Americas Heartbeat 2018

The Americas Heartbeat 1

www.ifmsa.org |

The Americas Heartbeat 2

IFMSA The

Imprint Regional Director Fabrizzio Canaval - Peru International Team

International

Federation

of

Medical

Students‘

Associations (IFMSA) is a non-profit, non-governmental organization

representing

associations

of

medical

students worldwide. IFMSA was founded in 1951 and

currently maintains 136 National Member Organizations

Iara Porro - Paraguay

from 127 countries across six continents, representing a

Manuel Mendive - Uruguay

network of 1.3 million medical students.

Mayara Secco - Brazil Leonardo Guimaraes - Brazil

IFMSA envisions a world in which medical students unite for

Gabriela Cipriano - Peru

global health and are equipped with the knowledge, skills

Ximena Paredes - Paraguay

and values to take on health leadership roles locally and

Juan Valderrama - Colombia Jose Espino - Panama Larry Leiva - Peru Erwin Barboza - Paraguay

Layout & Cover Design Iara Porro – Paraguay

Publisher

globally, so to shape a sustainable and healthy future.

IFMSA is recognized as a nongovernmental organization within the United Nations‘ system and the World Health Organization; and works in collaboration with the World Medical Association.

This is an IFMSA Publication

Notice

International Federation of Medical Students‘ Associations (IFMSA)

© 2018 - Only portions of this

All reasonable precautions have been

publication may be reproduced for

taken

International Secretariat: c/o

non political and non profit purposes,

information contained in this publication.

Academic Medical Center

provided mentioning the source.

However, the published material is being

Meibergdreef 15, J0-208

Disclaimer

1105AZ Amsterdam,

This publication contains the collective

The Netherlands Phone: +31 2 05668823 Email: gs@ifmsa.org Homepage: www.ifmsa.org

views

of

by

IFMSA

to

verify

the

distributed without warranty of any kind,

different

contributors,

the

opinions expressed in this publication

either

expressed

or

implied.

The

responsibility for the interpretation and use of the material herein lies with the reader.

are those of the authors and do not

Some of the photos and graphics used

necessarily

in this publication are the property of

reflect

the

position

of

their respective authors. We have taken

IFMSA.

The mention of specific companies or of certain manufacturers‘ products does not imply that they are endorsed or recommended by the IFMSA in preference to others of a similar nature that are not mentioned

every consideration not to violate their rights.

Contact Us vpprc@ifmsa.org

the

www.ifmsa.org |

The Americas Heartbeat 3

www.ifmsa.org |

The Americas Heartbeat 4

Dear Americas Family, The time in the year has come again when we share out knowledge, ideas and positions with the world. The Heartbeat is a platform created to for our members in the region to disseminate the Americas region's spirit and share with the world our activities, projects and most importantly to present the joint efforts we made in order to achieve our main goal: Think global act local.

For this year, we have selected as theme of the Heartbeat, Universal Health Coverage in the Americas region. Currently, this is a very important topic for our region, especially because a lot of our countries have not access to free health services, and in the ones that have achieved this the quality is not good enough to say we made it. This is a very important topic to talk about not just because of the coverage itself but because of all the different aspects involved on it such as accessibility to health systems and ethnicity and health. Saying it in simple words access is not just about the availability to get the service for free but also to reach the hospital/health establishment and feel respected no matter what cultural background we have.

The America‘s region is full of amazing projects related to our standing committees that are in line with all these thoughts, and it our amazing Regional Team a key point in the development of those. Once again, thank you to Manuel, Iara, Leo, Mayara, Juan Camilo, Juan Sebastian, Ximena, Jose, Gabriela, Erwin and Larry for all the effort they've made during the term and specially to make this magazine real. Thank you to all the people who took the time to send their submissions and contributions. Las but not least, thank you for reading this document that convey our soul as region.

This document was made for you, to enjoy it, feel motivates and proud of being part of our amazing Americas Region.

Sincerely,

Fabrizzio Canaval Regional Director for the Americas 2017 - 2018

www.ifmsa.org |

The Americas Heartbeat 5

National Efforts to Reach Universal Health Coverage

www.ifmsa.org |

The Americas Heartbeat 6

National Efforts to reach Universal Health Coverage: An outlook towards primary health care in Ecuador.

Germania MuĂąoz AEMPPI Ecuador

"Universal Health Coverage is to ensure that all people have access to the health services they need (preventive, promotional, and curative), of rehabilitation and palliative care with sufficient quality as to be effective and without exposing individuals to financial calamities.‖ A health system encompasses all organizations, institutions and resources whose main objective is to carry out activities aimed at improving health. Our government is supposed to be the responsible for the overall performance of Ecuadorean‘s health system, but the good governance of the regions, municipalities and each of the health institutions is also fundamental.

It is already known that all countries aspire that their citizens can enjoy the highest quality of life possible, and Ecuador is not excluded from this aspiration. Certainly, health is one of the most important aspects to achieve this goal since it is fundamental pillar not only of individual development, but also of the sustainable development of nations.

A good health system improves the daily life of people in a tangible way. Every time a mother reads an announcement about the upcoming vaccination campaign that reminds her that her child should be vaccinated against a life-threatening illness, she is getting a benefit from the health system. The majority of national health systems comprise the public, private, traditional and informal sectors.

The health conditions in Ecuador go beyond the already known characteristics of the Ecuadorean health system. It includes its structure and coverage, its funding sources, the physical, material and human resources available to it, the generation of health information, research tasks, and the participation of citizens in the operation and evaluation of the system.

Despite of being a small country we have come to agree that we have achieved a lot but we can reach those very wanted goals if each of us recognizes the necessity of changing from a curative approach, which contemplates a concept of pathologized and medicalized medicine, to a preventive vision of diseases. It is necessary to leave the concept of figures in Health and move to a comprehensive system, with public policies on prevention. This is why at some worldwide summit we have been recognized for the efforts form health administration within our ministers and all the health care community as well.

The most recent innovations that have been implemented in the Ecuadorian health system are also discussed, all of this started with someone speaking out loud after analyzing the found failures as well as the missing fields to work and focus resources on. This also included a big step that was the incorporation of a specific chapter on health into the new Constitution that recognizes the protection of health as a human right and the construction of the Comprehensive Public Health Network.

www.ifmsa.org |

The Americas Heartbeat 7 The process that was held in order to reach these huge steps towards a more complete healthcare system, occurred within this framework of a new Constitution of the Republic, which allowed the incorporation of historical social demands arising from criticism of past ways of government and political sides. But, what are the main points that marked the beginning of this change?

The axes of the reform consist of three components: on the one hand, to organize a National Health System that overcomes the previous fragmentation, which constitutes the Comprehensive Public Health Network; policies aimed at strengthening primary health care, articulating action on the determinants of health; and, finally, the increase in financing to consolidate the transformations. We conclude that in that time (2007-2008) the challenges in the reform had to do with the sustainability of the processes, financial sustainability of the system and with the greater activation of mechanisms of participation that allow the citizen oversight of services and the empowerment of citizens of their right to health. This holistic vision was crucial in order to star to set the needed and urgent tasks that were left to do as well as Ecuador has placed universal health coverage as a national set objective and, as we can see, has advanced to reach it in different degrees. Their experiences provide evidence on issues such as the levels of health spending needed to achieve universal health coverage; the best options to ensure financial protection against catastrophic diseases, and the need for a regulatory framework, governance mechanisms, and institutional capacity to ensure effective management of health systems.

The challenge involves beyond law modifications, it goes from the traveling of "targeting" policies towards universal public health policies that address the three dimensions indicated by the World Health Report 2010: the horizontal axis of the population under protection; the second horizontal axis of the amount of guaranteed rights; and the vertical axis that represents the percentage of free and of impact in the decrease of out of pocket expense.

One word that always appears very attractive when talking about UHC is ―free‖.

Here, it is important to outstand that when

you talk about gratuity, it does not mean that health "does not cost", but rather existence of ex ante financial arrangements that avoid disbursement at the time of care.

The explicit objectives of this are: 1) redistribute resources of those who enjoy good health towards those who need health services, that is why the need for "ex ante" contribution; and 2) protect individuals from incurring catastrophic expenses.

What was like before? For decades, health was not a priority for the governments. As part of the policies neoliberals that weakened the State, the health coverage was very poor fostering many health inequities that affected the majority of the population. (2006) (an approximate budget of 455 million USD) After the changes framework (2007):

in

the

normative

Health has become a high priority of the government, assuming the challenge of recovering the health system. This is reflected in the increase in the health budget by more than 300% (2012 budget 1.9 million USD) Our national health policy is mainly directed to the following: Strengthening institutionally and rectory, access and quality, citizen participation. Here are some examples of the topics that are developed under this framework and taken into consideration for reaching the set goals:       

Equipment, improvement and new constructions of healthcare units Improves talent conditions human Gap closure Operation of the National Sanitary Authority Strengthening of regulation and control Articulated policies: territorial planning, standardization New institutionality: Rescue and recovery of the dignity of the public health network

Of course, these activities put into efforts, are always making sure that the population is provided with effective access for all with the following conditions:  

To the same benefits In the same conditions

www.ifmsa.org |

The Americas Heartbeat 8  

Regardless of institutional adscription Economic recognition for the provider

The planning of health facilities is summarized in: Implementation based on the prioritization of territorial planning, specialization of health facilities in the network in order to complement each other, and the development and promotion of a system based on Primary Health Care.

Other achieved strategies had to do with the Initiatives to ensure healthcare quality.

The more outstanding among them are: licensing of service establishments of health, preparation for the accreditation of 44 hospitals of the MSP under the Canadian health model, supervision of the Quality of Health Care, continuous Quality Improvement, and a user satisfaction survey of the health services (outpatient framework).

In conclusion, what our national efforts have done so far regarding the Ecuadorian healthcare system toward UHC is to see and promote health as a right, not as a product of the market nor as a charity for the poor unable. Not just an ethical issue but a practical one, what has been proved

is that health market laws do not work and that the profit motive is not compatible with the exercise of the so tangible right to health. So now, we can say that our greatest wish is that never again should the right to health be taken as a privilege of a few, we will always seek to improve and look for the alternative that best suits the situation.

References: 1. The world health report – health systems financing: the path to universal coverage.

Geneva: World Health Organization.

2. A new global partnership: eradicate poverty and transform economies through sustainable development. Report of the High-level Panel of Eminent Persons on the Post-2015 Development Agenda. New York: United Nations; 2013 (http://www.post2015hlp.org/wpcontent/uploads/2013/05/UN-Report.pdf) 3. Malo, M. Reforma del Sistema de Salud del Ecuador: hacia la cobertura universal [Internet].MSP: 2014 4. Secretaría Nacional de Planificación y Desarrollo.

Secretaria Nacional de Planificación y Desarrollo [Internet]. Quito: SENPLADES; 2014

www.ifmsa.org |

The Americas Heartbeat 9

Universal Health Coverage (UHC) in Jamaica

Nikolai Nunes JAMSA Jamaica

The history of Universal Health Coverage (UHC) is rooted in the WHO Constitution of 1948 which declared health a fundamental human right. This principle was upheld by the Health for All agenda set by the AlmaAta declaration of 1978. Elements of this principle were incorporated into the United Nation‘s Millennium Development Goals (MDGs) and expanded upon in the Sustainable Development Goals (SDGs) that we have transitioned to for 2030. In 2012, when a UN resolution endorsing UHC was passed, former WHO Director General Dr. Margaret Chan announced that ‗UHC is the single most powerful concept that public health has to offer‘, while current Director General Dr. Tedros Adhanom Ghebreyesus in his 2017 inaugural address to WHO staff declared UHC to be one of his priorities.

In its simplest form UHC means every global citizen having access to affordable quality health services. UHC encompasses all components of the health system: health service delivery, health workforce, health facilities, health technologies, communications networks and information systems, quality assurance mechanisms, and governance and legislation. The path towards UHC is also the path towards equity, development, social inclusion and cohesion. Perhaps most importantly, UHC prioritizes the poorest and most vulnerable; those who are disproportionately affected, to close the widening gaps of health inequity. This is important because 1 billion people lack access to basic health care and another 100 million fall into poverty trying to access it, due to high out-of-pocket spending. Central to achieving UHC is a financing structure that shares resources to spread the financial risks of ill-health across the population.

Since 2013, the World Bank‘s Universal Health Coverage (UNICO) Studies Series and technical papers document country case studies analyzing and assisting progress towards UHC in 40 countries with a combined population of 2.6 billion people.

To date, 39 case studies have been published, including from the Englishspeaking Caribbean: Jamaica.

Jamaica is the largest English-speaking nation in the Caribbean Community (CARICOM), and a member of the Pan American Health Organization (PAHO). The University of the West Indies (UWI) is the region‘s premier university and medical school and is headquartered in Jamaica.

Along with the other UWI campus countries, Trinidad and Barbados, Jamaica has been an exemplar in primary health care and community health for the region and boasts some of the highest childhood vaccination rates globally.

However, Jamaica‘s health system is now challenged by the epidemiological transition, reemerging infectious diseases, an increasing burden in noncommunicable diseases (NCDs), and injuries due to accidental trauma and violence.

Concomitantly, the 2008-2009 global economic crisis has acutely exacerbated an economy that has experienced constant challenges since the 1970s leading to substantial foreign borrowing and debt burden. Despite these challenges, over the last two decades Jamaica has ambitiously taken noteworthy steps to achieve UHC and in recent years has recommitted to the goal of UHC. Jamaica‘s health system includes both the public and private health sectors where the public sector is the primary provider of

www.ifmsa.org |

The Americas Heartbeat 10 public health and hospital services, with the private sector dominating ambulatory and pharmaceutical services. The public sector is comprised of the Ministry of Health (MOH) and its four Regional Health Authorities (RHAs) with the Ministry responsible for policy, planning, regulating and purchasing and the RHAs responsible for health service delivery.

Total health expenditure, as a percentage of GDP has varied between 4-6% in the last decade. Public sector spending accounted for 46% of total health expenditure, private health insurance 16%, out-of-pocket payments 36%, and international donors and NGOs 2%. The cost of care has been rising due to an aging population, technological advances, and increasing demand for health care while at the population level it has become increasingly difficult to afford health care because of economic recession, high unemployment and global health care costs escalation.

Two policy decisions in the 21st century define Jamaica‘s most recent efforts towards achieving UHC for its population: the establishment of the National Health Fund (NHF) in 2003, and the abolition of user fees at public health facilities with all Jamaicans having access to health care free of charge at the point of service delivery in 2008.

The National Health Fund is the evolution and product of decades of developmental effort into a national health insurance system; the National Health Insurance Plan (NHIP). In 1997, the NHIP proposal identified key features such as universal coverage (‗Health Security for All‘) and a benefit package covering prescription drugs, diagnostic services, and inpatient hospital care. The National Health Fund Act (2003) empowered the mission, goals, principles of the NHF, adopted from the NHIP. The NHF utilizes both Institutional and Individual Benefits as a mechanism of health financing with revenue accrued from taxation.

Institutional Benefits are grants to two subfunds- Health Promotion which finances disease prevention, accounts for 10% of revenue and Health Support, which assists financing infrastructure development with respect to construction and equipment accounts for 15% of revenue. However,

most of revenue expenditure involves the Individual Benefits, employed to combat the increasing prevalence and incidence of NCDs, now the leading cause of morbidity and mortality in Jamaica.

The increasing burden of NCDs, combined with the recent macroeconomic recession, challenged the Jamaican population financially, especially in terms of the cost of drugs needed for the treatment and control of these diseases. Over half of the total health expenditure has been consumed by private health services, and 83% of this was out-of-pocket, mainly for pharmaceuticals.

Thus, NHF Individual Benefits include prescribed pharmaceutical subsidies for patients with specific chronic diseases There are two programs of the Individual Benefits that all Jamaicans are eligible for, the Jamaica Drug for the Elderly Program (JADEP) for those over 60 years old and/or the NHF Card Program for those under 60.

These drug subsidy programs cover 15 chronic illnesses including heart disease, diabetes, asthma, cancer, and glaucoma.

The subsidy is set at a fixed value (80%) based in reference to the lowest available price of the active pharmaceutical agent.

Current subsidies range between 47-75% retail drug price. Unfortunately, this means that NHF copayments are relatively high ranging between 25-53%.

User fees comprised 10.2% of RHA revenue in 2006/7 and were considered a ‗major impediment‘ for poor people in accessing health care. The abolition of user fees at public health facilities had a significant effect, increasing both access to and utilization of health care on average by 5% each year from 2007-2009.

The result of these two landmark policies are decidedly mixed. The NHF achieved its primary goal of reducing NCD drug prices for the Jamaican population thus increasing affordability and access despite high copayments. However, the distribution of the benefits are disproportionate across socioeconomic groups, with focus on the elderly and NCDs, and not specifically the poor and vulnerable who need the subsidy most. Those of higher socioeconomic status (SES) benefit more than those from lower SES, and it is the former who are more likely to join NHF and JADEP. Therefore, there is increased inequity in

www.ifmsa.org |

The Americas Heartbeat 11 access to health care. Paradoxically, the gap has also been widened between those who are better-off in society and the poor, with the former accessing more private health care than prior to the abolition of user fees. The increased use of the public health services has increased the burden on a system already understaffed and suffering from poor infrastructure and equipment. Thus, even those of lower SES are accessing private health care at higher levels prior to the abolition of user fees, at tremendous out-of-pocket costs further spiraling the cycle of eroding personal financial security. Indeed, these outcomes are not unique to Jamaica.

The commitment of Jamaica to UHC is admirable, but it is clear that in the near future there will need to be restructuring and reformation of the health system in terms of health financing if these initiatives are to be sustainable and developed even further. This in no way diminishes Jamaica‘s efforts and strides in accomplishing significant progression in the quest for UHC. Jamaica‘s UHC ambition in the face of its continued macroeconomic challenges should make it an exemplar among small island developing states

(SIDS) and its accomplishments thus far place the nation in a positive trajectory for the future.

References: 1) Universal Health Coverage (UHC) 31 December 2017 Available at: http://www.who.int/en/newsroom/fact-sheets/detail/universal-healthcoverage-(uhc) 2) The Global Push for Universal Health Coverage Available at: http://www.who.int/health_financing/Global PushforUHC_final_11Jul14-1.pdf 3) Universal Health Coverage Study Series (UNICO) Available at: http://www.worldbank.org/en/topic/health/pu blication/universal-health-coverage-studyseries 4) UNICO Studies Series 6, Jamaica‘s Effort in Improving Universal Access within Fiscal Constraints Available at: http://documents.worldbank.org/curated/en/ 408381468044133381/Jamaicas-effort-inimproving-universal-access-within-fiscalconstraints

www.ifmsa.org |

The Americas Heartbeat 12

National Effort to Reach Universal Health Coverage: Honduras

Luis Fernando Hawith Garcia IFMSA Honduras

Since the seventies, Honduras has made an effort to provide universal health coverage by implementing numerous health plans. These health plans are all based on different International agreements. These efforts have come from different parts of the society including the government, the Honduran Social Security Institute, the Honduran Medical College, Honduran medical students, and more meaningfully, from the concerned citizens of Honduras.

attained in 2004 by the Honduran government, but there were many issues regarding the distribution of these resources in the Honduran territory.

