à écrire au gouvernement pour que les grandsparents de mon petit patient puissent venir au Canada et ainsi les supporter durant cette épreuve.

IFMSA-Québec | www.ifmsa.qc.ca Après quelques jours, nous avions déjà bâtis une relation médecin-patient différente des autres. Sur papiers, les soins que l’on offrait étaient surtout de support, nous essayons de garder mon petit patient le plus confortable possible. Toutefois, je sentais que l’on faisait plus en tentant d’inclure la famille dans le plan de traitement. Je passais une partie de mes journées à répondre aux questions des parents et une autre à celles des spécialistes impliqués. Ce qui m’a impressionnée dans cette histoire c’est le dévouement de mon superviseur. Dès que l’on mettait le pied dans cette chambre, on dirait que le temps s’arrêtait et que peu importe les autres obligations qu’il avait, son attention était dédiée à mon petit patient. Il était là pour écouter ses parents, pour les encourager à restée positifs. Il n’était pas là que pour leur dire ce qu’il en était côté médical. Je sentais qu’il voyait au-delà de la maladie, qu’il voulait soulager ses parents de leur souffrance du mieux qu’il pouvait. Le médecin m’a confié lors de mon dernier jour qu’un membre de sa famille avait également perdu un enfant en bas-âge. J’ai compris que lui aussi était particulièrement sensible à la douleur des parents. Il m’a encouragée à ne pas garder pour moi la tristesse que je vivais à chaque fois que je quittais la chambre de mon petit patient. Il m’a dit de me confier à des amis ou de la famille, car d’autres histoires tragiques me marqueront durant mes stages et qu’il faut en parler alléger la douleur. Après une semaine, nous avons dû dire au revoir à cette famille à laquelle je pensais toute la journée. Le médecin me laissa faire mes adieux durant lesquels j’ai pu pratiquer mon accent espagnol et essuyer mes larmes. Deux mois plus tard, alors que je faisais mon stage d’obstétrique, figurait un nom sur la liste de patientes

dont l’accouchement était imminent qui me frappa. Mon petit patient dont je n’avais plus de nouvelles depuis trop longtemps, allait bientôt avoir un petit-frère. C’est ainsi qu’après plusieurs mois je renouais avec une petite famille qui s’agrandissait ce jour là. C’est avec un grand plaisir que le papa m’informa de la grande amélioration de mon petit patient qui maintenant souriait, mangeait et reconnaissait ses parents. Il me remercia de l’espoir que mon superviseur et moi leur avions donné et qui leur a permis d’avancer. Je partage cette expérience, car j’aimerais que vous gardiez les yeux et le cœur ouverts pour ainsi ne jamais rater une occasion d’en faire plus pour vos patients, d’être plus qu’un médecin, d’être un allié, d’être leur avocat et peut-être même leur ami. Soyez sensibles à la souffrance des patients et non uniquement au diagnostique qui leur a été étiqueté. Voyez au-delà de la science. Vos patients auront souvent peur et ne soyez pas étonnés d’être la seule personne près d’eux à ce moment là. Si vous sentez que vous pouvez en faire plus, donnez plus sans hésiter et vous verrez que vous pouvez faire la différence. Nous avons la chance d’étudier dans un domaine où la confiance que nous accorde la société nous permet de changer des vies à l’aide de petits gestes. Vous trouverez une personne dans le corps médical pour vous épauler. Je vous souhaite de vivre des expériences comme celleci qui vous marqueront à jamais et vous rendront plus humains et vous ferons réaliser que nous sommes tous vulnérables. Bon succès dans cette fabuleuse aventure qu’est la médecine. Lorsque vous verrez un patient, n’oubliez pas ce pourquoi vous rêviez de devenir médecin peu importe l’heure qu’il est ou le nombre d’heures de sommeil à rattraper!

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The reciprocity of caring “So Doc, what news do you have for me today? I have a feeling my counts are going to be better.” Mr. Jones was sitting up in his hospital gurney, gowned, shaved and eagerly awaiting the results of his daily CBC. By his amicability and optimism, you would think he was on a sailing vacation in the Caribbean, without a care in the world.