Nongovernmental organizations, as many city halls solved the problem by getting contracts from the government to create and supply different health centers.

Between 2002 and 2006 the efforts were conducted and managed to increase quality in the health system by enhancing hospitals infrastructure and equipment.

At the beginning of the 90‘s, Honduras established that health plans had to be built around equality, efficiency, effectiveness and social participation. "Access to health services" was a program established by the Honduras government in 1994 with the aspiration to increase the health personnel and involving the general Honduran community more in health issues. In 1998 a new president, Carlos Roberto Flores, started his term with the great intention of implementing a whole new health agenda that included reforms that gave a more equitable access to health services. This intention remained as such because Honduras was affected that same year by Hurricane Mitch changing the agenda entirely. As an emergency plan, the Honduran government created the "Master Plan for National Reconstruction and Transformation" (PMRTN) which included a strategy of several reforms in social security to reach universal health coverage.

Actually, the Honduras health care system is going through various changes to accomplish ―a unified universal public health insurance‖ according to the Pan American Health Organization. The actual health care system consists of two major divisions, the private sector and the public sector. The Honduran Institute of Social Security (IHSS) and the Secretary of Health make up the public sector. This health system covers 82% of Honduras' population. The new health system approved in 2015 by Honduras national congress, but still not implemented, is based on an insurance system. A nongovernmental party paid by the Honduran government will provide these health services. The payment made to these institutions depends on accomplished goals established by the Honduran government.

One of the objectives of this new health care system is that 95% of Honduras population must obtain health coverage.

In the 21st century, the changes in Honduras health system continue to develop. This century started in the right direction by creating the "2021 National Health Plan" in 2001. This program intended to divide the country into 20 different health regions. This objective was

Universities play an essential role in securing universal health coverage in Honduras. The lacking number of technicians in laboratories, nurses, and dental assistants to cover the demand of the population is a serious problem in Honduras. As a solution to this problem, the

www.ifmsa.org |

The Americas Heartbeat 13 National Autonomous University of Honduras (UNAH) opened new technical careers which are going to be available starting in 2019. These careers include University Technician in Nursing for Intensive Care, Technician in Oral Prosthesis, and Technician in Technohistocytology.

The Catholic University of Honduras (UNICAH) in 2016 started the construction of ―The Catholic Hospital Jesus Face of Mercy‖, which will provide services at a low price to the citizens and will add another fourth level care health center to the Honduran health system. These are just some ways universities contribute to Honduran health care services. After all, universities create professionals that can make a plan to make Honduran health care system the best in the world.

Students in the health careers have a fundamental role on the actual health care system, without them the system would collapse. Medical students give their knowledge, maximum effort, abilities, time, and everything they got to patients. Without them, the state would have a higher demand for physicians because they cover a large part of the deficit in doctors per inhabitants in Honduras. Students in Honduras not only help by assisting patients during classes but they also promote, research, fight for what is right for the people. That is why they decide to be part of institutions like IFMSA-Honduras (The International Federation of Medical Students Associations in Honduras).

Honduras citizens play a crucial job in securing a better health care system for themselves. Over the years they have used their freedom of speech to demand universal health coverage by asking for new health establishments to take place, to have free quality health access, and an equitybased health system. After all, universal health coverage is a right in Honduras according the Honduran constitution in its 145th article, which states as follow: "The right to health protection is recognized."

Every citizen of Honduras‘ is moving towards a Universal Health Coverage system in their own personal way. It's remarkable how even parts of society are moving towards it, without completely realizing it. Having a functional health system based on Universal Health Coverage in Honduras is a dream full of hope that will come true in the future.

References 1.

Carmenate-Milián, L., Herrera-Ramos, A., Ramos-Cáceres, D., LagosOrdoñez, K., Lagos- Ordoñez, T. and Somoza-Valladares, C. (2017).

Situation of the Health System in Honduras and the New Proposed Health Model. [online] Archivesofmedicine.com. Available at: http://www.archivesofmedicine.com/m edicine/situation-of-the-health-systemin-honduras-and-the-new-proposedhealth-model.pdf [Accessed 1 May 2018].

2.

Constitution de la Republica de Honduras [Internet].

Pdba.georgetown.edu. 1982 [cited 21 May 2018].

Available from: http://pdba.georgetown.edu/Parties/H onduras/Leyes/constitucion.pdf

3.

Health in the Americas 2017. (2018).

Honduras. [online] Available at: https://www.paho.org/salud-en-lasamericas-2017/?page_id=133 [Accessed 1 May 2018].

4.

Paho.org. (2009). PERFIL DE LOS SISTEMAS DE SALUD honduras. [online] Available at: https://www.paho.org/hon/index.php? option=com_docman&view=download &alias=138-perfil-del-sistema-desalud-de-honduras2008&category_slug=fortalecimientode-sistemas-de-salud&Itemid=211 [Accessed 2 May 2018].

Peréz, S. (2016). Hospital católico atenderá la salud de los más pobres.

www.ifmsa.org |

The Americas Heartbeat 14

National efforts to reach universal health coverage - focusing on public health actions towards the elderly

André Newman Cordeiro Machado & Iaçanã Novaes Teixeira DENEM Brazil

In the Decade of 1960 were observed changes in the brazilian social structure and the discussion about the health of the elderly began to come into agenda due to changes such as the steady rise in life expectancy and declining fertility rate. It became clear that the phenomenon of population aging characteristic of developed countries - those that have reversed their age pyramid- was already happening in Brazil. Health strategies that aim to better serve the growing elderly population began to be designed to relieve the Unified Health System (SUS), and to lower the costs of the State with health care, since the Ministry of health of Brazil predicts that by the year of 2030 there will be more people at their sixty‘s (or older) than people between the ages of zero and fourteen in our country.

The elderly tends to present various chronic diseases -such as vascular, respiratory, cancer and diabetesresponsible for 72% of deaths in the country. A measure adopted in 2011 was the Strategic Action Plan for Combating Non-communicable Chronic Diseases in Brazil, which aims to reduce that mortality rate by 22% until 2022. The preferential vaccination for people than sixty in SUS reached, in 2012, 97% coverage of the elderly group, and access to free medicines at the Basic Health Units in the country generate a social inclusion that strives to overcome the monetary barriers and reaffirm the commitment of the State in promoting the universality of health.

The Senior Citizens‘ Statute (Law No. 10741), created in 2003, calls for home care of the elderly population of Brazil, mediated by the actions corresponding to the primary care done by Community Health Agents, who work in constantly monitoring the residents of a given region, analyzing especially risk groups such as the older population. If for any reason a user of SUS isn‘t able to reach the health center closest to them, home-visits of a multidisciplinary team consisting of a doctor, a nurse, physical therapist, among others, will ensure equity of access to health care.

Not long ago, Brazil still had a relatively low life expectancy when compared to other countries, in such a way that we're a country that's still learning to take better care of their elders, whose individualities were neglected up until recently. Became the agenda among medical schools to include palliative care as part of the compulsory curriculum and it is possible to see the growth in demand for the third agefocused specialties, even if still insufficient to meet the demand.

Graduated professionals rely on the constant release of national guidelines to guide the care of the elderly so that potential deficits in their knowledge are addressed. All actions described serve as ground to say that the country seeks to achieve the concept of ―promoting health‖, starting at the moment of pregnancy and following up to the more distant periods of life, reaffirming the pursuit of universalization of health in Brazil, which claims to be a country for everyone.

www.ifmsa.org |

The Americas Heartbeat 15

National effort towards a universal health coverage World Health Day: Dentistry and Medical students act.

Esther Chrysostome & Didier Théodore AHEM Haiti

April the 7th marks the world health day, a unique occasion for organizations, for associations, or for professionals in the field of healthcare to promote health in general and point out the many relevant concerns linked to available health related services and systems in any country. Using this opportunity, the Student Association of the State University‘s Odontology Faculty (AEFO) joined by the Haitian Medical Student Association (AHEM) organized for three days, a series of activities to raise awareness in the general population and the students in medical related fields towards the Haitian healthcare system. Our main theme was: ―Universal health coverage for all in Haiti‖.

The first day of our intervention took place th on April the 5 , with training students in both groups on the organization of the healthcare system in Haiti. Two goals marked this training. First raise awareness on what the system is, how it works, what it entails and the hardships it faces in general. Second prepare them for the second part of our three-part action plan, visit many high schools in Port-au-Prince to meet schoolboys and schoolgirls and teach them about their health rights.

As a prelude to the world day, 6 April 2018, students from both associations went out in more than ten high schools in the capital Port-au-Prince. This action plan was done around the theme ―You have the right for a good health, assert your right‖. This action was well received by the high schoolers and their teachers. Our team enabled them to discover how the healthcare system was organized in learn about the many

possibilities reserved for them in it. This initiative also aimed to motivate them in visiting us at our premises where many workshops, exposition and conferences and other such activities would be held on the theme ―Universal health coverage for all in Haiti‖.

On Saturday 7 April, inside the State University‘s Medical school and Odontology school, we welcomed any who were interested for a unique day in which many activities around our theme took place.

Conferences, expositions, workshops on diabetes and dental care, screening tests and free consultations and dental prophylaxis were available for all to experience. The making of this day by us students subscribes to the goal of allying different health related professionals or future professionals (Physicians, Dentists, Nurses, Druggist…). Uniting them and laying out for them and with them the difficulties in the healthcare system first, then with hopes of possibly solving some of them with the objective of rising in country access to healthcare. With that in mind a debate was held at the end of the day around the forces and weakness of the national health policy.

The World Health Day, a moment that students, in dentistry or in medicine, manage to use to serve, inform and sensitize the general population and their peers who often struggle to comprehend or acknowledge their role in the healthcare system. That same healthcare system, who over and over again fails to properly answer their plea and needs. Despite all this we still believe there‘s still a lot to be done to bring us closer to our dream of an Haiti where all are in good health.

www.ifmsa.org |

The Americas Heartbeat 16

National Efforts to reach Universal Health Coverage: TTMSA

Jonathan Edwards

TTMSA - Trinidad and Tobago

―Healing requires a legitimated, credible and culturally appropriate system.‖

well as the PAHO/WHO Cooperation Strategy.

― Mildred Blaxter

The Ministry of Health (MOH) has the responsibility of governing, financing and regulating the health system as well as setting policies and legislation as it pertains to healthcare. The MOH has outlined specific priority areas in their work plan for 2015-2020 including Non-Communicable Diseases, Maternal and Child Health, Care for the Elderly, Mental Health, Dental Services, Environmental Health and Allied Health Care and Support services. An example includes the creation of a Directorate of Women‘s Health which is challenged with the responsibility of implementing policies that specifically target and bring about improvement to the quality in the delivery of Women‘s Health with one of its major goals seeking to reduce the peri-natal mortality rate. There also exists a programme called the Chronic Disease Assistance Plan which offers forty-seven drugs for the treatment of many chronic conditions including cardiac disease, asthma, diabetes and more which can be obtained via a registered pharmacy following presentation of a specialised prescription form. Dialysis services are also subsidised heavily by the state and allows patients to access these services at private institutions at minimum cost to the user.

Universal Health Coverage (UHC) can be defined as ensuring that all persons have equal access to all necessary health services of sufficient quality to be effective while also ensuring that the use of these services does not expose the user to the financial hardship.

This concept encompasses prevention, promotion, treatment, rehabilitation and palliation and involves all levels of healthcare and hence must be holistically ingrained within a health system of a country for optimal coverage of a population. The Republic of Trinidad and Tobago has made many strides in the acquisition of UHC, this paper will look at the efforts made thus far in part by the state, the medical university as well as the Associations and relevant nongovernmental organisation including the Trinidad and Tobago Medical Students‘ Association (TTMSA).

The Government of the Republic of Trinidad and Tobago has shown their commitment to the drive for UHC as laid out in the National Development Strategy VISION 2030 which has the specific outcomes ―Improved Health Service Delivery‖ and ―Healthy Lifestyle Adopted‖. The Ministry of Health (MOH) has aligned to this plan through many strategies and partnerships for the period 2017-2021 made evident by National Strategic Plan for the Prevention and Control of Non-Communicable Diseases as

Country

In Trinidad and Tobago there exists two tiers of healthcare delivery, the Paternalistic public sector and the Consumeristic private sector. The public sector is an extension of the state and is run by Semi-Autonomous

www.ifmsa.org |

The Americas Heartbeat 17 Regional Health Authorities (RHAs) which ensures coverage across the country. All levels of healthcare are provided and the expenses are covered in part by the state and in part by the taxpayers of the population.

This sector takes into consideration all socio-economic determinants of health and does not discriminate persons based on income level, level of education, gender nor ethnicity. To address primary healthcare through quaternary care there exists numerous health centers, district hospitals, general hospitals and teaching hospitals interspersed amongst the RHAs which provide easily accessible services of a high standard for all areas of health.

A greater focus is being placed on the rural areas with the construction of a hospital within the Eastern region of Trinidad to ensure greater ease of access to high quality and essential services to persons in those communities. Subsequently, this would allow for the divide in the flow of patients on the existing hospitals, decreasing the burden of the staffing and increasing the overall efficiency of the Health Sector. As can be expected, there may be challenges to maintaining an allinclusive system, fortunately there is a thriving Private Sector to act as a supplement.

The private sector provides a consumeristic approach to healthcare delivery and exists as an alternative to the doctrinal public system. This tier is more subscribed by the persons of the higher socio-economic classes and provides services in exchange for capital. Due to a greater ratio of health professionals to patients, there is more time spent with patients, decreased turnaround time of test results as well as a greater control given to the patient with respect to their management. There has been ever increasing collaboration between the private sector and the MOH with respect to the acquisition of statistics in relation to disease burdens and outcomes. This data can be extrapolated and used to bring about improvements in health quality amongst both tiers in the health sector.

To supplement the existing quaternary care services, there are also plans to utilise an

existing health facility to produce a part public, part private institution with the goal of delivering highly technical services by utilizing the state of the art equipment present in the institution and training the local workforce appropriately. This will be in part managed by the university of The West Indies to ensure training of medical professionals in these sub-speciality areas.

The University of the West Indies (UWI) St. Augustine aims to provide a high quality teaching and learning environment, facilitate critical thinking, and produce graduates who are equipped to innovate regionally and impact globally and houses the sole medical school for the Twin island Republic. UHC is incorporated into the curriculum with the prospect of instilling within the future health workforce the importance of a nation to achieve this ideology. On a national level, UWI is the leader with respect to Research in Health.

This research can be used for both evidence based decision making to influence public policy and reformation of the health system as well as for evidence based decision making in medicine in the production of guidelines to allow for a greater quality in health care delivery. Both research outcomes weigh heavily and play a major role in the pursuit of UHC. There are numerous Non-Governmental organisations that work autonomously for the improvement of the health system through their advocacy, promotion of health as well as aiding the system through quality control. The Trinidad and Tobago Medical Association (T&TMA) act as an avenue for Continuing Medical Education through accredited events and sessions to produce a consistently skilled workforce to increase the overall standard of healthcare delivery.

The Medical Research Foundation allows for a specialised HIV/AIDS centre which allows for extended operational hours to allow for a greater access to services by affording them more convenient clinic times. UWI Blood donor foundation acts to promote the concept of non-remunerated blood donations with the goal of providing the health sector with adequate blood and blood products for patients in need with the aim of preserving life and decreasing the

www.ifmsa.org |

The Americas Heartbeat 18 overall time spent warded in a hospital.

There are countless other organisations and groups of motivated persons from all generations that operate for the benefit of the wider population, the medical students can also be placed in this category.

With these profound and long-lasting impacts, it begs the question, what can medical students do to aid in the nation attaining UHC? The Trinidad and Tobago Medical Students‘ Association has understood the importance of UHC and can best function to advocate for and promote the ideology. As the representative body of the medical students, we can allow for peer education on the importance of UHC and equip the future health professionals with the knowledge and practices to achieve this endeavour. Medical Students can act as grass-root champions and lead social media campaigns to promote greater patient autonomy as well as share what efforts are being made within the health sector to other young persons. With respect to advocacy the TTMSA has made progress in recent years by becoming more involved in the conversation as well as in areas of decision-making having more formalised relationships with the MOH, T&TMA, UWI and the Pan American Health Organisation. The work of advocacy is never ending and future endeavours include advocating for: the improvement of

psychiatric facilities to increase the overall desire for the public to seek assistance in dealing with mental health problems; greater involvement of TTMSA in joint committees for the purpose of providing an unbiased, un-pressured perspective on daily life in the public system for the purposes of monitoring and evaluation; greater involvement of communities in the determination of local challenges in achieving UHC; the incentivising of companies to mass produce products aimed at providing a healthy alternatives to food and drinks with hopes of decreasing risk factors for non-communicable diseases.

In conclusion, there have been countless efforts that run cross-sectoral within Trinidad and Tobago which seek to the achieving the grandiose picture of UHC. It can be concurred that the most appropriate method forward is to foster greater partnerships between influential stakeholders. The approach of operating in silos only succeed in stymieing progress and keeps societies further away from an all-inclusive system. No existing system is perfect but only through a multidisciplinary approach can a healthcare system which takes into consideration all social determinants of health be achieved.

www.ifmsa.org |

The Americas Heartbeat 19

Health system reform and universal health coverage in Latin America

Ivan Fabrizzio Canaval Díaz & Gray Gilberto James Muñoz IFMSA-Peru - IFMSA-Panama

In Latin America and the Caribbean (LAC), health -system reforms have produced a distinct approach to universal health coverage, underpinned by the principles of equity, solidarity, and collective action to overcome social inequalities. In most of the countries, government financing enabled the introduction of supply-side interventions to expand insurance coverage for uninsured citizens with defined and enlarged benefits packages and to scale up delivery of health services.

At the same time, countries have achieved improvements in health and well-being for all segments of the population: average life expectancy has risen significantly, more children live to see their first and fifth birthdays, and fewer mothers are dying from complications of childbirth.

Nonetheless, health inequities persist between and within countries, and some health outcomes are still unacceptable, challenging health systems to develop innovative approaches that will improve responsiveness and address people‘s changing needs. Universal health coverage (UHC) has been at the center of the global public health agenda in recent years. As one of the overarching goals of health systems, UHC provides countries a way forward to address unmet needs and health inequities.

A distinguishing feature of the health system reforms in LAC was the strong focus on the development of comprehensive primary health care on the basis of Alma Ata principles as the platform of primary health care and the vehicle for achieving universal health coverage, reducing inequities, and democratizing health through participation.

The improvements in mean level and equity for all countries for both indicators were achieved by increasing access to the

poorest segments of the population.

However, despite improvements, there is still opportunity for further improvements in all countries.

To appreciate the influence that the political landscape has on health service delivery in LAC, it is important to understand how it has changed over time. During the nineteenth century, charitable organizations provided health services to the majority of the population. The most notable progress in health outcomes took place in the mid20th century after public sector investments in safe water and sanitation infrastructure, vector control, vaccinations, health promotion, and the expansion of education centers for physicians, nurses, and other medical professionals. In more recent times, Latin Americans have demanded more responsive health systems, compelling their countries‘ governments to explore reforms in order toto advance UHC. Efforts to improve system responsiveness include developing clear medical guidelines and standards, linking resources to incentives for providers, and implementing information systems that improve strategic decision-making.

Democratization, coupled with sustained, equitable economic growth and broad social reforms, has improved living conditions and increased demand for better health care. In this environment, health emerged as a fundamental human right and, in turn, UHC as a means to make this right a reality. The LAC countries have also shown a tendency to perform better than expected, which can be partly attributed to sound public policies and increased public health expenditure. The region continues to show improved health outcomes and strengthening economies.

Despite progress, however, inequality remains high.

To counter inequality, countries must

www.ifmsa.org |

The Americas Heartbeat 20 maintain macroeconomic stability and adapt to changing demographics, which fuel demands for more comprehensive health coverage. The region must find ways to expand fiscal space for health. Slowing population growth is almost certain to continue and countries will progressively age. This trend will challenge the region to become more creative in expanding financial protection and health care coverage in a sustainable manner to deal concurrently with NCDs and infectious diseases.

It is our work, as part of the IFMSA and the future healthcare professionals to keep

working in the reform of a friendlier health system, focused in primary healthcare, but overall, a system that moves towards UHC. T, this is the only way we can really advocate for the right of health, looking for not just attention but also quality.

References: 1)Toward Universal health coverage and equity in Latin American and the Caribbean.

PAHO/WHO & WBG, 2015 2)Health-system reform and universal health coverage in Latin America, LANCET, Rifat Atun, Luiz Odorico Monteiro de Andrade, et all, October 16th, 2014

www.ifmsa.org |

The Americas Heartbeat 21

Ecuador: Have we made enough efforts to reach universal health coverage?

María José Jaramillo Cartwright AEMPPI Ecuador

Universal Health Coverage (UHC) has become one of the most prominent global health policies, after following endorsement

by WHO, the World Bank and the United Nations Sustainable Development Goals (Rumbold, et al., 2017). Still, half of the world still lacks access to essential health services (Dhaliwal, 2018). The problem for reaching it arises when it comes to financing reforms and strategies; given that they need to be specifically designed to provide all people access to quality health services and ensure that using those services do not cause financial hardship (WHO, 2010). But, specifically for Ecuador, the main problems at attaining universal health coverage reside on health system fragmentation, lack of equal distribution and political instability.

One of the principal problems identified by PAHO for global health is the health system fragmentation. In Ecuador, not only do we have a public and private division; but also, independent funding systems such as Social Security, Public Health Ministry, National Police, Armed Forces, among others. These creates inequities and inefficiency that compromises access, quality and funding of a global system, perpetuated as well by the lack of regulatory capacity and the vertical nature of health programs (PAHO, 2014).

According to the Public Health Ministry (2012) this even allowed a dismantling of the public health institutionalism by weakening their control and regulation capacity, creating a profound inequity in health care services access; specially for the lower economic quintile population.

When discussing attempts at a joint health system, we need to look back at history. In 2006, Ecuador implemented the universal health insurance program called PRO AUS; whose objective was to provide insurance

that offered benefits characterized by ―quality, efficiency, and equity; includes social protection and public insurance; and gives priority to the population living in poverty and extreme poverty‖ (PAHO, 2008). Yet, by 2007 it was only limited to Quito and some zones from Guayaquil and Cuenca, were the Health Integral Attention Model (MAIS) was proposed for other areas (PAHO, 2008). This model was promising, with a first stage that focused on improving infrastructure, equipment, human resources, medicines and other materials among health centers (Ministerio de Salud Pública Ecuatoriana, 2012). Sadly, tangible results from this model have been meager in quality and quantity, especially considering that the theoretical guidelines have not been even close to the practical application of the system.

Although, there are ways in which one could interpret what is a just distribution of health care resources and what constitutes the human right to health (Rumbold, et al., 2017); governments haven‘t been able to satiate demand or needs from the Ecuadorian population. Because they have succumbed on to creating the minimum intervention that doesn‘t transcend or mitigate prevailing health conditions, our country is filled with ghastly situations for our medical system every day. This reality is filled with patients waiting for medical appointments for 6 months, striving to reconcile the lack of medication available, struggling to get to medical centers; among thousand other examples that demonstrate all our failures. Governments have acknowledged that even though 90% of health problems could be solved on a first level health center, the public sector has been weakened by low budget, center abandon, shortage and instability of workforce and limited solving capacity

www.ifmsa.org |

The Americas Heartbeat 22 (Ministerio de Salud Pública del Ecuador, 2012). Now, considering inefficiencies is essential to achieve progress, thus, resources should be allocated based on programs with priorities, populations and service‘s quality (Kutzin, 2016). The fact is that, sometimes, to abridge responsibilities; measures taken do not have much impact on equity or the population‘s benefit, but rather on a repertoire of minimal actions with minor quibbles for popularity on next election periods. What our country needs is to achieve equity in the distribution of health resources, efficiency in system organization, service deliver and administrative arrangements; but more than anything, transparency and accountability of the system to the population (Kutzin, et al., 2016).

Political and administrative instability experienced by Ecuador has prevented the development of implementation plans, nor specific or sustained, given contradictory policies that have been adopted in different governmental periods (PAHO, 2008).

Countries that have made significant progress on UHC have had a strong political commitment to UCH, reflected on the prioritization of health on their national budgets (Kutzin, et al., 2016), yet in Ecuador this has not been seen.

Governments have seemed to be elusive when it comes to health budgets, and their priorities have been rather opaque. During the actual government, a 3,5% from the annual GDP has been assigned to health (Reyes, 2018), when the ideal value that a government should invest on health should be 8%. This makes you wonder whether governments have been spendthrifts and truant with our national budgets, or if the importance of health is understood poorly.

The main effect of this political instability is reflected on lack of clear and effective legislation that promotes prevailing and successful health strategies, and are rather reinforcing patent ideas that do not create real solutions.

Ecuador is far from achieving universal health coverage; mainly due to the health system fragmentation, lack of equal distribution and political instability. Three fundamental problems do not allow

countries to achieve universal coverage: availability of resources, overreliance on direct payments at the time people need care and inefficient and inequitable use of resources (WHO, 2010). All three are major barriers that Ecuador face and need to resolutely overcome. Currently, there is WHO/PAHO cooperation with strategic priorities that could support the development of regulatory framework, system reformation and other strategies that may be the answer to attaining the lofty objective for Ecuador of a UHC. References Dhaliwal, M. (2018). Universal health coverage is out of reach unless we eliminate discrimination. United nations Development Programme. Retrieved online on May 14th, 2018 from http://www.undp.org/content/undp/en/home/blog/ 2018/universal-health-coverage-is-out-of-reachunless-we-eliminate-di.html Kutzin, J., Yip, W. Y Chasin, C. (2016).

Alternative Financing Strategies for Universal Health Coverage. De Folland, S., Goodman, A. y Stano, M. The Economics of Health and Health Care. Washington D.C.: Routledge Ministerio de Salud Pública del Ecuador. (2012).

Modelo de Atención Integral del Sistema Nacional de Salud. Quito: Subsecretaría nacional de Gobernanza de Salud Pública.

PAHO. (2008). Health systems profile: Ecuador.

Monitoring and analysis health systems change/reform (3rd edition). Washington D.C.: PAHO. Reyes, G. (2018). Análisis de la proforma presupuestaria 2018.

Revista Rupturas.

Retrieved online on May 14th, 2018 from http://www.revistarupturas.com/analisisproforma-presupuestaria-2018.html Rumbold, B., Baker, R., Ferraz, O., Hawkes, S., Krubiner, C., Littlejohns, P., Norheim, O., Pegram, T., Rid, A., Venkatapuram, S., Voorhoeve, A., Wang, D., Weale, A., Qilson, J., Ely, A. and Hunt, P. (2017). Universal health coverage, priority setting, and the human right to health.

The Lancet.

1(17). http://dx.doi.org/10.1016/ S01406736(17)30931-5 WHO. (2010). The World Health Report: Health Systems Financing, the path to universal coverage. Geneva: WHO Press

www.ifmsa.org |

The Americas Heartbeat 23

Health Financing for Universal Coverage: A Developing Country’s Perspective Esther M. Bueno Diaz - Eunice C. Cuevas Duval - Lliamel P. Guzmán Wagner ODEM - Dominican Republic.

―Universal Health Coverage provides a platform for integration across global health.

Let‘s work together to make this work!‖ − Dr. Christine Sow, President and executive director of Global Health Council

Health has always been and will always be a human right. Health is a conglomerate of approaches with one final aim: access. When analyzed from this perspective, health seems easy, achievable, favorable, and possible, even though the reality is a completely different story. Universal health coverage (UHC) means that all people, no matter their ethnicity, political or religious beliefs, socioeconomic status or country, should receive the necessary health services without suffering economic hardship (1).

Although it is easy to guarantee health from the perspective of Alma Ata, in which governments should aim to provide health services for their citizens, this ideal requires a mixture of organization in budgets, health expenditure plans, human resources, policy makers and community integration.

Three main obstacles prevent countries from moving closer to UHC. The first one is the unavailability of resources.

No country, regardless of its gross domestic product (GDP), has been able to provide to the entire population immediate access to every health intervention and technology.

The second obstacle is an overreliance on out-of-pocket payments at the time of service use. These include direct payments

for medicine and fees for procedures and consultations that generate problems of financial protection. In some cases, even when people have some form

of health insurance, they are forced to contribute with copayments or deductibles.

Reliance of these direct payments constitute a major access barrier to health care, preventing millions of people from receiving necessary care and resulting in financial hardship. The third barrier is inefficient and inequitable use of resources.

Even though scarcity of funds for health represents an issue everywhere, all countries can do more with existing resources. It is a matter of improving efficiency by taking a more strategic approach when allocating these resources by linking such decisions to information on the population health needs and providers‘ performance (3).

The way a health system is financed is a critical factor for reaching universal coverage because it determines which health services are available and whether people are able to afford such services. A coherent and well aligned strategy for health financing plays an important role in the progress towards UHC. The functional components of health care financing can be subdivided into three categories: revenue collection, fundpooling, and purchasing. a) Revenue collection refers to the way in which money is gathered in the system. The main mechanisms of revenue collection are through taxation, social insurance contributions, voluntary insurance, and out-of-pocket payments.

Taxes can be charged to individuals, households and businesses through direct taxes, and they can also be applied to transactions and commodities through indirect taxes (e.g., fuel, alcohol). b) Fund-pooling refers to the accumulation of health care revenues on behalf of the population. The purpose of pooling is to ensure financial protection by spreading financial risk across the

www.ifmsa.org |

The Americas Heartbeat 24 population so that no individual carries the full burden of paying for health care.

Pooling of funds is a precondition for redistributing them to persons with the greatest health needs. Some forms of revenue collection do not enable financial risks to be shared between contributors (e.g., out-of-pocket payments). c) Purchasing means the transfer of pooled resource to service providers on behalf of the population for which the funds were pooled. Providers then can utilize these resources to deliver benefits to the population.

Direct, out-of-pocket health payments (including fees for consultations and procedures, payments for lab tests and medication, and sometimes, informal payments) represent barriers for health care access that can potentially endangered living standards and disrupt household welfare. Financial hardship associated with use of these services can also prevent people from seeking necessary care, thus further contributing to access barriers.

Protecting against catastrophic medical expenditures by reducing reliance on out-of-pocket charges can lower financial barriers and reduce the impoverishing impact of health payments.

It will be impossible to achieve universal coverage if people suffer financial hardship or are unable to use health services because of required fee payment upon rendered services. Thus, individuals bear all of the financial risks associated with paying for care. Households may be unable to insure their basic needs and may be forced to choose between paying for health services and paying for other essentials, such as food or education. In countries where out-of-pocket fees are the main source of health care financing, as is the case in most developing countries, everyone pays the same price regardless of their economic status. There is no formal expression of solidarity between the sick and the healthy, or between the rich and the poor. Almost all countries use some form of direct payment (sometimes called cost sharing), although the poorer the country, the higher the proportion of total expenditure that is financed in this way.

Limited public spending on health results in increased out-of-pocket spending for the population. The only way to reduce

this over-reliance on direct payments is for governments to ensure the effectiveness of prepayment mechanisms and to encourage risk-pooling, an approach chosen by most of the countries that have come closest to universal coverage. When a country uses prepayment and pooling mechanisms to finance health, the goal of universal coverage becomes more realistic. These approaches are based on payments made in advance of an illness, pooled in some way and used to fund health services (including prevention, promotion, treatment, rehabilitation and palliation) for everyone who is covered.

In 2014, a meeting was held in the Dominican Republic to propose the implementation of UHC. Before proposing any strategies, encountered challenges were numerous: political commitment in response to the health needs of the population, high levels of inequity in health outcomes, segmentation and fragmentation in health systems, lack of quality and integrality, deficit of health financing and inefficiencies (2% of the GDP), among others (4). In order to achieve a UHC, three strategies were proposed: a) expanding equitable access to health services, comprehension and quality, focused on people and communities; b) strengthening governance; c) increasing and improving financing, without out-of-pocket expenses and with equity and efficiency (4).

It is not a secret that health care is the image of governments in the mirror of actions. As mentioned, actions are the reflective decisions of policy-makers which are controlled by economics, circumstances, political background, and culture. Culture itself is defined by people, and people are the number one subject of interest for governments. Likewise, actions are the cornerstone of these entities, and therefore they become the constituents of societies, and health is an integral part of this weird yet beautifully organized core to which our communities belong.

Within actions, we find that systems regulate, lead and manage the course of humans at different levels, which have particular meaning when discussing ―health‖, ―health care costs‖ or ―public health‖.

As Johan Galtungs described:,―…action systems within which invisible forms of violence are activated are

www.ifmsa.org |

The Americas Heartbeat 25 structurally violent systems‖, systems in which quality and accessibility to proper health care are not consistent through time can become structurally violent systems to policies or people. Many physicians are not aware of this topic because our system fails to emphasize the influence of social determinants of health and guarantee equitable access to health care.

Following these concepts, it can be said that health care is the reflective mirror of structural disparities within our society‘s health care delivery system. These disparities enclose lack of accessibility to basic services in low-income, developing communities and countries. However, what about other population health challenges, including appropriate HIV care, emerging infectious diseases or food insecurity?

Development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries. Lancet.

2017;389(10083):1981-2004 4. Morales C. Estrategia para la cobertura universal de salud [Internet]. 2014 [cited 2018 May 23]. Available from: https://www.paho.org/dor/images/st ories/archivos/chikungunya/consult a_nacional_estrategia_salud.pdf?u a=1

In summary, there is no magic strategy to reach UHC. Nonetheless, numerous global experiences have proven that when working towards a final aim, countries can achieve and maintain UHC. It is possible to increase funds and to diversify funding sources. Medical students can make the difference by developing innovative health initiatives in underserved communities. As future leaders in international health systems. it is crucial to understand that medicine requires a holistic approach to improve population health outcomes.

References 1. World Health Organization. Health Systems Financing [Internet].

WHO. 2010 [cited 2018 May 23].

Available from: http://www.who.int/whr/2010/10_su mmary_en.pdf?ua=1 2. Fan V, Savedoff W. The health financing transition: A conceptual framework and empirical evidence.

Center for Global Development.

2014 [cited 2018 May 16]. Available from: https://www.cgdev.org/sites/default/ files/health-financing-transitionframework-evidence_1.pdf 3. Global Burden of Disease Health Financing Collaborator Network.

Evolution and patterns of global health financing 1995–2014:

www.ifmsa.org |

The Americas Heartbeat 26

Universal Health Coverage in the Dominican Republic: An achievable goal or just a dream?

Katherine Candelario & Lilian Teresa Pimentel Gonzรกlez ODEM - Dominican Republic

The Dominican Republic (DR) is a developing country located on the Greater Antilles of the Caribbean region. In the 1990s, the country experienced great advances in economy and took the leading role in the region. However, this development and stability were not used properly and did not correspond to the present DR reality. The statistics places us as one of the countries in Latin America with the greatest health difficulties. Some health determinants, such as poverty, education, access to quality health care, health inequalities and indicators as high child and maternal mortality, reflect the poor health of the nation (1). It is worrisome to point out that these health determinants directly affect community development and do not allow the country to respond to the Sustainable Development Goals and universal health coverage (UHC).

Observing the need for a change, a new legal framework for the health system is created, integrated by a broad set of laws, regulations, norms and administrative dispositions coming from the different instances and state institutions. The two fundamental legal tools are the Laws 42-01 and 8701, which give the premise for the foundation of the National Health System and the Dominican Social Security System, respectively. More specifically, Law 42-01 regulates all actions that allow the State to enforce the right to health. Law 87-01 establishes the foundations for the development of a social protection system with universal coverage, promoting the

increase of insurance through social contributions with the contributions of the State, employers and workers. After the reform, the system continued having a private sector, constituted by Health Insurance Companies (ARS) and private health care centers. It also had a public sector, where the National Health Insurance (SENASA) was the primary insurance affiliated with the subsidized population, paying providers the agreed services according to the Basic Health Plan through the funds granted by the Social Security Treasury (TSS). The TSS is dependent on the National Health Council, which receives money from the fiscal funds that are located to the Ministry of Public Health. SENASA also covers government employees and private sector contributives who elect them as ARS. Finally, there is a group of people able to pay for health services in private establishments for out-of-pocket payments (2).

The reform of the national health system was a step towards UHC, which implies that all individuals are able to receive the necessary health services with no monetary affectations. UHC implies a wide range of services, from disease prevention and promotion of healthy choices to treatment and palliative care. It is important to protect the Dominican population from the financial aftermath of health care expenses, especially those low-income communities.

By achieving health for all, other sectors of the nation, like education, economic

www.ifmsa.org |

The Americas Heartbeat 27 development benefit.

and

social

stability,

can

The truth notwithstanding, is that most of the Dominican population still end up paying out-of-pocket expenditures for medical services. This is related to the fact that the state commits a low percentage of the gross domestic product to health, resulting in the population self-financing all health expenses. Individuals who earn less than DOP$4,000 (equivalent to US$81) every month are additionally secured. This covers the worker and not their family; however, it does include maternity care for the spouse. The individuals who do not fall into these classifications must pay their own medical charges. Some of them work for a company that provides health coverage at local health centers with no extra cost.

Thus, even with endeavors to make an inclusive national medical insurance, there are still gaps amongst the vulnerable populaces.

In order to decrease the morbidity and mortality indicators and decrease their impact on the Dominican society, health system changes are required to reach UHC. First, more efficient distribution of services and goods offered by the health system is necessary. Areas that are more impoverished or marginalized tend to lack access and availability of health care services. Just by allocating the services and funds correctly by disease category, which can be done by looking at the morbidity and mortality indicators, money does not have to be invested in unnecessary supplies.

Second, educational programs can provide insight on appropriate health-seeking behaviors and availability of health services and programs. Information technology can be used to create media posts that increase public awareness about health priorities.

Many countries are discussing future strategies to achieve UHC, currently implemented in Turkey, Argentina, and Cuba. In Europe, it is important to recognize that public plans provide basic coverage only or only essential health care services. Coverage for outpatient care, prenatal care, and certain medications are available, but there are still disparities for issues like rare chronic diseases.