Mali Worme 3rd year medical student

McGill University

Mr. Jones was actually in for his third Chronic Lymphocytic Leukemia hospitalization in two years and was suffering from one of the complications of this disease; autoimmune hemolytic anemia. His hemoglobin was wavering around 70 when I met him but somehow, that did not prevent him from being the avid conversationalist, the pleasant patient, the committed husband, the generous human being, the exercise fanatic or the focused entrepreneur that he was. We often talk about the physician’s role and responsibility in educating patients (1), yet this encounter was humbling in that it illustrated for me, just how much a “physician” can learn from their patients about the healer role. This 65-year-old gentleman educated me, not through text or lecture, but rather through his unwavering optimism, his thirst for knowledge and his utmost respect for his neighbour. Thinking back on my time as part of his treating team, I remember considering, “What an incredible attitude towards life and healing this man has.” The enthusiasm and hope that stemmed from him belonged to the kind of story I had only ever read in books before. It is known that optimism has been linked to better emotional well-being, more effective coping strategies and even to better outcomes in several areas of health (2). Yet, what I did not know is how contagious this attitude could be. I remember leaving the hospital that week

feeling more inspired, and appreciative of the time I had spent with this notable gentleman. “My hemoglobin is going to be up today, I can tell. I just finished my morning laps around the ward (much to his wife’s chagrin) and don’t feel as pooped as I did yesterday.” Sure enough, his hemoglobin had started to rise, slowly, but a rise nonetheless. On reviewing his oncological history with him, he seemed to have overcome similar obstacles, one after another, all the while continuing to live his life with vigor and purpose. It was a new experience for me, having a patient request each one of their CBC results so that he could add them to his immaculate chart, documenting the most important clinical data and thus tracking his recovery. As a former engineer, Mr. Jones had a knack for organization and detail. As such, every morning I would print him a copy of his lab results and we would sit to discuss them as he transcribed. He would “stump me” with his sophisticated questions at times and I would have to return later in the day, having revisited, for instance, the white blood cell production line in detail. Through this thirst for knowledge he gained a greater understanding and with that understanding, he was in greater control of his healing process. I was merely a mediator in that process but I was pleased to be a part of it. It has been argued that the manner in which a physician communicates information to a patient is as important as the information being communicated. Patients who understand their doctor are more likely to acknowledge their health issues and follow through with their treatment plans (3). Though career advancement will bring with it greater time restriction, I aim to maintain this high standard of communication with my patients in years to come.

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10 Y ans ear s !

One day I was looking for a newspaper to entertain another patient; one who was less fortunate than Mr. Jones in terms of visitor frequency. Seeing as Mrs. Jones would visit each morning and bring him the Globe and Mail, he not only offered it to me that day but also everyday for the rest of his hospitalization. If I did not come to collect it one morning, he would remind me through his offering at my next visit. Though this gesture was small, it was so appreciated by his fellow patient. This magnitude of regard for others was a part of his character; a part that I admire and try to emulate in my role as healer. We sat down one day near to the end of his weeklong hospitalization as he questioned me on my future aspirations. At the end of our conversation, he said something that I will always remember fondly. “We are going to miss you when we leave. You have made this visit both more tolerable and enjoyable. One day you will make a wonderful physician, I am sure of it.” To think that my role as a third year medical student had affected this gentleman that I looked upto, in such a meaningful way was sobering.

IFMSA-Québec fête son 10e anniversaire !

It is these moments that I look forward to during my career in medicine, the moments where as a physician, you can connect with your patient on a level so much higher than provider and receiver, a level of mutual respect and progression, in both the physiological and the psychological realm. References 1) Wechsler H, Levine S, Idelson R, Rohman M, Taylor O. The Physician's Role in Health Promotion — A Survey of Primary-Care Practitioners, N Eng J of Med. 1983; 308:97-100 2) Carver C, Scheier M, Segerstrom S. Optimism. Clinical Psychology Review. 2010; 30 (7):879-889 3) Travaline J, Ruchinskas R, D’Alonzo G. Patient-Physician Communication: Why and How, J of Amer Osteop Assoc. 2005; 105 (1):13-18

Faites-nous parvenir vos anecdotes sur IFMSA-Québec à info@ifmsa.qc.ca !

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Nouvelles d’IFMSA-Québec Il nous fait plaisir de vous présenter l'équipe nationale d'IFMSA-Québec 2013-2014. Ces officiers entreront en poste dès le 1e juillet prochain.