In addition to indicators like disease burden, sociodemographic indicators should be assessed for correlations with health and wellbeing. Through socio-demographic indicators, you can examine how populations shift in terms of growth, and population movement in regards to education, work, economic possibilities, and other social interests, such as better living areas or participating in or with more affluent societies. Observing population changes can be a prevention mechanism.

For example, tuberculosis has been linked to overcrowded and impoverished living areas, and thus these sociodemographic indicators can influence health and overall health care coverage distribution based on disease prevalence and incidence rates.

As medical students, we may feel that shifting the current health system to universal coverage is the responsibility of policy makers and graduate physicians.

However, there are specific things that we can do to help initiate and facilitate the forward process. Sharing knowledge and welcoming other students from all careers to examine reasons of why universal coverage benefits everyone. Educating the public about the importance of their collective voice can increase awareness about this movement toward universal healthcare. Although there is no perfect health system, we must seek a health system that reduces health disparities, inequalities and other coverage gaps. Our ultimate goal is seeking health for all.

References Pan American Health Organization.

Dominican Republic [Internet]. 2017 [cited 2018 May 24].

Available from: https://www.paho.org/salud-en-lasamericas-2017/?page_id=115 Rathe M, Moliné A. Sistema de salud de República Dominicana. Salud Pública Méx.

2011;53:s255–64.

www.ifmsa.org |

The Americas Heartbeat 28

www.ifmsa.org |

The Americas Heartbeat 29

Message from the SCOME Regional Assistant

Ximena Paredes IFMSA Paraguay

Being part of a medical education that is constantly growing and improving, students must grow and improve at the same time. How could we achieve this?

IFMSA offers us endless opportunities, trainings, skills development, knowledge, materials and more.

Americas is a region full of motivation and great potential, which continues to develop in the field of medical education.

The students are contributing and being part of this process, through projects, activities, campaigns and advocacy.

Including the student in its medical formation process encourages not only an improvement in the learning process, but also in the teaching process. With continuous feedback and constant evaluations, we seek to contribute to excellence and quality in the education of future health professionals.

IFMSA is an excellent development platform for medical students of the Americas.

And in addition to contributing to the students' own education, it prepares them for the challenges of the world, and makes them one of the most powerful agents of change.

www.ifmsa.org |

The Americas Heartbeat 30

Academic League of Health and Spirituality: breaking paradigms to achieve breakthrough results

Aline Barbosa Maia, Bruna Paola Santos Zonta, Estella Ramos Rezende, Larissa Cristine Souza Lopes DENEM - Brazil

From primary care1 to burned patients2 and people with mental illness3, spirituality and religiosity have been considered to be a source of strength and comfort and therefore a meaningful approach in health care. Although the reluctance of academic community to discuss this subject, it has become an important field of studies, specially for Brazilian medical students by means of Academic Leagues.

Integrated in this background, we founded the Academic League of Health and Spirituality4 (LASE) at our university (Unirio). Our aim was to introduce and to deepen the topic among other students and professionals, as well as the social community. Based on a triad of teaching, research and extension, the league has been hosting talks and sharing grounded knowledge.

In accord with our goals, it is by the public events and league's regular activities that spirituality is becoming a tangible reality for our colleagues and we are proving its applicability on clinical practice. As for the extension division, we are establishing group dynamics in order to boost social awareness of the impact of spirituality and religiosity on physical and mental wellbeing.

In addition, regarding our research branch, we had the opportunity to develop a groundbreaking opinion survey which provided us important data for future

initiatives. It embraced medical students from all terms and the results showed that 64,71% found the discussion of health and spirituality relevant and that 70,59% classified the League as a significant contribution to academic qualification.

Based upon these analyses we presented our poster on the XXX Congress of Brazilian Medical Students and on the 1st International Congress of Health and Spirituality. At this last one, we had the chance to meet Kenneth Pargament, one of the research pioneers in the field of health and spirituality. Inspired by his experiences we were able to forecast new approaches.

Considering medical students propensity to lose interest and develop signs of depression and anxiety along the course5, one of our methods innovation aims to create rounds of conversation to recover the ―why medicine‖ question every one had to answer once. Additionally, we intend to invite professionals from our own university to present lectures on the matter of spirituality and its importance to health care.

With that in mind, we can only accomplish breakthrough results in the academic traditional environment by breaking paradigms among the student body as freethinkers. After all, taking into account all individual dimensions is just putting into practice the meaning of health as a condition of complete well-being and not only the lack of illnesses6.

References:

www.ifmsa.org |

The Americas Heartbeat 31 1. Ellis MR, Thomlinson P, Gemmil C, Harris W. The spiritual needs and resources of hospitalized primary care patients. Journal of Religion and Health.

2013.

2. Garimella R, Koenig HG, Larson DL, Hultman CS. Of These, Faith, Hope, and Love: Assessing and Providing for the Psychosocial and Spiritual Needs of Burn Patients. Clinics in Plastic Surgery. 2017.

3.

Pargament KI, Lomax JW. Understanding and addressing religion among people with mental illness. Official Journal of the World Psychiatric Association (WPA). 2013.

4. LASE – Academic League of Health and Spirituality.

Available at <https://m.facebook.com/LASE-AcademicLeague-of-Health-and-Spirituality1558813970906130/> 5. Baldassin et al. The characteristics of depressive symptoms in medical students during medical education and training: a cross-sectional study.

BMC Medical Education. 2008.

6. Constitution of WHO: principles.

Available at http://www.who.int/about/mission/en/

www.ifmsa.org |

The Americas Heartbeat 32

Meditation inside a Health Sciences’ University, an Experience Report

Bruna Rudolfo Faraco DENEM - Brazil

When entering the field of Health, students automatically feel the intense pressure around it: heavy workload, grades competition, non-empathetic professors and colleagues, student loan and most importantly, the responsibility over the patients‘ life. It has been shown that medical students have a high rate of deterioration in quality of life due to extensive work hours and hazardous work 1 related patterns . Moreover, researchers have shown a prevalence of depression on medical students up to 27%, related mostly 3 to risk factors as stress and burnout .

Coping with this huge load of distress is not easy, as many students are still reluctant on seeking help, often finding themselves around no support.

One way to improve health support is through contemplative and complementary health practices, such as yoga and meditation, as several papers have been published establishing their benefits for the improvement of treatments outcomes, along with general well being of patients.

But lately, these studies have also measured the gains of those practices for health sciences students, helping them deal with academic stress, anxiety and depression.

With that perspective in mind, our students‘ study group here in UFCSPA - focused on the study of Spirituality on Health - has developed a project aiming the support of the academic community, using meditation as its tool. The objective was to introduce, sustain and expand spaces for weekly meditation practices, in order to create visibility of the subject inside the University by showing its positive reflex on Health.

The practices took place twice a week, with thirty minutes for stretching and four periods of meditation with 15 minutes each.

Students conducted all the practices, with

different backgrounds inside meditation techniques. Monthly, one of the meetings would include a small lecture on the subject by a guest speaker.

Throughout the year, we noticed an increased adhesion of the academic community, resulting in the development of other practices inside the University by the group, like yoga. More people started joining and showing interest around the theme. In a total of 21 practices, over 145 different people participated. The impact of meditation on their daily activities was very important and positive, as we could acknowledge by their shared experiences of reduced stress, anxiety and general improvement of their well-being. The total number of participants in the meetings made it clear for us how essential that space was inside the University.

Meditation practices have been shown to decrease stress levels and increase empathy in medical students, by making them more aware of themselves, their stress and time management and 2 connectivity with the patients . However, meditation is not yet well known as a tool inside the students‘ routine and academic space. The good results we had on the general well being of the participants of our project make us certain that students all over could benefit from the practice, if only they had the incentive, support and spaces inside their Universities for such.

References: 1.

Lona Prasad, Aneesha Varrey, and Giovanni Sisti.

Medical Students’ Stress Levels and Sense of Well Being after Six Weeks of Yoga and Meditation.

Evidence-Based Complementary

www.ifmsa.org |

The Americas Heartbeat 33

2.

and Alternative Medicine, vol.

2016, Article ID 9251849, 7 pages, 2016. doi:10.1155/2016/9251849 Allison R. Bond et al. Embodied health: the effects of a mindâ&#x20AC;&#x201C;body course for medical students. Med Educ Online, 2013, 18: 20699

3.

Bailey, E. , Robinson, J. and McGorry, P. (2018), Depression and suicide among medical practitioners in Australia. Intern Med J, 48: 254-258. doi:10.1111/imj.13717

www.ifmsa.org |

The Americas Heartbeat 34

Discovering the Advocate of my Education

Jerry Francisco Sabio Durón IFMSA Honduras

For me, this academic period has been very different than the others. The classes I am currently taking are a whole lot more interesting than they used to be. I can say that somehow, I have done advocacy for a better education in my medical education system. Finally, I approach my classes in a way that I had not thought of before. In such a short time SCOME made me fight for a better education, not only for me but for all my colleges. What I value the most of SCOME is the way to change a mindset, from accepting the way education is to one that can’t be satisfied by any type of educational system but the best. With the tools SCOME provides us, it can make small impacts that will add up in the minds of the medical students and propel the capacity to make changes in our communities.

You may be thinking what SCOME did to make an impact in my life the way it did.

The experience that opened my mind to a new way of thinking was the first ever AMET held in this year´s Regional Meeting in Paraguay. I learned so much from my facilitators, Ximena, Pablo and Pahua. To be honest I had never experienced this learning experience anywhere else. The way of transmitting knowledge on improving medical education was astonishing. Every day I would wake up

wanting to know what I could do to make my education system better. The approach they had for us to learn how to change and improve our medical education system was efficient. They worked on the way we think, the capabilities we have, and the inspiration we need to make impact in our universities. I Firmly believe that each one of the friends I made in the AMET is making important changes in their communities.

Since the AMET I have grown in my knowledge of teaching and creating educational opportunities. As a SCOREan I worked with SCOME to make a workshop on the writing of clinical cases back in Honduras.

I owe the AMET for making me know about the influence I could have to advocate for medical students all over the world. I don’t plan on staying here, SCOME made me realize that I have a lot of work to do and working in my university is just the start. I encourage every medical student to know more about education and how they can change it for the better. As Future Doctors we need transmit our knowledge to our communities to bring real change in our Health systems.

www.ifmsa.org |

The Americas Heartbeat 35

Medical Education Student Representation at UWI Mona, Jamaica Nikolai J. Nunes & Nidhi Thomas JAMSA - Jamaica

This academic year, the Jamaica Medical Students‘ Association (JAMSA) Standing Committee on Medical Education (SCOME) built on phase 1 (‗SCOME to the Students‘) of its two-year strategic plan with phase 2: ‗SCOME to the Faculty‘, the priority; positioning SCOME, for the first time, at the forefront of medical education representation at the UWI Mona Campus.

We welcomed our new Dean, Dr. Tomlin Paul, leading the student charge for his vision of Interprofessionalism and Social Accountability, and introduced the first Global Health programs to UWI.

Global Health In September, we lead JAMSA‘s first collaborative Standing Committee event including SCORA, SCORP, and SCOPH in a Sexual and Reproductive Health and Rights (SRHR) seminar: ‗From Mona to Global Health Leadership‘ featuring Dr. Kizanne James, Chevening Scholar and SRHR leader. In November, we launched the University of Toronto (UofT) Global Medical Student Partnership (GMSP) program, partnering four UWI students with a UofT cohort working on global health themed case studies. Finally, four UWI students were selected to attend the International Federation of Medical Students‘ Association (IFMSA)/Groningen University Summer School in Global Health in Holland, promoted by the National Officer who is the first alum of this program.

Human Resources Interprofessionalism Accountability

in

Health and

(HRH): Social

medical education: UWI Surgical Society and the American College of Physicians‘ local chapter. In July, the National Officer, the former JAMSA President H. Anton

Small, and Guild FMS Representative Jeremy Smith founded and launched the Mona Campus FMS ‗Student Leadership Committee‘, uniting all 7 health professions schools‘ student leadership to drive interprofessionalism and social accountability. Over the year we co-lead three interprofessional health fairs addressing community priority health needs and the National Officer attended the Beyond Flexner Alliance 2018 Conference in Atlanta, GA to present this work.

Medical Education Systems: Education Representation

Medical

In another historical first, SCOME engaged the Faculty in medical education representation this year, specifically with respect to the curriculum. We coordinated medical education student leadership involvement in a curriculum pilot project developing a course in medical Spanish. In March, after two years of development, we submitted a concept note to reform medical education representation with the proposal of a medical education committee cochaired by the Local Officer and MBBS Guild Representative and comprising all five MBBS Class Presidents and a secretariat and auxiliary officers to be appointed as required.

We initiated collaboration among fellow medical school organizations involved in

www.ifmsa.org |

The Americas Heartbeat 36 The Future After serving two terms as National Officer, Nikolai Nunes is succeeded by Nidhi Thomas for the 2018/19 academic year, and with the adoption of the 2018 JAMSA Constitution, it is anticipated that the Western Jamaica Campus (WJC) and All American Institute of Medical Sciences (AAIMS) will be incorporated into JAMSA leading to SCOME‘s phase 3: ‗SCOME to the Nation‘. We are currently developing a proposal to train and certify the incoming

medical student cohort in Basic Life Support (BLS) and Emergency Medical Response (EMS) and finally, the former National Officer has been selected by IFMSA to attend the premier global medical education conference: Association for Medical Education in Europe (AMEE) 2018 in Basel, Switzerland as a Student Task Force Member, another historical first for the UWI and region.

www.ifmsa.org |

The Americas Heartbeat 37

Teaching from the Medicine in PerĂş, a visit to the Medical Education Community

Paul I. Arias Bravo IFMSA - Peru

Summary: In Peru not only requires knowledge and technical skills for the competent exercise of medicine it requires a service attitude, ability to work in teams, interpersonal communication and ethical values.

Currenty with more than 31 million inhabitants, officially has 142 universities (51 state and 91 private) with 25 medical schools (13 state and 12 private) and 33 additional faculties still in process of acceptance there is a notorious advance in research, as well as in different learning methods used by different medical schools that allow to unite the population and promote health.

Keywords Universities, Education, Ethical values.

Introduction Currently students have a different way of studying and learning, they are more independent and questioning, they come from a world saturated with images and with new forms of communication.

Your way of accessing information is fast, unlimited and without much effort but they do not consider the most important thing that is clinical practice.

In the current context it is sought to develop in the medical student knowledge and clinical skills to perform practical procedures, investigate and manage a

patient, as well as clinical judgment and making correct decisions.

Experience based on facts In Peru a person obtains the title of specialist doctor after 11-12 years of study: 7 years in the undergraduate, one year in a social medical service, called the Rural and Urban Marginal Health Service (SERUMS) and 3 to 5 years of medical residency1.

Doctors, after undergraduate, obtain 2 degrees: one professional surgeon and an academic degree of Bachelor of Medicine.

With medical residency, doctors obtain the professional title of specialist doctor.

During undergraduate there are two stages: one of basic sciences and another of clinical sciences where we begin to join different extracurricular activities, one of them is the family of SCOME (Medical Education) that aims to help and improve the intellectual capacity and clinical practice in medical students

The medical education committee receives medical students from different cycles who want to form the family, as well as different activities in order to promote knowledge and improve practical skills before boarding.

SCOME oriented to the student community

www.ifmsa.org |

The Americas Heartbeat 38 Different faculties of medicine in Peru use different methodologies to promote their community.

Among these activities: symposium (interpretation of EKG, talk of Arterial Hypertension, Diabetes, Oncology, etc.), emergency activities for example: Sutures in the first level of care, types of bandage, blood gas analysis and intake, injectable and administration route.

All these activities are carried out with the support of medical teachers or students prepared for the project, sometimes you have special guests from different hospitals that offer their support.

Conclusion The learning associated with the practice is fundamental for the development of a health professional, always taking into account the principles of bioethics The medical education community is a great family in Peru that seeks to provide practical and intellectual contribution, participation in society and development of new skills.

References 1. Castillo G, et al. Comprehensive training in medical schools in Peru: Goal beyond the national exam. FEM 2016; 19: 311

www.ifmsa.org |

The Americas Heartbeat 39

www.ifmsa.org |

The Americas Heartbeat 40

Message from the SCOPH Regional Assistant

Juan Sebastian Valderrama ASCEMCOL - Colombia

Dear SCOPHeroes from the Americas, The Standing Committee on Public Health has been for years a platform created in order to tirelessly work in regards of the public Health issues that we as population are always coping.

Within this standing committee, all our SCOPHeroes have the opportunity to work towards our general aim which is achieve global health. During a year, it is certainly impressive the number of creative documents, campaigns, talks, trainings, etc. that our members create in order to make of this world a healthier one. For that, it is really inspiring to say that we, as medical students, are currently supporting with our knowledge, skills and values to meet the biggest goal that the agenda 2030 has which is â&#x20AC;&#x153;No one left behindâ&#x20AC;?. For that, I would like to invite you to feel proud for belonging to a Federation which is, without hesitation, helping change the world.

Having the opportunity to read all your articles has truly inspired me because once more I realize there are many people out there as motivated as I am to work for this Federation and for the good of our communities.

For the ones who were able to share your thoughts and experiences through the following articles I really have to say thanks for the efforts made since I think your words are going to boost that level of motivation with which you have written it.

Finally I want to say that I feel proud of what we have achieved as region up to date and really want to encourage the reader to go over the whole articles since I think those are ideas worth noticing and spreading.

Without any further word more than a big rib-cracking orange hug.

Juanse.

www.ifmsa.org |

The Americas Heartbeat 41

Time to Prioritize Prevention in the Dominican Republic

Yessi Paulette Alcántara Lembert

ODEM-Dominican Republic

―Treatment without prevention is simply unsustainable‖ − Bill Gates World Health Organization (WHO) define health as a ―state of complete physical, mental and social well-being and not merely the absence of disease or infirmity‖, medical students must consider all aspects of health when they develop projects in health promotion and disease prevention (1). Thus, the top leaders in global health and medicine will include countries with national health systems that emphasize preventive medicine and population health.

Universal health coverage is one powerful concept that favors population health, including attention to marginalized populations with limited access and availability of health care services.

Recognizing health as a human right, the goal is to ensure that all citizens have equal access to health care services, without any financial restrictions. The global move is to achieve universal health coverage by 2030, reinforced by the adoption of the Sustainable Development Goals (2). For any country, achieving universal health coverage requires that a national health system has regular access to medications and well-trained health professionals.

In the Dominican Republic (DR), the national health system depends on health promotion and disease prevention strategies to improve population health. The public health system focuses on vaccination programs, maternal and child health, including prevention and control of infectious (e.g., tuberculosis), chronic diseases (e.g., diabetes) and associated risk factors (e.g., hypertension). Since

health leaders recognize the importance for early and timely disease prevention and control, to favor both patients and health professional staff, these health programs have been successfully implemented and financed.

Case Study: Diabetes. In 2012, the Model of Chronic Disease Care was implemented to provide high-quality health care services to patients living especially in marginalized communities in DR. This model was adapted by the Pan American Health Organization (PAHO), integrating the approach in self-care strategies to improve long-term care and increase longevity and quality of life of diabetic patients. This program documented the results of patients‘ medical visits and progress in the treatment program as well as provided personalized follow-up appointments (3).