Équipe nationale Santé publique : Alissar Jaber Santé sexuelle : Camille Marcoux Santé mondiale : Anne Paquette-Tremblay Droits humains et paix : Camille Pelletier-Vernooy Échanges cliniques : Mathieu Hains et Peter Maliha Échanges de recherche : Élyse Perron et Jouhayna Bentaleb Immersions : poste vacant

Équipe support

Conseil exécutif Présidente : Claudel P-Desrosiers VP Affaires internes : David Alexandre Galiano VP Affaires externes : Laurent Darveau VP Finances : Camille Pelletier-Vernooy Secrétaire générale : Joelle Bouchard

Coordonnateurs de campus Université de Montréal : Tanya Girard Campus Mauricie : Chérine Zaim Université de Sherbrooke : Stéphanie Lanthier-L. Campus Saguenay : poste vacant Université McGill : Susan M. Ge Université Laval : poste vacant

Programme social des échanges : Tarik Hadbi Division des anciens : Geneviève Bois Webmestre : Kenjey Chan Bulletin de Santé Mondiale : Antoine Désilets Colloque de santé mondiale 2014 : Fannie L. Trempe Nutrition : Gouraya Ait Zaid Osmose : Laurence Veilleux Sexperts : Estelle Leblanc-Malette Fiers et en Forme : poste vacant INcommunity : nomination en septembre 2013

Si vous êtes intéressés par l’un de postes vacants, contactez-nous à info@ifmsa.qc.ca.

Le Congrès s'est terminé après deux belles journées à Sherbrooke, remplies d'idées, d'innovation, de passion et d'engagement. Merci à tous les membres qui se sont joints à nous pour la fin de semaine! Un grand merci au comité organisateur du Congrès national de Printemps 2013 pour votre travail impeccable et votre énergie à tout casser : Florence Couturier, Nina Nguyen, Anne Paquette-Tremblay, Mathieu Hains, Stéphanie Lanthier-Labonté, Élyse Perron, Chloé Sainte-Marie-Lestage, Laurence Jobidon, Jacinthe Blouin, Geneviève Riendeau-Beaulac et Camille Latreille. Un merci spécial à Dr. Claude Cyr, pour sa presence parmi nous et son témoignage vivant de l'implication communautaire.

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Prise de positions sur la maladies non transmissibles IFMSA-Québec, de par son mandat d’améliorer la santé d’ici et d’ailleurs, lance un appel en faveur : 1) Du soutien des initiatives visant une réduction des principaux facteurs de risque, par exemple: a) Des mesures fiscales et législatives prouvées efficaces par la convention cadre de l’OMS pour la lutte anti-tabac; b) Des mesures fiscales et une sensibilisation accrue pour la réduction de la consommation nocive d’alcool;; c) Des mesures pour favoriser l’accès à des aliments sains, pour instaurer des environnements alimentaires sains dans nos institutions et pour réduire l’accès à certains produits nocifs;; d) Des mesures pour promouvoir des environnements urbains favorisant l’activité physique et les transports actifs; 2) De la nécessité d’une approche multisectorielle dans l’implantation des mesures de réduction des facteurs de risques des MNT; 3) De l’intégration de stratégies visant à réduire les inégalités sociales de santé dans les efforts de contrôle des MNT; 4) De la reconnaissance et de la promotion de l’engagement des étudiants en médecine dans le mouvement national et international de la lutte contre les MNT. Adoptée le 20 avril 2013, Québec.

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L’année en images Délégation d’IFMSA-Québec à l’assemblée générale d’IFMSA. Mars 2013, Baltimore (USA)

Délégation d’IFMSA-Québec à la rencontre régionale des Amériques. Janvier 2013, Salvador.

Formation Fiers et en Forme, Octobre 2013

Le SCOGH souligne la journée mondiale de lutte contre la tuberculose Université de Sherbrooke, 25 mars 2013.