Case Study: Tuberculosis. TB remains a significant health burden in the DR, estimated with 59.8 cases per 100,000 persons. However, with an international campaign to eliminate tuberculosis by 2050, the incidence and mortality rates are expected to be reduced by 90 percent (4).

On March 2017, PAHO/WHO collaborated with the DR Ministry of Health to coordinate a symposium that intended to educate medical students about key strategies to target tuberculosis prevention and control.

As future steps in global health, health professionals should understand that they serve as leaders and advocates for strengthening national health systems and promoting the use of evidence-based guidelines in clinical practice.

As physicians-in-training, we must continue to

www.ifmsa.org |

The Americas Heartbeat 42 develop and implement national health campaigns that widely disseminate preventive health messages to reduce risk of chronic and infectious diseases. By prioritizing prevention in patient care, global health systems will be prepared to face any endemic or epidemic disease concern and optimize health care service delivery.

References 1. World Health Organization.

Constitution of the World Health Organization. Basic Documents, th 45 ed., Supplement. 2006.

Available from: http://www.who.int/governance/eb/ who_constitution_en.pdf 2. World Health Organization.

Universal health coverage. Fact sheet. 2016. Available from: http://www.who.int/mediacentre/fact sheets/fs395/en/

3. Pan American Health Organization.

Mejorando el control de los pacientes con diabetes en la República Dominicana.

2015.

Available from: http://www.paho.org/dor/index.php? option=com_content&view=article&i d=1983:controldiabetes&Itemid=213 4. Pan American Health Organization.

La representación de la República Dominicana junto al Ministerio de Salud realizan simposio sobre la prevención de la Tuberculosis.

2017.

Available from: http://www.paho.org/dor/index.php? option=com_content&view=article&i d=2407:la-representacion-de-larepublica-dominicana-junto-alministerio-de-salud-y-launiversisdad-autonoma-de-santodomingo-realizan-simposio-sobrela-prevencion-de-latuberculosis&Itemid=362

www.ifmsa.org |

The Americas Heartbeat 43

IFMSA - UNIG TOBACCO CONTROL

Samuell Santos Ferreira, Tatiane da Silva Santos, Ariele Souza Melo, Lais Bastos Guerra Boechat, Sara Ramos da Silva Guerra, Elisa Freitas Macedo IFMSA Brazil

Introduction: This project highlights the work of smoking prevention and control as a voluntary act of solidarity, which may be spontaneous or linked to a particular patient.

This act is of fundamental importance for the public health world that still suffers great rejection by the population for lack of information. Within this vision, it is of the utmost importance that the future health workers act to raise awareness and guidance of the general population so that there is an ever smaller range of smokers.

Objectives: To develop the knowledge of medicine in tobacco prevention and control, and to integrate them into the context of the doctors and academics involved in the project. In addition to demonstrating to students that medical / public health can and should be done beyond the hospital setting.

Experience report: The campaign was held in the city of Itaperuna, Rio de Janeiro, in May, as a result of the World No Tobacco Day (May 31), in three moments that aimed to train the students about smoking and creation of strategies for the effective approach of the population that was held in the third moment in the free fair of the city, taking the information to the population and registering the smoking patients who wish treatment and that will be offered through a university extension project of IFMSA Brazil UNIG Itaperuna. The power of social networks was used as a fundamental tool as a factor of social development with the use of the hashtag #itaperunasemtabaco so that a greater number of people could be raised.

Methodology: Weekly meetings to plan projects, campaigns and events, with the possibility of participation of university students of various courses, besides the supervision of specialist teachers, the project stimulates the experience of the themes addressed by the World Health Organization (WHO) being smoking the fundamental theme, having the academic as a vehicle for this public awareness, adapting the global theme to our local reality, adapting the approach with focus to the public health of the region, including decentralization of health with support to work carried out in health units family.

Results: actions were organized that stimulated the active participation of the academic to advocate for a social cause, contributing to the development of social protagonism through education beyond the walls of the university, creating an effective public health policy, training how to correctly orient the target population on smoking and the detection of health problems, especially by taking information about disease prevention. In addition to the activities supervised and supervised by the teachers, those involved in this project were stimulated to develop research protocols, seeking to broaden the interest in scientific production and knowledge construction.

Considerations: A communication focused on a humanized praxis is essential to approach issues such as smoking that inform and educate the population to draw people's attention to the importance of prevention. And the fact of being carried out with the protagonism of the students provokes the credibility of the population.

www.ifmsa.org |

The Americas Heartbeat 44

We are still on time: Let’s talk about Diabetes

Ina E. González

ODEM-Dominican Republic

According to the World Health Organization (WHO), approximately 422 million people 1 were reported with diabetes in 2014.

Diabetes is a complex, chronic disease characterized by elevated blood glucose, when the pancreas does not produce enough insulin(type 1) or cannot effectively use the insulin it produces (type 2). It is recognized as a cause of precipitous disability and death, which is why diabetes prevention and early diagnosis are global health priorities. Hence, as physicians, it is important to promote healthy habits that reduce the risk of diabetes and other complications.

In the Dominican Republic (DR) the WHO reported that 9,3% of the population were diagnosed with diabetes, which composed of 4% of all deaths at any age.

Since the prevalence of diabetes has increased, due to factors such as increased weight gain (e.g., body mass index classified as overweight or obese) and 2 sedentary behaviors.

DR health prevention campaigns have use television and radio shows as well as social media technology to emphasize healthy lifestyles for optimal cardiovascular and metabolic 2 health. These programs target all age groups and promote the importance of proper nutrition and routine of physical activities, including health fairs and marathons.

Since uncontrolled diabetes can lead to complications, such as blindness, renal insufficiency, myocardial infarction, cerebrovascular accident, and limb amputations, diabetes care is multifactorial.

Patients should seek medical care from

their endocrinologist as well as other medical specialties, receive appropriate counseling and health education about their disease, and adopt lifestyle choices that optimize their psychosocial health and 3 wellbeing.

The WHO has developed a health promotion strategy in the Americas region called healthy municipalities, which takes four important aspects of daily life, 1) socioeconomic; 2) way of life; 3) environmental health; and 4) health service systems. These activities are implemented in health tents, comprised of weight control, glycemia control, and promotion of physical [4,5] activity and health nutrition seminars.

In Dominican Republic at Dr. Robert Reid Cabral Children‘s Hospital, in Santo Domingo, a pediatric endocrinologist Dr. Elbi Morla Baez developed a manual to serve as a guide, for child and adolescent diabetes control, including glucose levels, insulin doses and proper nutrition. This manual has benefited many children and adolescents, since it has helped them to know and manage their illness in a more 6 easy and committed way.

As medical students, it is our responsibility and commitment to promote healthy habits, physical exercise, and prevention of risk factors related to chronic and metabolic diseases. Patient education about diabetes remains a valuable resource to empower healthy behaviors and reduce risk of developing chronic diseases and related complications. Since we have time, let‘s talk, fight and combat diabetes.

Diabetes education is a resource that saves lives!

www.ifmsa.org |

The Americas Heartbeat 45 References 1. World Health Organization. Global report on diabetes. Geneva: WHO; 2016. http://www.who.int/diabetes/globalreport/en/

Available from: https://www.paho.org/hq/index.php?option= com_content&view=article&id=10691&Itemi d=41985&lang=en

5.

Cimmino K, Matos E, Iglesias M, et al. Municipios saludables: Miradas desde la evaluaciĂłn externa. Washington D.C.: 2.

World Health Organization.

PAHO; 2015. Available from: Diabetes country profiles: Dominican https://www.paho.org/arg/images/gallery/Municipios%20 Republic. Geneva: WHO; 2016. saludables%20Miradas%20desde%20la%20ev http://www.who.int/diabetes/countryaluaci%C3%83%C2%B3n%20externa%2023% profiles/dom_en.pdf 20de%20Septiembre.pdf?ua=1 3.

American Diabetes Association.

6.

Herramientas para el control de la Standards of medical care in diabetesâ&#x20AC;&#x201D; diabetes [Internet]. 2014 [cited 6 Mar 2018].

2018. Diabetes Care. 2018:41:S1-S156.

Listin Diario. Available from: https://www.listindiario.com/la4.

World Health Organization. Latin vida/2014/12/01/347367/herramientasAmerican network of healthy municipalities para-el-control-de-la-diabetes and communities. Geneva: WHO; 2017.

www.ifmsa.org |

The Americas Heartbeat 46

Harm Reduction: strategy for increasing life

Henrique Caetano Mingoranci DENEM Brazil

"Cracolândia drug users in São Paulo dispersed to places near of the Luz region after the action taken on Sunday by the Civil and Military policies of São Paulo with the aim of ending the use of drugs in this area.‖ This excerpt was extract from Globo news portal (G1) on May 22, 2017 and reports one action of the project "Redenção" by João Dória, former mayor of São Paulo. That makes evident how the Brazilians in street situation are commonly treated: as "drug users". Such treatment does not consider their names, histories, health needs or rights, placing the use of psychoactive substances (PSs) as the central role of their lives. However, for pursue Health rights for people in street situation (PSS), it is necessary to have a broader view, with harm reduction (HR) as a pragmatic strategy to guarantee integral care.

The HR was adopted as a public health strategy for the first time in Brazil in SantosSP, in 1989. It was a syringe exchange program for injected drug users, reducing blood contamination and HIV transmission.

Although the HR has initially stood out from those needles distribution, it can be good in many ways, since it considers the uniqueness of individuals, capable of constructing practical strategies for reflection on water consumption, nutrition, safe-sex practices and hygiene care, for example.

Even though no limited to this, HR plays a crucial role in taking care of street people who use drugs. Also, it problematizes the emphasis on a biological, unilateral and repressive approach, the detachment of the health professionals and the common culpability of subjects. It seeks, however, a methodological approach to consider

Individual issues that are responsible for this situation, creating actions aimed to prevention and care, not necessarily reducing its consumption.

Despite their positive achievements, HR policies still suffer great resistance in Brazilian scenario. When discussing use of PSs, the used speech is still of prohibitionist policies, that are linked to dualism of legality/illegality and to the appreciation they offer to capital, mainly through security and pharmaceutical industry. This binomial is based on the biomedical discourse and on actions aimed to public safety that criminalizes the users, like the war on drugs.

The hygienist and repressive approach of João Dória‘s project, disguised as an humanitarian discourse, reduces street individuals to drug users and potential criminals, who should be treated through hospitalization.

Such actions further intensify the vulnerability of these people by treating them in a mental institution, as the government is uncapable of guaranteeing their basic rights.

Therefore, if the State seeks to fulfill its duty to ensure health as a right of PSS, it is necessary to have harm reduction as a guideline for health policies, respecting individual autonomy, deconstructing the unilateral knowledge of health professional and allowing the users to be co-managers to building their care. Only in this way government actions will cease to be punitive and inefficient, being replaced by a strategy that, makes the PSS protagonists of their own history.

www.ifmsa.org |

The Americas Heartbeat 47 References ABREU, D. Consultório na rua e redução de danos: estratégias de ampliação da vida. Rev Bras Med Fam Comunidade.

2017;12(39):1-2.

DENEM DIREÇÃO EXECUTIVA NACIONAL DOS ESTUDANTES DE MEDICINA. Cocult – Coordenação de Cultura. Cartilha de drogas. 2017. 52 p.

Disponível em: <http://www.denem.org.br/cartilhas/Cartilha %20-%20Drogas%20-%20CoCult.pdf>.

Acesso em: 11 out. 2017. OLIVEIRA, R. et

al. Redução de danos no atendimento a sujeitos em situação de rua. Argumentum, v. 7, n. 2, p.221-234, 21 dez. 2015.

Disponível em: <http://periodicos.ufes.br/argumentum/articl e/viewFile/10440/8255>. Acesso em: 11 out. 2017.

PAIVA, I. K. S. et al. Direito à saúde da população em situação de rua: reflexões sobre a problemática. Ciência & Saúde Coletiva, Rio de Janeiro, v. 21, n. 8, p.

2595-2606, ago. 2016.

WACQUANT, L. As prisões da miséria.

Rio de Janeiro: Zahar, 2011.

www.ifmsa.org |

The Americas Heartbeat 48

Horticulture therapy in a medical university in SĂŁo Paulo, Brazil Elise Kanashiro DENEM Brazil

In the beginning of February 2018, a new extracurricular project was created in my university, the Federal University of Sao Paulo (UNIFESP): "Composting and gardening: harvesting health, healthy mind and planet". Idealized

by PhD Luciana Yuki Tomita, it was something entirely new in my campus, a project which wanted to discuss not only sustainability, but also students' health.

The main idea was to start composting with organic waste from the University Restaurant and to use this compost to create a vegetable garden. This way, we'd be able to reduce waste (and its cost) to the restaurant and, therefore, to the university. At the same time, the aim was to create a garden which students could take care of, helping to improve our mental health. As for the composting, the project has been a success, with more than 168 kg of organic waste recycled (until May 2018).

Working on this project has helped me to be less anxious and to actually enjoy my time spent inside university.It seems to me that our current technological immediatist environment has given many people anxiety problems, and even amplified that sort of issue in people who already had them. This can be even worse when it comes to medical students, due to the tiring routine, the heavy amount of studying and the unhealthy competition that surrounds academic spaces. That was exactly my situation when I first started composting and gardening: I was extremely anxious. Not only about university, but also concerning my personal life. And now, three months later, even thoug I am still anxious, it's something much more controlled, that doesn't interfere in my routine.

Taking care of plants, which donâ&#x20AC;&#x2122;t grow immediately, was essencial to anchieve this. It's necessary to seed and then to water the seedlings for days, maybe weeks, before being able to actually see some result, the daily routine itself can help dealing with stress. I realized that when I was tired of studying, taking a break to go water the plants really helped me to be less tense and to go back to studying almost fresh new. Besides, not only students take care of the vegetable garden - university employees also help. Being a part of this has definitely enhanced my sense of community, something important when there are days I spend more time at UNIFESP than at home. My routine became lighter and the university became cozier once I started to get to know professors, laboratory technicians and cleaning workers by their names.

All united because of gardening.

So that's why I say that having a green finger has improved my health. To conclude, I want to emphasize the importance of initiatives that are concerned with medical student's health, like this one.

www.ifmsa.org |

The Americas Heartbeat 49

LET'S TALK: EXPERIENCE REPORT Gabriel Alves de Godoy, JosĂŠ Roberto Scalone Barbosa and Samantha Mendes Vidal Dantas IFMSA Brazil

According to WHO, every 40 seconds a person dies of suicide in the world. In 2012, the UN pointed out that suicide is the second leading cause of death among young people aged 15 to 29 years, where the highest prevalence occurs in low- and middle-income countries.

In Brazil, suicides increased from 5.3 to 5.7 per 100,000 inhabitants in the years between 2011 and 2015. In addition, physicians and medical students have suicide rates higher than the general population in the country. The profession requires heavy workload, sleep deprivation, difficulty with patients, unhealthy environments and information overload, where all these factors contribute to the individual's psychological suffering. These data draw attention to this serious public health problem and, in view of that, the local committee of the Centre University Mauritius of Nassau of IFMSA Brazil, has created a campaign to address this context with the medical students of the university itself.

The campaign was elaborated in a project format, being executed in seven different days. In the first six days, groups of approximately twelve students met with three psychologists to hold a collective debate about their experiences, anguish, and perceptions about undergraduate medical course. Each meeting lasted around three hours. Already on the seventh and last day, all the participants, from the 6 different groups, were able to join in a big meeting to discuss their experiences with the action.

According to the discussions that took place during the project sessions, the fact that most medical students tend to dedicate themselves excessively to the university and little to other areas of their life was confirmed. This is often because the medical course, in addition to having a high daily workload, also places high expectation for undergraduates to have high level extracurricular activities, with monitoring, extension projects, publications, voluntary activities etc. The biggest complaints reported by the students were: sleepless nights; intense anxiety; lack of time for social life; extreme tiredness and lack of family and friends outside college. In addition, many exposed that the heavy routine and high hours dedicated to activities linked to academic training prevented them from trying to have a healthier lifestyle, leading to poor diet and sedentary lifestyle.

The project, in addition to breaking taboos related to depression and suicide among medical students, also emphasized the importance of psychological and psychiatric care in this public. The participants praised the initiative because, when they realized that they were not alone, and that others also shared the same fears and charges, they motivated themselves to seek new ways of dealing with the issues they faced. Thus, it was evident the contribution of adequate mental health care, both in reducing the rates of depression and suicide in the academic environment, and in improving the quality of life of the students themselves.

www.ifmsa.org |

The Americas Heartbeat 50 References:

1. - Nações Unidas do Brasil. OMS: suicídio é responsável por uma morte a cada 40 segundos no mundo. 2016. Disponível em: https://nacoesunidas.org/omssuicidio-e-responsavel-por-umamorte-a-cada-40-seg undos-nomundo/

Médicos e Estudantes de Medicina: Revisão de Literatura. 2016. Disponível em: http://www.scielo.br/scielo.php?pid=S0100 -55022016000400772&script=sci_abstract &tlng=pt 3.

- Medscape. Meta-análise mostra prevalência de ansiedade, depressão e uso de álcool entre estudantes de medicina brasileiros. 2018. Disponível em: https://portugues.medscape.com/verartigo/ 6502151

2.

- SANTA, Nathália Della and CANTILINO, Amaury. Suicídio entre

www.ifmsa.org |

The Americas Heartbeat 51

Public health makes better physicians

Lilian Teresa Pimentel González ODEM-Dominican Republic

‖Alone we can do so little, together we can do so much‖ − Helen Keller Public health is the science of protecting and improving the health of people and their communities. Commonly, physicians are trained to acknowledge the importance of clinical medicine: diagnosing illnesses, treating diseases, and relieving the pain and discomfort of our patients. For this reason, the International Federation of Medical Students‘ Associations (IFMSA) Standing Committee on Public Health (SCOPH) promotes prevention of disease, increased access to health care services, and elimination of health inequalities. This early connection with public health will strengthen health professions education and train responsible physicians to promote health at the individual and community level (1). Hence, physicians who practice evidence-based medicine and understand the strengths and limitations in their communities will deliver high-quality care.

In Latin America and the Caribbean, the leading cause of mortality is cardiovascular disease (2).

This epidemiological transition is characterized by non-communicable diseases (NCDs) replacing the burden of communicable diseases (CDs). The Dominican Republic (DR) is not far from this reality, where 70% of all deaths are attributable to NCDs and secondly to CDs. Strategies have been made to target these health issues. For instance, between 1990 and 2015, the infant mortality decreased 50.3%, health coverage went from 43% to 65%, and the national immunization program expanded coverage to almost all communities (3).

However, DR

Health authorities still report gaps in health access in marginalized communities as well as elevated maternal and child mortality rates. Thus, the design of prevention programs must take into account health determinants, such as poverty, education, and inequities, which in turn requires physicians to understand the country‘s profile and current situation.

SCOPH members are active in an estimated 19 countries in the Americas region, including the DR. This committee allows medical students to act locally, fight against diseases, spread awareness, and promote health care growth. SCOPH activities focus on educational outreach regarding environmental health, social discrepancies, advocacy and disease prevention. Because of this wide scope, members of the Dominican Medical Student Organization (Organización Dominicana de Estudiantes de Medicina, ODEM) have collaborated on various public health issues, such as pediatric health, immunizations, tobacco cessation, sexual and domestic abuse, suicide awareness, and vector-borne disease prevention and control.

As a SCOPH leader in ODEMDominican Republic, I strongly believe that our SCOPH members have significantly contributed to medical education in the DR. Members have completed numerous activities, including community outreach, educational and awareness campaigns, skill-building workshops, and academic conferences. Many activities have been included collaborations with other National Member Organizations (NMOs) from countries of the Americas region. As John Maxwell described that ―Teamwork makes the dream work‖, I believe that when health leaders act together towards a common

www.ifmsa.org |

The Americas Heartbeat 52 objective, population health outcomes can be enhanced.

In summary, SCOPH members will change the future health care system. With new daily challenges in health care service delivery, we have the opportunity to develop innovative health initiatives that can positively impact the health and quality of life of our communities.

References 1. Gillam S, Maudsley G. Public health education for medical students: Rising to the professional challenge. J Public Health (Oxf).

2010;32(1):125â&#x20AC;&#x201C;31.

2. Pan American Health Organization, Health in the Americas, 2007.

Washington, DC: PAHO; 2007.

Available from: http://apps.who.int/iris/bitstream/ha ndle/10665/170245/healthamericas-2007-vol1.pdf;jsessionid=5D79BD70C4259 EDE470074E91E974E25?sequenc e=23. Pan American Health Organization. Country report: Dominican Republic [Internet].

2017 [cited 2018 May 24]. Available from: https://www.paho.org/saluden-las-americas2017/?page_id=115

www.ifmsa.org |

The Americas Heartbeat 53

EXPERIENCE REPORT: PROBLEM-BASED LEARNING AS AN ACTIVE METHODOLOGY OF TEACHING-LEARNING PROCESS OF FIRST AID IN MUNICIPAL SCHOOLS OF SANTO ANTÔNIO DE JESUS – BA, BRASIL

Yago Vinicius de Santana Brito Lígia Maffei Carnevalli Jaynne Silva Borges Tayana Santos Barbosa Reisyanne Cristinne Santos Lopes Mauricélia dos Santos Sibele de Oliveira Tozetto Klein Clara Maia Bastos Lírio IFMSA - Brazil Accidents are unintentional episodes that can cause injuries of different degrees of complexity, even possibly leading to death (COELHO, 2015). The main causes of complications are the lack of medical service and inappropriate medical care.

Therefore, to prevent deaths and sequelae from happening, the use of proper first aid techniques is essential (VECCHIO et al., 2010). With this in mind, it is possible to think about places that are more favorable to accidents, like the school environment, so it is important for the school staff to be prepared to deal with situations where first aid techniques are required (COELHO, 2015). However, that is not what usually happens in Brazil. Education workers have neither training nor information about the subject, what can lead to a nonperformance of first aid techniques, to the wrong manipulation of an injured person or even actions that could aggravate the situation (FIORUC et al., 2008). Taking this problem into consideration, members of Educational Program through Work for Health (PET) at Reconcavo Federal University of Bahia developed a minicourse for the school workers in the area. In these ways, the objective of this article is to describe the perception of these medical students during the course, about the knowledge on first aid by school staff of municipal schools in Santo Antônio de Jesus – Bahia, Brasil. The Problem-based

Learning methodology was used, including theoretical stations with open discussions on situations that could occur in such environment and, subsequently, practical stations were developed for a better understanding of some first aid techniques.

The first part of the course was characterized by the enormous amount of questions and by the remarkable insecurity presented by the workers. The main questions were related with regular problems that occur in schools and around the neighborhood, like epistaxis, fainting and fractures. During the discussion, it was noticeable that even calling the emergency services was a hard task, due to the lack of familiarity about the theme, revealing how unprepared these workers are.

During the practical station, some maneuvers and scenarios were demonstrated, from approaching the victim to providing medical care. For example, manikins were used to train the techniques to be used in the event of a cardiopulmonary arrest. In general, the discussions were substantial and full of real cases lived by the professionals, demonstrating the concern and the necessity familiarizing these workers with this subject. In conclusion, the knowledge of first aid techniques by education workers is insufficient, and it requires better access to the issue to improve the knowledge and the techniques, considering how relevant that information is for students and teachers in aiming the prevention of predictable

www.ifmsa.org |

The Americas Heartbeat 54 accidents. In the end, it was possible to notice greater confidence by the professionals to discuss and act before urgent and emergency situations, however

is important to highlight that for themes like these, the health education must be updated so workers can be constantly in touch with the issue.

www.ifmsa.org |

The Americas Heartbeat 55

www.ifmsa.org |

The Americas Heartbeat 56

Message from the SCORA Regional Assistant

Gabriela Cipriano IFMSA Peru

Dear Reader, It is my pleasure to introduce to you the amazing and eye-opening articles that the Scorangels from the Americas have written for this edition of Americas Heartbeat.

While reading you will experience firsthand all the passion and motivation that characterizes American Scorangels who fight every day for the full recognition of sexual and reproductive rights of our people within their local associations and NMOs. You will discover the different barriers we face daily, the stigma and discrimination we have to endure but not everything is bleak, since you will find the creative solutions we have come up with to overcome the obstacles and the strength to do so. To help you remember a little, the topics you are about read are related to the five focus areas of Scora which are the following: 1. Comprehensive Sexuality Education 2. Maternal Health and Access to Safe Abortion 3. Sexuality and Gender Identity 4. Gender Based Violence 5. HIV and other STIs

These articles aim to reach the Scora Vision which is a world where every individual is empowered to exercise their sexual and reproductive health rights equally, free from stigma and discrimination. But how do we do this? By providing our members with the tools necessary to advocate for sexual and reproductive health and rights within their respective communities in a culturally respected fashion. This has been accomplished through building the skills and the knowledge about, providing trainings on Comprehensive Sexuality Education other respective reproductive health issues, exchanging ideas and projects, as well as drafting policies and working with our external partners in order to create change in local, regional and international level With this concise explanation, now I invite you to take a moment off your day, relax, and come enjoy a little piece of reading we have prepared for you because you will not regret it.

Remember, prejudice!

live

and

love

Gabriela Cipriano

www.ifmsa.org |

without

The Americas Heartbeat 57

Light a candle and erase a prejudice: a history of the fight against HIV/AIDS

Leonardo GuimarĂŁes de Almeida IFMSA Brazil

The International AIDS Candlelight Memorial Day began in 1983 during a time of confusion and misconception about a mysterious disease that was sweeping the gay community in San Francisco, United States of America. Four young - Bobbi Campbell, Bobby Reynolds, Dan Turner and Mark Feldman - knowing that they would die within a year and without political support, decided to put a "face to the disease", coordinating a little vigil behind a banner with the words "Fight for our lives".

The first coordinators planned a parade with many posters. Others gathered, holding a "candlelight" event, which attracted thousands of people. In this way, began a movement that would inspire countless other people living with HIV and AIDS in other countries: the International AIDS Candlelight Memorial. This ultimately led to HIV in the light of the discussions, attracting the attention of local, regional and national communities, not to mention the leaders who joined the cause. In addition it sought to promote, support and move people against prejudice with those who have the disease. More than thirty years after these movements, more than 33 million people live with HIV in the world, the International AIDS Candlelight Memorial acts are an important intervention for global solidarity, breaking stigma and discrimination barriers and providing hope for the new generations.

Regarding Brazil, the history of the disease began in 1980 with the registration of the first case of a carrier in the country.

Over the past 35 years, the number of people infected has increased exponentially.

According to the Epidemiological AIDS Bulletin, published by the Brazilian Ministry of Health, since the beginning of the AIDS epidemic in Brazil up

to June 2015, 798,366 AIDS cases were registered.

In addition, it is verified that in the first fifteen years of the epidemic there were 83,551 cases, with a more pronounced concentration in the capitals of the South and Southeast and in some municipalities of the state of SĂŁo Paulo. In the period from 1995 to 2004, there were 304,631 cases, with an increase in the concentration of cases, mainly in the capitals of the Northeast and Midwest and two capitals in the North. In the period from 2005 to June 2015, 410,101 cases were recorded, observing that the distribution of cases expands throughout the national territory.

Based on these data, in 2016, five local committees of IFMSA Brazil came together to hold a large multicenter campaign on the model of the International AIDS Candlelight Memorial. More than 1,000 people were affected in all regions of Brazil. The methodology used by the medical students consisted in the approach of the population that passed through public places, where they were invited to light a candle in honor of those who died as a result of AIDS and then were educated about the disease, in order to "turn off the candle" of their prejudices. The topics of health education consisted of: prevention, transmission and diagnosis of AIDS through the rapid test, in addition to encouraging people in the fight against prejudice of the carriers. The candles were placed on the symbol of HIV / AIDS, where the largest was 30 meters long.

Finally, such campaigns are effective in raising awareness of preventive methods, effective use of condoms - which have also been distributed to those who were passing by the campaign place- and in the fight

www.ifmsa.org |

The Americas Heartbeat 58 against prejudice. Infection with the AIDS virus can be prevented. People with HIV / AIDS are equally humans as who are not infected. In this way, this type of action aims to promote the change that we want to see. Thus, join us, light a candle and erase a prejudice.

MINISTÉRIO DA SAÚDE DO BRASIL (Brasília). Boletim Epidemiológico HIV/AIDS 2015. Novembro de 2015.

Disponível em: http://www.aids.gov.br/sites/default/file s/anexos/publicacao/2015/58534/boletim_ai ds_11_2015_web_pdf_19105.pdf. Acesso em: 20 dez. 2016.

References:

www.ifmsa.org |

The Americas Heartbeat 59

IDAHOT in AMMEF A.C.

Estefan Rubi Arispuro Arellano AMMEF - Mexico

In the framework of the International Day Against Homophobia, Transphobia and Biphobia, the Asociación Mexicana de Médicos en Fomarción AMMEF A.C. by the SCORA Committee, decided to carry out a week of open training sessions for our active members by Webniars, given by highly qualified people in the country, as well as former members of IFMSA. The topics that were given were: ∙ Hate crimes: Expressions and prejudices towards sexual diversity: This topic was to train our LORA's in the occurrence of hate crimes in our country, in the expressions that we often think are not discriminatory when they are and, above all, to place them in the current perspective of our country in terms of gender diversity. ∙ Intersexuality and diverse families: In order to train our LORA's in the legal, psychological and social aspects of talking about homoparental families, this topic was given by a representative of a diversity group from a state with one of the greatest impact in the country. ∙ Equity in the health of LGBTTTIQA people: We can talk a lot about equality, equity and nondiscrimination, but are doctors really capable of taking care of people from the LGBTTQQA community?

In this

presentation a doctor explained us the basic rules that any doctor should know about how to give quality medical attention. ∙ Contemporary vision: trans identity vs. mental disorders: Maybe you do not know this project because SCOMP is in a few parts of the world, however, it is a super enriching project, in which you created a discussion panel to analyze an article, in this case was "Removing transgender identity from the classification of mental disorders: A Mexican Faithful Study for ICD-11 where each person expresses their personal point of view on the subject and a kind of debate is created in which all the perspectives are taken into account until it is reached a conclusion as a whole. In this case, the article provides additional support for classifying health-related categories related to transgender identity outside the classification of mental disorders in the ICD-11.

The training of our LORA's has become the most priority task of my work as NORA, because if we want to generate a change, we must be highly trained, that is why the importance of our first intervened peolple are medical students, so they know how to approach the general population and make true changes in our activities, but without forgetting that our first field of work is to give our members the skills and resources to be health leader

www.ifmsa.org |

The Americas Heartbeat 60

Health without bias or prejudice.

FĂĄtima Andrea RodrĂ­guez Osorio IFMSA Guatemala

What do you do when you have health problems? You fall off the bike, a cold, and stomach pain by eating too much, the hangover of the feast, the unbearable pain of your period or unexplained symptoms that require medical attention. Do you like the idea of going to a public hospital?

Go to one of those gigantic hospitals crowded with sick people that show us in the news and newspapers. Suppose that you are going and when you get to the external consultation, do a great row on the outskirts and expect from 2 to 4 hours for you to attend. While you're waiting, you realize many things: there are no inputs, there is overcrowding, there are employees who do not work, doctors go from top to bottom, nurses are in a bad mood, the guards tired or abusing their authority.

Among all this, there is something that passes in front of all: discrimination and illtreatment of patients by their economic status, sexual orientation, or being a woman.

That the discrimination and marginalization of patients is more common than we might imagine; it happens, above all, when people are not treated properly in the first level of the health system (health posts) and should arrive at the large national hospitals. In our health care system, in the 21st century, the machismo is still alive and in force.

For example, when a woman sees the health post, the husband usually accompanies you and be the one who responds to questions of the doctor. Many times, if it is answered by a man, the family (and again the husband) prohibit you continue with the treatment. We also have the typical "lady" to refer to the doctors, because it is not yet conceived the idea that

women can be doctors. The taunts of the gynecologists to women by the pain of childbirth, the incomprehension of the shame and pain of the patients to talk about your period or sexual life, the fear felt by the internal/external to be harassed by their "superiors" or professors.

A day in which men and women, around the world and mainly in Latin America, took to the streets under the same ideal: "Not one more", that is to say: not one more woman murdered, sexual harassment, violence of any kind or feeling that is worth less than a man.

Here it is not a question nothing more than "try again" or "make the effort", we must commit ourselves, work and be consistent with this ideal; an ideal that also encompasses health for all, nondiscrimination or exclusion of hospitals and a halt to the violence of gender in medicine.

Because all the struggles that we do for a more just society and a decent health care system, they are also so there is no more boys and girls who are victims of malnutrition, innocent people killed by violence and inequality, for the attention to be for allâ&#x20AC;Ś for the peoples, for the LGBTI community, for the Mormons, evangelicals, Catholics, Jehovah's Witnesses, workers, sex workers, professionals, vendors and to gangs.

Like any ideal that guides our struggles and work, it must be accompanied by a realistic attitude, to recognize the time and the reality in which we find ourselves.

We are still far, how far are we from hospitals supplied and to respond in a timely manner to patients, to prohibit and

www.ifmsa.org |

The Americas Heartbeat 61 condemn the child marriage or that we can talk about sexuality in the schools.

Distant glimpse even the "not one more" in our Guatemala, how to see the HIV infection eradicated in our country, eliminate discrimination and the repudiation of our peoples, to the LGBTI community, people with HIV or to the poor. Product of exclusionary policies, corrupt doctors, misdirected and customs unions and imaginary indifferent, full of fear, ignorance and hatred among Guatemalans.

The fight against the dragon of 6 heads (corruption, machismo, indifference, fear, intolerance and greed) has to be waged from every area of society, from our homes,

neighborhoods, schools, churches, jobs, universities, associations and cities. That is why, as medical students, we are struggling in the world, in Latin America and in Guatemala by health, respect, tolerance, openness, dialog, inclusion, training and transformation of the imaginary of the medical students and health professionals.

In this struggle, we are not alone, but dispersed; in our case, divided into 5 committees seeking the construction of a system of universal health care.

"I strongly believe that respect for diversity is a fundamental pillar in the eradication of racism, xenophobia and intolerance." Rigoberta MenchĂş.

www.ifmsa.org |

The Americas Heartbeat 62

Group Of Expecting Mothers: Return Of The Female Protagonism In Childbirth.

Israelita Tihara de Almeida Sussuarana; Juliana de Almeida Portela; Raul José Almeida Albuquerque.

DENEM Brazil

INTRODUCTION AND OBJECTIVE Brazil occupies the first place of countries that perform cesareans, and the number of maternal death has only grow in the past decade. Cases of bad obstetric services are common in the country, due to either negligence or the lack of update in medicine based on evidences. The experience accomplished during the National Meeting of Medicine Students – ECEM 2015 was able to make the academics dialogue with women that were pregnant or just hade babies and their relatives, about the humanizing of the natural childbirth.

METHODS

number of women who gave birth with medicine academics. At that meeting, people introduced themselves and discussed about the topic, and after that, a member of the group made an introduction about the subject. Then, the participants made questions. This activity occurred in a day, during the morning.

RESULTS AND CONCLUSIONS Medicine students had the opportunity to listen to critical opinions from women about the bad obstetric services, concluding that mother‘s protagonist about their pregnancy is fundamental to the good obstetric procedures.

The performed activities during the meeting Gestar&Amar were able to integrate a large

www.ifmsa.org |

The Americas Heartbeat 63

Congenital Syphilis in Panama: A Fight We Continue Losing.

Joritzel Ailyn Quijano Scott IFMSA Panama

Syphilis infection is a major public health problem that affects women and their newborns directly and, consequently, the whole community. Between 50% and 80% of cases of gestational syphilis end in an adverse way: they can cause abortion, fetal death, neonatal death, premature birth, low birth weight and congenital infection with varying degrees of affectation and consequent disability.

Effective and affordable interventions are available for the prevention of mother-tochild transmission of syphilis. These interventions contribute to reducing maternal and neonatal morbidity and mortality. They also contribute specifically to the fulfillment of the Millennium Development Goals MDG 4: Reduce child mortality; MDG 5: Improve maternal health; and MDG 6: Combat HIV / AIDS, malaria and other diseases. However, despite the fact that some countries in the Region have made significant progress towards the elimination of mother-to-child transmission of congenital syphilis as a public health problem, significant gaps persist in other countries.

In Panama, prenatal care coverage was 88% for 2013. The percentage of pregnant women screened for syphilis did not exceed 33% in 2014, obtaining a percentage of 1.16% of positive results in the syphilis test.

Finally, by 2015, 61% of pregnant women positive for syphilis receive appropriate documented treatment in our country. 70% of pregnant women with syphilis infection had adequate documented treatment for syphilis, in the 2013-2015 period.

The appearance of congenital syphilis reveals structural and technical deficiencies of the health services, being reflected in the number of reported cases of congenital syphilis and calculated rates of congenital syphilis in Panama in the period of 2009-

2016: 32 cases for 2008, with a rate of 0.46 per 1000 live births; 113 cases for 2013,

with a rate of 1.50 per 1,000 live births; 104 cases for 2014, with a rate of 1.38 per 1,000 live births; 83 cases for 2015, with a rate of 1.10 per 1,000 live births.

In 2015, Panama was cataloged as "in progress towards the goal of the elimination of mother-to-child transmission of syphilis".

In regards to all these important facts, it‘s remarkable that there´s still a lot to address on the way to eliminate Congenital Syphilis in Panama, as in the Americas. There shouldn‘t exist any valid justification for such poor compliance with health policies and the incompetence of health services towards prenatal care and follow-up. In addition, the lack of education among the population, especially pregnant women, leads to an increase in the numbers we continue watching on institutions reports.

Being aware of the magnitude and depth of this problem that arises from the communion of multiple factors, my dear Panama and our beloved region must have an aggressive and more effective action plan to achieve success in this undesirable panorama of public health.

References Organización Panamericana de la Salud.

Iniciativa regional para la eliminación de la transmisión maternoinfantil de VIH y de la sífilis congénita en América Latina y el Caribe: documento conceptual. . [Internet].

Montevideo, Uruguay: CLAP/SMR; set.