Souvenirs du Congrès d’automne 2013 (Montréal)

IFMSA-Québec | www.ifmsa.qc.ca

Délégation d’IFMSA-Québec, à l’assemblée générale d’IFMSA. Août 2012, Mumbia (Inde) Training New Trainers Février 2013, Saguenay

Merci au comité organisateur du CSM 2013, sous la direction de Tanya Girard pour la belle fin de semaine

Fête de Noël, Québec

Duke Von York

Merci à tous les membres, coordonnateurs, et officiers pour une très belle année, marquée par une présence augmentée d’IFMSA-Québec sur les campus de la province, par un effort de renforcement de la mémoire institutionnelle, et par un enthousiasme contagieux et une énergie éternelle des équipes locales. Passez un bel été & On se revoit en août !

Bulletin de Santé Mondiale - Global Health Newsletter

Negotiating for better global health “Not just training for the future, but participating in the present” were the words of Dr Wilson, President of the World Medical Association, at the Closing Ceremony of the recent Pre- World Health Assembly (WHA) youth workshop, organised by the IFMSA. In many ways, his words reflected exactly what we were doing in this three-day workshop, which involved over 30 young people interested in health advocacy. With students from all over the world gathered in Geneva, covering disciplines such as medicine, pharmacy, dentistry, law, and public health, we had come together to prepare for the upcoming WHA. The workshop involved a combination of keynote addresses, expert panels on five important WHA agenda topics, and small working groups on these issues for advocacy preparation. These five topics were non-communicable diseases (NCDs), human resources for health (HRH), maternal and child health (MCH) and sexual and reproductive health (SRH), the post-2015 agenda, and research and development (R&D). Throughout the three days, we split into groups to prepare focus points and briefing papers on these issues, which we would use throughout the WHA to discuss with member states, and interventions, which we would submit for presentation to the Plenary. But first, we had a range of excellent introductory lectures. The opening address was given by the wonderful Dr Sigrun Møgedal, who spoke about the importance of youth involvement in global health. She inspired us all by promoting the key differences youth can have in this field, most particularly, by being able to take risks, be strong, and demand change. We talked about the difficulties in defining global health, but ultimately the one that resonated with me the most was simple: “global health means…we’re all in this together!” This was followed by a lecture on global health diplomacy, given by Professor Ilona Kickbusch of the Graduate Institute of International and Development Studies. She gave an excellent overview of the current global health agenda, and the need for global governance for health. An introduction to the World Health Organisation (WHO) was provided by Dr Mihály Kökény, former Chairman of the Executive Board, and Dr Andrew Cassels, current Director of Strategy. Dr Cassels spoke about WHO reform and highlighted the

fact that one of the WHO’s key roles in creating normative standards and public goods is often not recognised, resulting in criticisms of the organisation as a whole. Dr Kökény shared the lessons he learnt while at the WHO, including the importance of preparing for all scenarios, consulting with experts on topics, and discovering the vested interests of those you are working with. Workshop days two and three were made up of panel sessions for each of our focus areas. An attempt at brevity prevents me from going into detail about the speakers and issues discussed in each, but we were fortunate to have interesting and experienced panellists who were able to provide new perspectives on each topic. A highlight was to hear from Dr Lola Dare, of CHESTRAD, who spoke about the need for reform in medical education, and emphasised the need for social accountability as a component of training for all health workers. Similarly, Carlos Dora, of the WHO Department of Public Health and Environment, spoke about the importance of health in the post-2015 agenda – as he pointed out, “health is central to development; as a precondition, beneficiary, and indicator.” Perhaps the most useful session of the workshop however was an advocacy simulation exercise, coordinated by representatives from the Graduate Institute, World Vision and Save the Children. This forced us to play various roles in the WHA process – member states, nongovernmental organisations, and the WHO Secretariat – in order to understand how the lobbying process works at the assembly and think more critically about our role as an NGO agitating for change within the system. So, after three long days, we concluded the pre-WHA workshop with a greater understanding of the issues on the agenda, a renewed focus on interdisciplinary collaboration in health, and concrete goals for our advocacy throughout the assembly itself. The inaugural pre-WHA workshop was most definitely a success, and will no doubt see an improved recognition of the role for informed and coordinated youth involvement in global health. Freya Langham

Australia Medical Students’ Association International Federation of Medical Students’ Associations Follow the World Health Assembly on twitter : #WHA66