2009. [Citado el 20 Nov. 2017] Disponible en:

www.ifmsa.org |

The Americas Heartbeat 64 https://www.unicef.org/lac/Documento_Con ceptual__Eliminacion_de_la_transmision_maternoin fantil_del_VIH_y_de_la_sifilis_congenita(2). pdf Organización Panamericana de la Salud.

Eliminación de la Transmisión Maternoinfantil del VIH y la sífilis en las Américas. Washinghton, D. C.: OPS; 2017.

Pág. 39. Actualización 2016. ISBN: 978-9275-11955-6 Organización Panamericana de la Salud.

Eliminación de la Transmisión Maternoinfantil del VIH y la sífilis en las Américas. Washinghton, D. C.: OPS; 2017.

Pág 47. Actualización 2016. ISBN: 978-9275-11955-6

Organización Panamericana de la Salud, Organización Mundial de la Salud.

ORGANIZACIÓN MUNDIAL DE LA SALUD 50.° CONSEJO DIRECTIVO [Internet].

Washinghton, D. C., EUA: PAHO. 2010 [Citado el 19 Nov. 2017]. Disponible en: http://www1.paho.org/hq/dmdocuments/201 0/CD50-15-s.pdf Organización Panamericana de la Salud.

Eliminación de la Transmisión Maternoinfantil del VIH y la sífilis en las Américas. Washinghton, D. C.: OPS; 2017.

Actualización 2016. Pág 30. ISBN: 978-9275-11955-

www.ifmsa.org |

The Americas Heartbeat 65

Comprehensive Sexuality Education in Latin America: Urgent need for action?

Luis Torres FEVESOCEM Venezuela

Comprehensive Sexual Education is a tool that empowers human beings to achieve their goals, to plan and decide on their future (1). Even in our time, accepting, understanding and recognizing sexuality has been difficult.

In Venezuela, there is an epidemiological profile that shows the persistence of problems that mainly affect the health of women and that are a product of gender inequalities and poverty: maternal mortality, high fertility rate in poor areas of the country, persistence of social and economic gaps for women to access services, among others (2). Although there are regulatory frameworks that reflect the exercise of sexual and reproductive rights assumed in different national and international commitments, the services and strategies for this purpose have not been enough.

In Latin America, sex education has been particularly controversial.

In diverse countries and periods, the various sex education initiatives proposed to the formal system, have been met with resistance by hard core conservative groups, thus effectively thwarting its dissemination and consolidation. (3)

stimulating others to sustain and initiate sexual relations. Sexuality is an integral component of the human being, sexuality includes emotions; our personal expression, the way we talk, how we dress and relate is sexuality. We need to ensure the effective implementation from early childhood of comprehensive sexuality education programs, recognizing the emotional dimension of human relationships, with respect for the evolving capacity of boys and girls and the informed decisions of adolescents and young people regarding their sexuality, from a participatory, intercultural, gender sensitive, and human rights perspective (4) The beginning of this process requires the identification of the obstacles to overcome and the conviction of the need for a change in the vision of sexuality and the educational fact. For the fulfillment of the educational work in the area of sexuality, the SCORAngels trained as multipliers in our focus areas fulfill and will continue to play a leading role.

The approach to the topic of sexuality is still a source of anxiety and fears, not so much because of lack of knowledge as because of the presence of deeply-rooted sociocultural patterns, in which the topic is excluded from family conversations, with children and even with the couple, because it is considered "inappropriate".

We still believe that if we talk about sexuality we are encouraging and References:

www.ifmsa.org |

The Americas Heartbeat 66 1.

70% of students in Latin America do not have comprehensive access to sexual education [Internet]. Plataforma LAC. 2017 [cited 2018 Jun 3]. Available from: https://plataformalac.org/en/2017/04/70-ofstudents-in-latin-america-do-not-havecomprehensive-access-to-sexualeducation/ 2.

UNFPA Venezuela | Educacion de la Sexualidad y Salud Sexual y Reproductiva - GuĂ­a para Docentes [Internet]. [cited 2018 Jun 3]. Available from: http://venezuela.unfpa.org/es/publicaciones /educacion-de-la-sexualidad-y-saludsexual-y-reproductiva-gu%C3%ADa-paradocentes

3.

The Major Project of Education in Latin America and the Caribbean (19802000) | United Nations Educational, Scientific and Cultural Organization [Internet]. [cited 2018 Jun 3]. Available from: http://www.unesco.org/new/en/santiago/pre vious-international-agenda/the-majorproject-of-education-1980-2000/ 4.

Comprehensive Sexuality Education in Latin America. State of the Art, achievements and challenges ScienceDirect [Internet]. [cited 2018 Jun 3].

Available from: https://www.sciencedirect.com/science/artic le/pii/S1743609517306161

www.ifmsa.org |

The Americas Heartbeat 67

SCORA in AEMPPI Ecuador.

Maria Paz Lasso AEMPPI Ecuador

In Ecuador, we have participated in various campaigns on sexual and reproductive health.

In March, we participated in the global HPV campaign #GiveLoveNotHpv, we sent videos made by medical students and we shared campaign posters in social networks.

In April, we participated in the international campaign for the International Day for Maternal Health and Rights #SafeMotherhood # IntlMHDay2018 sending several photos of the members of SCORA of AEMPPI holding a poster with statistical data on maternal health.

In May, we organized a national project on gender based violence called "Open your eyes" which had a greater impact than expected, since the project was published in several newspapers in the country. For this project, the LORAs made posters with statistical data on gender based violence that were published on the AEMPPI Facebook page as part of a media campaign; later, medical students received training on what gender based violence is; then they participated in a community awareness campaign in which participants put on makeup with bruises and with

posters of statistical data and images about the gender based violence and gave information about this topic to the community; also they carried out social experiments.

In addition, local projects have been carried out on HPV, STIs, male sterility and childbirth in several cities. The experience has been enriching due to controversial issues have been addressed which allow us to know different points of view, we have also opened the eyes of several people regarding gender based violence and we have learned to solve conflicts and work as a team.

SCORA is a family in which there is no discrimination and that creates safe spaces in which everyone can give their point of view without being judged.

In Ecuador sexual and reproductive health still have a long way to go, however with the various initiatives and teamwork it will be possible to open the eyes of many people and an impact will be achieved that will eventually grow and produce great changes.

www.ifmsa.org |

The Americas Heartbeat 68

www.ifmsa.org |

The Americas Heartbeat 69

Message from the SCOME Regional Assistant

Jose Espino IFMSA Panama

â&#x20AC;&#x2022;Of all the forms of inequality, injustice in health care is the most shocking and inhumaneâ&#x20AC;&#x2013; Martin Luther King.

The human right to health means that everyone has the right to the highest attainable standard of physical and mental health, which includes access to all medical services, sanitation, adequate food, decent housing, healthy working conditions, and a clean environment.

Throughout almost all recorded history and virtually every place in the world, being a doctor means something special. People go to the doctor to ask for help for their most urgent needs: relieve pain and suffering and regain health and well-being. They allow the doctor to see, touch and manipulate every part of his body, even the most intimate; they do it because they have confidence that their doctor will do it for their own good; as SCORPions as well as medical students, we have the mission to show to other this beautiful fact: vocation.

The right to health contains freedoms.

These freedoms include different examples: the right to be free from non-consensual medical treatment, such as medical experiments and research or forced sterilization, and to be free from torture and

other cruel, inhuman treatment or punishment.

or

degrading

From SCORP, in order to meet the expectations of medical students, it is important that physicians know and show the core values of medicine, especially compassion, competence and autonomy.

These values, together with respect for fundamental human rights, serve as a basis for medical ethics.

Then we have to ask ourselves, if the National Efforts to reach Universal Health Coverage have the highest attainable standard based on human rights, because we have the right to health with equality, ethic, equity and without discrimination, respecting physical and mental health, because health is unconditional right to be healthy.

Fortunately, we are the change in our health system, recognizing the patients with their rights, feelings and emotions, because the patients are the reasons why you chose to take a medical career.

Jose Espino

www.ifmsa.org |

The Americas Heartbeat 70

â&#x20AC;&#x153;Write my voice, wanna be my hero â&#x20AC;?

Lesly Gonzalez IFMSA Peru

International Children's Day with Cancer was coming and we really wanted to make them feel loved and happy. The initiative was to bring a little joy to a group of little angels who show us every day the importance of life and the struggle that they and their parents represent.

For us, as future health practioners, it is important to be able to make a change from the beginning of our training, that is why in this activity was done; we participate with students from the first to the last cycle of medicine from my university.

There were many interested guys and we received quite a few applications. Under a personal interview we were choosing those who were going to accompany us in this beautiful adventure. And so 20 brave people emerged.

We had to be prepared to face the reality with our patients and that is why we trained on the subject with a specialist and prepared all the materials to use with the children.

- Raise awareness among the population about the importance of adequate palliative care.

- Provide more information to the family member about the patient's illness. and all this sharing a pleasant moment with them and their relatives.

The fact of studying medicine gives us the opportunity to be able to do something for people and help those who need it the best way possible, but often this is not enough, we need beyond being good doctors, to be what the world needs .

I have always believed that when you make decisions to improve your life, you are in a perfect position to improve the world of those around you.

Scorp we will have the doors to be able to do something for ourselves and for others, fight together to defend our and the rights of all, in different ways together we can achieve change.

Our General Objective was: - To measure the level of overload in the caregivers of our patients, since the constant struggle is as much of them as of their relatives And for that reason our specific Objectives were: - Improve the Patient-Family relationship.

www.ifmsa.org |

The Americas Heartbeat 71

About Human Rights: What’s happening in Guatemala?

Daniel Andrés Sierra García IFMSA Guatemala

When it comes to Human Rights, we just need to read the news and notice the importance of it. Inequality, violence, discrimination, conflicts & poverty are part of world‘s everyday reality. Somehow, societies have blinded to these problems, and don‘t give it the importance it deserves.

70 years ago, Universal Declaration of Human Rights was signed. The first words of this international agreement: ―all the human beings are born free and equal in dignity and rights‖, remain today as relevant as it were in 1948. The Declaration constitutes the foundations of a just and dignified future for all, and offers all human beings a powerful instrument in the fight against oppression, impunity and insults to human. But, sadly, today‘s world is not what United Nations General Assembly dreamed in 1948.

Guatemala is the ninth most unequal country in the world, with a Gini coefficient of 52.4 according to the World Bank. 10% of the rich population concentrate about the 40% of the country‘s wealth, while the 10% of the extreme poor population have a little more of the 1%. More than 50% of the population lives in poverty, and 13 of every 100 personas lives in extreme poverty, with less than US$1.5 per day. 71% of our people live in the rural area, and these people suffer the most unequal opportunities; 74.8% of the indigenous lives in poverty and 47% of the kids of this social group have to work instead of studying.

43% of the kids suffer of chronic undernourishment. In the health field, the maternal mortality rate is 219 per 100000 live births, and it affects by the double to the indigenous mothers. Low birth weight incidence is 11.4% at national level, and under-one mortality rate is 34 per 1000 live

birth. Even when 80% of the population has access to the national health system, it doesn‘t guarantee their protection, can‘t solve their heath issues, doesn‘t respect the social relevance, quality of services is not good and the health care centers are saturated. In 20 years, the inversion on health system is under 3% of the gross domestic product, and it represents 16% of the public investment of the State. It‘s a national crisis!

We are a generation that is not afraid of change, that‘s why we are able to make the change the world needs. Based on what Eleanor Roosevelt said, Human Rights begin in small places, close to home, the neighborhood, the collage… places where every man, woman, and child seeks equal justice, equal opportunities, equal dignity without discrimination. Changing the world can be just a dream, or can become a reality if we take action in our realities.

Today societies need people that work, day by day, in achieving equality, equity and justice for everyone; we, as future medical practitioners, play a major role in this challenge, working to guarantee Universal Health Coverage, as the first step to create healthy societies that can lead a change for a better future for everyone, everywhere.

References: Mata A. La problemática de la salud en Guatemala. Diario La Hora. 2015 [cited 2018 May 5].

Available from: https://goo.gl/aktAin Cabrera Escobar JA, García LF, Zea Flores R, Figueroa M, Mazariegos C. Desigualdades en salud en Guatemala.

Ministerio de Salud Pública y Asistencia Social, Organización Panamericana de la

www.ifmsa.org |

The Americas Heartbeat 72 Salud en Guatemala. 2016 [cited 2018 May

5]. Available form: https://goo.gl/Te6Fi1

Guzmán V. Sobre la pobreza y la desigualdad. Plaza Pública. 2011 [cited

2018 May 5]. https://goo.gl/xGuuhJ

Available

www.ifmsa.org |

from:

The Americas Heartbeat 73

International Day of Happiness – “Hands Up, this is a HUG”

Jhan Carla Laime Aranda IFMSA Bolivia

This cheerful day is celebrated worldwide, every March 20, and was conceptualized and founded by a prominent United Nations special advisor, Jayme Illien; who brought the idea and concept of creating a new global day of awareness, to inspire, mobilize, and advance the global happiness movement.

This day was adopted by the unanimous consensus of all 193 UN member states of the United Nations General Assembly on June 28, 2012. He chose March 20 for its significance as the March equinox, a universal phenomenon felt simultaneously by all of humankind, which occurs when the plane of Earth‘s equator passes thought the center of the Sun‘s disk.

In IFMSA Bolivia, we celebrate this day since 2017, and we do in a special way: GIVING HUGS! This beautiful activity is an international movement and implemented by our beautiful exLORP from the OLM UNIVALLE, Shirley Vidaurre.

We first did this activity in the heart of Bolivia, Cochabamba, and this year was realized too, by the hotness city of Santa Cruz, with the beautiful LORP, Natalia Coimbra.

Is so powerful giving hugs all kind of strangers on the streets, as medical students, we don‘t realized about this simply but enormous medicine we have in our hands and in our hearts, is a true fact, and is confirmed by science that, we release oxytocin ( ―love hormone‖) and make someone happy. During this activity, we heard a lot of sad stories (like an old lady who doesn‘t see their grandchild‘s) and a lot of accomplishments because we woke a lot of beautiful smiles! When the activity finished, all the committee members felt really happy and enjoy every single hug that they gave, and they were so stunned about the power we have in our hands every single day!

www.ifmsa.org |

The Americas Heartbeat 74

Respecting our roots: Understanding indigenous cosmovisión

Michele K. Severino M. FEVESOCEM - Venezuela

When we thought about indigenous people we cannot accept their lifestyles. We do not understand how they could live without properties, economy, politics technology an all that stuff that we had today. But what we need to know, it is that they have their own world and their own voice.

They were very curious about anesthesia and how it could stop the pain and also about the injection process because it seems like a ritual for them and that is the most important thing. It is not a thing about the medicine it is about the process involved.

Heriberto Gonzalez-Mendez is a psiquiatrist and professor from the School of Medicine of Universidad de Los Andes, Venezuela.

When he was younger he decided to go to Amazonas, to a tribe of indigenous people called yanomami, maquiritare and piaroa.

He was a recently graduated general doctor who had a natural affinity to this people developed when he was a young kid. He identified with them when he played ―cows and indigenous‖ and when all of his friends wanted to be the cowboy, he wanted to be the native. He also asked for a crossbow to play.

But the most interesting story shared by Dr. Gonzalez Mendez was the day he saw a ritual of Death.

He was the doctor of the place. When he get there, he understand that they do not have the concept of ―Property‖; They share everything they had without a doubt. And in the moment he arrived he was one of them.

In the matter of health he saw some memorable moments. They don´t have medical technologies but they have faith.

With every ritual, they could cure diseases.

In that moment many of them died of the flu, and tuberculosis; But they resist to malaria. When someone get sick, immediately that person decided to run away from home, cause they think that it is some negative spirit chasing them.

There was one of them dying and he could not do anything to save his life. So he decided to wait and see.

All of the indigenous of the Chabono (This is how they call their ―communitary house‖) made a circle and immediately they start fighting with some evil spirits, the ones who stole someone else soul. You could see them throwing arrows and stones to no one.

Then, they go inside the circle and this is when the war stop. They start crying and that is when the person dies. He does not know it you could call that a coincidence.

Then, they put the corpse in a special place with high temperature, far away from the chabono. It is when the mourning started.

They were sad for a time of three months.

They cried for the one who left until the day they go to the place and pick up the bones.

They make a soup with them and shared it with all the community. Instantly they start smiling and you could see them happy again, because the one who left now belongs to every one of them and live inside of his body.

www.ifmsa.org |

The Americas Heartbeat 75 This is what opened him the curiosity from human mind. Living with them was a moment of his life he call â&#x20AC;&#x2022;Magicâ&#x20AC;&#x2013;. We do not have to underestimate what indigenous could represent to us. They are pure love,

wisdom and culture. So we have to defend and respect their rights and keep making this kind of testimonies to go around the world.

www.ifmsa.org |

The Americas Heartbeat 76

POPULATION IN STREET STATE: EXPERIENCE REPORT Gabriel Alves de Godoy, JosĂŠ Roberto Scalone Barbosa and Samantha Mendes Vidal Dantas IFMSA Brazil

Vulnerability means groups or individuals who are judicially or politically weakened in the promotion, protection or guarantee of their rights. This concept is expressed in different ways depending on the aspect addressed. In general, the individual can subject himself or herself to a situation of vulnerability, or society, by not having effective services, information, programs and policies, can end up exposing the person to this type of scenario. In this context, is included the population in the street situation. Although it is a phenomenon present throughout the world, it is treated in different ways in each country. In Brazil, the vision of social hygiene ends up marginalizing and stigmatizing these individuals. Thus, social reintegration programs, such as work, housing, family and health, are far from reality.

The heterogeneity present in the group of people in street situations is due to the multifactorial character of this phenomenon, where natural disasters, biological and socio-structural factors can lead the individual to live in the streets. In Brazil, in 2015, the Institute of Applied Economic Research (IPEA) counted little more than 100 thousand people living on the streets.

Of these, approximately 94% were settled in municipalities with more than 900 thousand people, because they presented conditions more favorable to survival. In addition, the IPEA pointed out that only 47% of these individuals are enrolled in the base of single cadastre for social programs (CadĂ&#x161;nico), which makes it difficult to transfer income and housing to these

people. Thinking about this scenario, the Local Committee of IFMSA Brazil, Mauricio de Nassau University Center, in partnership with the Project Samaritans, carried out a campaign called: Samaritans.

The action was divided in three stages: (a) initially, the participants of the action were trained by the members of the Samaritans project, where the correct way to behave in front of the individuals in a street situation was presented; (b) then the members were divided into groups, led by a member of the Samaritans project. Each group went to a specific area, following established logistics, to reach as many people apossible. At that moment, the activities consisted of delivery of: food, water, blankets and clothes.

In addition, participants were able to interact with the most vulnerable individuals, seeking to educate them about the risks of alcohol and drug use, and of sexual relationships without condoms; (c) Finally, all groups met at the starting point to discuss the experiences of the campaign.

The campaign achieved largely satisfactory results, being well received by both the students involved and the population covered. These, exposed their experiences of life, talking about the abandonment and the prejudice faced in their daily life. It has been pointed out that much remains to be done to ensure full access to public health for Brazil's vulnerable people, and that such attention should not be focused only on physical issues, but also on psychological and social issues. In addition, it was clear the importance of social actions, which put

www.ifmsa.org |

The Americas Heartbeat 77 medical students in direct contact with citizens, for the training of professionals prepared to provide support to populations neglected by society.

Bibliographic references:

- National Policy for social inclusion of the population in street situation. 2008. http://www.mpsp.mp.br/portal/page/portal/c ao_civel/acoes_afirmativas/Pol.NacionalMorad.R ua.pdf - Institute of Applied Economic Research.

Research estimates that Brazil has 101 thousand street dwellers.

2017. http://www.ipea.gov.br/portal/index.php?opti on=com_content&view=article&id=29303 - Right to health of the population living in the street: reflections on the problem. 2015. http://www.scielo.br/pdf/csc/v21n8/14138123-csc-21-08-2595.pdf

www.ifmsa.org |

The Americas Heartbeat 78

www.ifmsa.org |

The Americas Heartbeat 79

Initiative on the importance of research by and for medical students

Germania MuĂąoz, Mercedes Robles AEMPPI Ecuador

Ever since we have been involved in IFMSA through AEMPPI Ecuador we have come to realize that this organization represents constant educational and teaching opportunities at its core. When working on Research Exchanges we have strengthen that point of view by promoting educational activities and by trying to share relevant information that will led to new activities and strategies towards medical education within research exchanges.

These activities are intended to be carried out thinking globally and acting locally, in which our members could put their efforts and learn about the basics of research, and how to perform them efficiently and outcome-oriented.

After the SCORE Awareness Campaign and being very motivated, alongside the LOREs, we prepared and designed a series of publications shared from April 23rd to April 26th in the official social networks of AEMPPI Ecuador to raise awareness about the importance of research in the field of Medicine. Why we decided to do that?

Nowadays, for medical doctors, medicine is based on evidence, which is why it is relevant that we understand not only the published papers, but also the importance of developing a culturally sensible perspective towards inequities around healthcare systems around the world.

Thanks to research, medical students manage to develop self-discipline, a crucial commitment in their formation. Research is

the fundamental axis of the progress of the academic education of a medical student: new proposals, ideas and theories are being investigated. To investigate is to look for the beginning of everything.

In order to encourage medical students, we must be able to answer this question: How can research benefit the medical profession as a whole? Well, it improves the way medicine is taught and understood by its students. Medical education is the foundation and stepping stone of the institution of medicine. With collaborative learning into the practicalities of medicine along with investigations into the basic sciences, the student is better suited to practice this medicine. Modern medicine is characterized by activity. The student no longer merely watches, listens, memorizes: he does. His own activities in the laboratory and in the clinic are the main factors in his instruction and discipline. An education in medicine nowadays involves both learning and learning how. We must understand the scientific method as not only a tool for the investigator, but also for the physician working at the bedside. This process is highly hypothesis driven and highly evaluative of facts and problems, allowing students to be analytical, thorough, and critically open minded. These qualities are not only important for the student, but also the teacher of medicine. Medical research serves to keep the quality of medical education high, at both the teacher and student ends.

www.ifmsa.org |

The Americas Heartbeat 80 Research around the world contributes to the advancement of medicine, helps to understand public health problems around the world and this is strongly connected to IFMSAâ&#x20AC;&#x2DC;s vision and established goals, especially within exchanges programs.

www.ifmsa.org |

The Americas Heartbeat 81

The Perfect Host

Verònica Anayansi Moreno AMMEF Mexico

No one said working on exchanges was going to be easy. Well… yeah, maybe someone did. Some people might think working on exchanges is just about parties and new friends. Actually, it is a full time job; from one day to another, you become a party planner, tourist guide, translator, history teacher, confident, and sometimes even cupid. However, your life as medical student does not stops. You have to balance between your schoolwork, exams, shifts, consults, teamwork and your life as an exchanges officer.

What‘s really being an exchanges officer?

As students, we wait all the semester to get our vacation started, but as an exchanges officers that is when the work begins. While all our classmates are feeling anxious to start again after all the rest they got, you are still wondering, ―Where did all that free time go?‖ I remember having a great and full of work summer with all the incomings. I was about to start a really stressful and hard semester and I really wanted to sleep for a week, but I couldn‘t.

For the upcoming month, I will be on call almost every day plus classes. In addition, we had full house for incomings. As the incomings start arriving and the classes began, the amount of things I had to do, start to pile up just like a bunch of dirty dishes waiting to be washed.

Running, not sleeping, being hungry, sometimes grumpy. Having to change my

shift, staying after hours; not going home for a couple of days, having tons of deadlines. Despite everything, exchanges is all I want to do. Meeting different people, cultures, new languages (some words at least), have fun with them, learn about how health is in their countries, planning new projects to change the world, showing around the country and being proud of it. I liked and sometimes loved them. In the blink of an eye, the month is over. They start packing and saying goodbye, asking to come visit, even fighting each other to make me choose their country to go on an exchange.

After all the people, the memories, the great and not so great moments you had, I‘ve grown. I made many new friends crash on their couch if I travel. I smile at their messages asking how I‘ve being doing.

Sometimes convince their friends to come because they really enjoyed being here.

They even say it was one of the best experiences of their life and they think is because of me.

I can‘t lie, not everything is going to be easy. Sometimes you will have to say no, spend more money or have less time to do your work but, you will end up with many new friends, new experiences that not a lot of your classmates can say they had. Your global vision of medicine will teach you more than you think. Of course, you‘ll be tired but nothing is going to stop you to keep growing and learning. Nothing will stop you from becoming the perfect host.

www.ifmsa.org |

The Americas Heartbeat 82

Competencies for Global Health

Heber Josè Oliva IFMSA Honduras

Our exchange program has grown over the years since the beginning of 1951 and today we have more than 15,000 medical students in more than 90 countries participating in it, and now as a country we will be part of that history. SCOPE IFMSAHonduras completes its first year of international activation. It has been a long journey in which many people, both nationally and internationally, have contributed to its achievements, one of the most significant is provide a platform for about 32 Honduran medical students to take a professional exchange in more than 20 different countries.

determinant they use to identify and implement competencies into their own exchange experience .

But what competencies may be acquired through an international elective?

2,3

Global Burden of Disease: Encompasses basic understandings of major causes of morbidity and mortality, and with major public health efforts to reduce health disparities globally .

2

Globalization of Health and Health Care: Focuses on understanding how globalization affects health, health systems, and the delivery of health care .

2

The first step in developing the core global health competencies was to agree on a definition of global health. Global health refers to ―an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide .

1

Global health reflects the realities of globalization, including the global spread in public health of infectious and noninfectious risks. The architecture of global health is complex and a mutual cooperation is needed. The World Health Organization stressed the importance of interprofessional collaboration in a 2006 report that encouraged stakeholders in global health endeavors to ―work together through inclusive alliances and networks local, national, and global across health problems, professions, disciplines, ministries, sectors, and countries .‖ 2

Social and Environmental Determinants of Health: Focuses on an understanding that social, economic, and environmental factors are important determinants of health, and that health is more than the absence of disease . The social determinants of health are mostly responsible for health inequities the unfair and avoidable differences in health status seen within and between countries. Health equity and social determinants are acknowledged as a critical component of the post-2015 sustainable development global agenda and of the push towards progressive achievement of universal health coverage (UHC) 2

Capacity Strengthening: ―Capacity strengthening is sharing knowledge, skills, and resources for enhancing global public health programs, infrastructure, and workforce to address current and future global public health needs.― .

4

Since competencies are often framed in terms of knowledge, skills, or attitudes and represent the goals of the learning process, medicine students should not see the only a comprehensive a list as the sole

Collaboration, Partnering, and Communication: ―Collaborating and partnering is the ability to select, recruit, and work with a diverse range of global

www.ifmsa.org |

The Americas Heartbeat 83 health stakeholders to advance research, policy, and practice goals, and to foster open dialogue and effective communicationâ&#x20AC;&#x2013; with partners and within a team .

4

Our actions as holistic health professionals can be really effective only after abandoning the biomedical paradigm in favor of a new holistic approach to medicine.

Health. Geneva, Switzerland: World Health Organization; 2006.

3) Eckhert L. Getting the Most Out of Medical Studentsâ&#x20AC;&#x2DC; Global Health Experiences Ann Fam Med 2006;4(1):S38S39 DOI: 10.1370/afm.563.

4) Calhoun JG, Spencer HC, Buekens P. Competencies for global heath graduate education. Infect Dis Clin North Am 2011;25:575e92. viii. doi: 10.1016/j.idc.2011.02.015.

1) Jogerst et al. Identifying Interprofessional Global Health Competencies for 21stCentury Health Professionals . Ann Glob Health. 2015 Mar-Apr;81(2):239-47. doi: 10.1016/j.aogh.2015.03.006.

2) World Health Organization. The World Health Report 2006. Working Together for

www.ifmsa.org |

The Americas Heartbeat 84

ExChange the Feeling

Gabriela Macedo IFMSA Brazil

The year is 2005. Steve Jobs is at Stanford Commencement Speech releasing one of the most inspiring quote: ―Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do.‖ By believing in this quote I became National Exchange Officer for Incomings. Some people call me crazy. Other just don‘t understand why am I doing this or what I‘m learning from it. So let‘s try to explain in a few words why am I NEO. In 2015 I joined my local committee as Local Coordinator in Exchanges because I loved getting to know other cultures. In 2016 I became Local Exchange Officer because I wanted to make the experiences in my city, Joinville, even better. In 2017 I felt I had more to show and share in Brazil, so I was accepted as NEO Assistant. I learned and grew personally, got to know many amazing people from the Americas, Brazil and even the world. So I felt I had more to share. On October 2017 my National Exchange Officer application was sent.

But why on earth would I want to abdicate so much on my personal life to help almost 500 students per year get their dream on track? To be honest, I still don‘t know. All I‘m sure is that it‘s a feeling.

Being NEO is not a ―job‖ or a hobby. It‘s just part of my life. There are moments that I get overwhelmed and my parents get mad at me because I was supposed to be

studying to become a doctor and not running a ―travel agency‖ (it breaks my heart in so many pieces when I hear this).

But there are those special moments that are worth all the stress involved. Those are called gratitude from the students. Every time I receive a message just saying ―thank you!‖, I feel complete. Another exchange successfully completed?

Mission accomplished!

My eyes glow for the Exchanges. That‘s why I spend nights on and on trying to finish the Placements and Hosts Puzzles, why I make such an effort to get the Social Programs and Educational Activities done in most local committees. Because the Exchanges are the whole IFMSA pack: it includes Medical Education (especially when we compare hosting and sending university and their health systems), Public Health and Sexual and Reproductive Health including HIV/AIDS (the students can learn so much from it during their clerkship even if it‘s just observing and discussing the cases), Human Rights and Peace (by discussion and watching practical things getting done inside universities/hospitals and observing the minorities getting help, what happened and how to first arrive there).

That‘s why I‘m NEO. Because I want people to see the world, especially my country, the way I see it.

Break barriers and stereotypes while learning more about Medicine. ExChange the world. Always.

www.ifmsa.org |

The Americas Heartbeat 85

Once SCOPE, always SCOPE: My first experience as LEO

Danilo Pariono Oropeza IFMSA Peru

My journey started 1 year ago, I belong to a small Local Committee called SCHEM and SCOPE was something new for us, it was the first time that we were going to have the committee active.

It was so that I assumed the task of being the first LEO of my local committee.

From the first day I faced a whole new world; Complete XP or ECs or answer CAs. Honestly I got dizzy sometimes. I always bothered my NEOs with many doubts.

Days later, I was already registered on the platform so I received the Application Form (AF) from a girl from France, I was excited so I told all my colleagues from the Local Committee. Weeks later I received the AF from a boy from Mexico. I have always admired the culture of both countries and I was sure that receiving them was going to be a great experience.

Two months after their arrival, I began to process the exchange; It was complicated by problems at my university but the doctors at the Hospital supported me a lot, I introduced them to the wonderful world of IFMSA and many of them dared to be tutors, even doctors who do not teach me at university.

Until the day arrived, on 1st July, we received Juliette, our first incoming. Early next day, Luis arrived. Both arrived in Huacho that day and they were wellreceived by my local committee. An incredible social program and a very

productive rotation in the Hospital. The month passed very quickly and the time of the farewell was close, it was at that moment that I realized that they were not only incomings but great friends who were leaving this new home they had made with us.

Months later, we received two incomings from Brazil, Gabriel and Ana Paula; The experience was great, being the second time, new guys joined the experience of being Contact Persons and being part of the Social Program.

That month finished my management as LEO and in summary it has been one of the best experiences in my life, all the work you do is rewarded at the end with every bond you form between people that maybe in a different world they would never have met; Supporting a student to achieve their goals and being part of it, it's a great experience..

Unlike other committees, here are people who depend on the work we do and sometimes it can be heavy but worth it.

Someone once said to me: "Do not let the charge explode you, you explode the charge" this helped me to see the committee in a different way. I am very grateful to my NEOs: Larry, Macla and Humberto because they taught me to love the committee in the same way they do; to my Assistants: Maryuri, Franks and AndrĂŠ, because they were with me all the time and to my incomings, because each one gave me experiences that I will never forget.

Thanks for everything.

www.ifmsa.org |

The Americas Heartbeat 86

When there is more than just being a NEO

Lara Moreno DENEM Brazil

When someone accepts the challenge of working with Exchanges on IFMSA, I believe one cannot even imagine what this is really about. For me, when I accepted, it was about coordinating something that involved people, exchanges and a lot of bureaucracy. But after two years of experiencing DENEM, I learned it was so much more than that.

It was, and still is, about dreams, of meeting new places, that firstly were only imagined after hours of web surfing or through the movies. Of getting to know a totally different culture and its life values. It is about chasing after your own dream of being part of something bigger, but always reminding to work hard for other studentsâ&#x20AC;&#x2DC; dreams too.

It is about people and meeting friends that you will carry for your whole life, not only internationally but also in your own country.

People that might become essential in your daily life. It is about starting making a list of countries and cities to visit, especially the most popular ones, all because of friendship. But it is also about learning that dealing with people can be a different experience depending on the day and situation. Outgoings or incomings may be really grateful for you, but some days they also can be your nightmare. But I guess this is part of the fun of working with exchanges, right?

Still, it is about medical students, always curious about different medical practices

and health systems. At the same time, they are trying to become better doctors for the future generations, by sharing experiences and adapting their local committee for the best. It is literally working hard to think globally and act locally.

It is, however, about politics too, and recognizing that not everyone has the same opportunities. That depending on your countryâ&#x20AC;&#x2DC;s reality, all your plans can be cancelled because of a denied visa, for example. That if you are a girl, you must be brave to travel alone and, more than that, you must prove yourself worthy for othersâ&#x20AC;&#x2DC; sake. That depending on your color or sexuality, you might be treated differently.

And that is why we must fight our way for equality.

In addition, it is about growing as an individual. This involves a process of developing knowledge about foreign affairs, communication, global health, economy and leadership. Believing that you are capable of achieving goals but also understanding your limits. Limits because you are a student, a person that also has a family, friends and yourself to take care of.

Finally, it is about being concerned about the world and being prepared for it.

Because you learn about dreams, people, medicine, politics and yourself. And in the middle of it, you can have fun while learning a little bit about Exchanges.

www.ifmsa.org |

The Americas Heartbeat 87

The time of my life with SCOPE

Jennifer Bernal ASCEMCOL Colombia

When I was in third semester a friend of mine approaches to me and tell me ―Hey Jenn, you speak English and like to hang out with people, I need someone like you to help me with exchanges here in Bucaramanga, are you in?‖, and that was all I needed to start this amazing journey that had given me countless histories and true friends all around the world. First of all, I was LEO from my LC for two years, having incomings, being hosts, serving as a guide, etc.

After this I thought, ―what a crazy idea would be to become NEO, but I‘m all in for it‖, so after lots of struggling, in October 2016 my first period as NEO Out of ASCEMCOL began. At that point everything was clearer for me: I had to exchange my world so I can inspire others like me to get out of the box, that was the moment when I decided that I would go out finally on an exchange.

I started working things out with my parents and my university, decided when was the right time to go, the country and suddenly, like if it was a reward for all the hard work I‘ve done, I got accepted to a four months‘ exchange in Sao Paulo – Brazil to do it as an intern and I was all over the place!!!

When I was already there I didn‘t want to let that adventure to end, I had 3 months left to end my intern year, so I thought, what if I could go on another exchange? Would this

even be possible to arrange with so short notice? So, I applied to my motto: ―there‘s nothing you can‘t do, there are only things you are afraid to do‖. I started asking to other NEO‘s in our awesome region to see if it was possible, when finally, from AEMPPI – Ecuador, I received a card of acceptance to make my last three months with them!

Now, I can‘t stop thinking that what begins four years ago, with a simple proposition, is now ending with the time of my life: I‘ve finally had the chance to see the world with my eyes, to live the most awesome experience I have until now, to be an inspiration for other students that believe that you can‘t go on an exchange while studying medicine, and even harder while you‘re on your last year, well, for all of you that are taking your time to read this I tell you: IFMSA makes it possible.

So, if you haven‘t go on an exchange, what are you waiting for? And if you had, start planning the next one!!! IFMSA, SCOPE and SCORE, and for me, ASCEMCOL, had made me not just a better medical student, but a better citizen of the world, aware of the beauty of our small difference.

Keep rocking the world by exchanging it and may the blue force be ever on your side.

www.ifmsa.org |

The Americas Heartbeat 88

AMMEF Mexico: Where teamwork gives you a family.

Carlos Alberto De la Torre AMMEF Mexico

AMMEF Mexico is one of the biggest NMOs when it comes to SCOPE, and when you have 40 active local committees, more than 150 tutors, 72 hospitals and 5 regional social programs, it can get really exciting.

As the NEO In, it’s amazing to be part of such a big and committed team, not only our national team, which includes regional coordinators, the capacity building team, our assistants, secretary and marketing, also our LEOs, Contact Persons are so good, and put so much of their effort and time for one goal, to provide an incredible exchange program for everyone that decides to come to Mexico, it’s so lovely to witness that, it feels like a big family.

Hospitality and teamwork are two things that characterizes us, so that works out perfectly for our program and our incomings, no matter in which city you do your exchange, in all of them our tutors will provide all the help and knowledge our incomings need, and also, even let you take part on procedures, but not only that, nurses, interns and residents are willing to help out and make our incomings feel comfortable, by showing them everything they know, inviting them to go out, etc.

along with other local officers of public health and medical education.

There’s a lot of work, time and effort behind everything we do, coming up with ideas, protocolize our projects and training everyone that is involved takes a lot or energy, but nothing our team isn’t able to handle. Coordinating this is not hard when everyone tries their best to be present in the virtual reunions, the national assemblies, reading the protocols, working along with other local officers, filling out templates, creating documents, etc.

Culture, diversity, fun and excellent cuisine have always defined Mexico, but in addition to that AMMEF Mexico through SCOPE knows how to work with that and provide not only an incredible social program, but a month full of experiences and knowledge on medical skills that will give our incomings memories for their lives.

Besides that, our contact persons and host families, do their best so that our incomings feel like they’re at home, and while all of these is happening our LEOs are working to provide the best social program and excellent academic quality activities

www.ifmsa.org |

The Americas Heartbeat 89

www.ifmsa.org |