IFMSA-Québec | www.ifmsa.qc.ca

Retour à la réalité : souvenirs du March Meeting Entrée publiée le 30 mars 2013 20 jours après le MM et on dirait que c’était hier.. Première fois que j’assiste à un GA, une expérience qui m’aura été profitable à plusieurs niveaux: des trainings, des meetings sessions, des socials events, des plénières etc bref, une semaine beaucoup trop courte… Dès que j’ai mis les pieds au Sheraton, j’ai su que je faisais partie d’une grande famille. On commence par une cérémonie d’ouverture des plus inspirantes; des conférences données par des médecins mais avant tout des militants pour une justice sociale et une santé mondiale, des personnalités d’influence dans le monde de la médecine et de la santé publique. Parmi eux, un anciens d’IFMSA, médecin canadien qui a su garder le “magic” de cette fédération, cette même fédération qui lui a appris à guider ses actions par ses propres principes et idéaux. En tant que LORE, j’ai assisté aux réunions de SCORE durant lesquelles plusieurs sujets ont été abordés: database, lobby des compagnies pharmaceutiques, amélioration des stages offerts etc. J’ai aussi eu la chance de rencontrer la SCORE-D avec laquelle j’ai longuement parlé des possibilités d’améliorer les stages de recherche. Après avoir partagé quelques idées, nous sommes en train de mettre en place des projets pilotes. Les stages de recherche et cliniques constituent un aspect important du volet “international” d’IFMSA en plus d’être le programme d’échange le plus important au niveau international. Ces stages sont très formateurs d’autant plus qu’ils permettent d’avoir du recul face à notre système de santé sans parler de l’expérience culturelle! Durant le AF market, j’ai pu parler à plusieurs NORE pour “faire connaître le Québec” et garder une bonne

relation avec eux, c’est certainement ce que j’ai le plus apprécié du AF! Il est toujours intéressant d’avoir une double nationalité lors de ces événements, une québécoise qui parle arabe ca nourrit les relations avec les pays du moyen orient et ceux du Maghreb! Le plus impressionnant des GA est le rassemblement de centaines d’étudiants en médecine venant de partout à travers le monde. Une expérience des plus uniques! Allant de la dégustations du thé à la menthe du Maroc, aux délicieuses sucreries du Kurdistan, passant par le Portugal et sa production de livre en liège, le Brésil et sa dance traditionelle, l’Egypte et ses papyrus offerts en guise de souvenir, la Corée et ses gadgets à n’en plus finir, la Palestine et ses bracelets, bref un amas de pays dans une salle à Batlimore, il n’y a rien de mieux! Un partage d’idée, de motivation, de projet et de culture, un GA inoubliable et une expérience qui forge une personnalité! Jouhayna Bentaleb Déléguée SCORE au March Meeting 2013 Going to a GA is an experience you are likely to remember all of your life : the instant and lasting friendships, the endless working sessions either too early in the morning or too late at night, the crazy moments late at night when you don’t really understand what is going on but you are just happy to be surrounded by international friends, the never-ending laughs that no one remember why they started, the wierd energizers, those magic moments that only happen once. I remember one afternoon when we blasted the music in the plenary room and started dancing: we were unstoppable! And we are not talking about the nights when the plenary went wild and collectively moved on the beats of “Ai se eu te Pego”, “Open Gangnam Style” and the classic “Call me Maybe”. Or this famous roll call where every NMO president confirmed their presence in their own langage. Times like these make you realise how lucky you are to be able to sit with people from 100+ different countries, to be a part of a Federation that embraces diversity and respects your values and ideas, that takes you as you are, regardless of your backgrounds. Claudel P-Desrosiers President of IFMSA-Québec

Bulletin de Santé Mondiale - Global Health Newsletter

Équipe éditoriale / Editorial Team Laura Patakfalvi Claudel P-Desrosiers

Nos partenaires / Our partners

Auteurs / Authors Laura Patakfalvi Claudel P-Desrosiers Christian Kraef Omid Zahedi Niaki Debra-Meghan Sanft Vanessa Martelli Soumia Senouci Mali Worme Freya Langham Jouhayna Bentaleb

Photo de couverture / Frontpage picture : Coongrès de printemps 2013 Équipe entrante et équipe sortante, en session de transfert des connaissances, sous le soleil de Sherbrooke. 5 mai 2013.

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