NEWSLETTER Newsletter Volume 30/no. 2/December 2012
Editorial In this issue, among others:
• Conference on the Move • Dr Erica Wheeler, WHO • Rendez-Vous 2012 Impressions
Another year has passed, as well as another great, although a bit different conference too! So here we are again with our yearly conference report. We hope that for those of you who were there, this is a great way to relive some nice moments or catch up on things you couldn’t attend. For those of you who couldn’t make it, we will try to give you a glimpse of RendezVous 2012. Hopefully you can attend next year from November 16th to 20th 2013 in Ayutthaya, Thailand! We realize how important communication is between the office and our members and besides our monthly alerts, this newsletter is a great way to bridge the gap between conferences and between all the different members all over the world. Don’t hesitate to share things with us: secretariat-network@ugent.be. We’ll make sure your word gets out!
Enjoy your reading!
Julie Vanden Bulcke, Editor
In the Newsletter we refer to The Network: Towards Unity for Health as The Network: TUFH.
Message from the Secretary General Health Professionals’ Education at the Crossroads
Contents Message from the Secretary General Health Professionals’ Education at the Crossroads
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Conference Report Annual International Conference Message from the Office
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Site Visits Conference on the Move Marathon Sioux Lookout Sudbury
4 5 6
Local Site Visits Thunder Bay Regional Health Sciences Centre Grey Wolf George Jeffrey Children’s Centre
6 7 7
Students Report Rendez-Vous 2012: The Students Perspective!
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Great Stories from Great People Interview with Dr Erica Wheeler from WHO
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Conference Declaration Thunder Bay Communique
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Rendez-Vous 2012: Impressions
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The ‘Rendez-Vous 2012’ conference was a special kind of gathering: for the first time, members of different international organizations were interacting, exchanging experiences and reflecting on the challenges for health professionals’ education in the 21st century. The WONCA-Rural-Working Party brought in their field experience of professionals working in remote and rural areas. The Consortium for Longitudinal Integrated Clerkships (CLIC), demonstrated innovative ways of thinking ‘out of the box’ when it comes to training. The Training in Health Equity Network (THENet) framed the social accountability of institutions in the broader context of the needs of society, with special emphasis on the most deprived. FAIMER was represented by a lot of Fellows and Flinders University and Northern Ontario School of Medicine brought innovative experiences in recruiting and training those individuals that have a high chance to really serve their communities. The Network: Towards Unity for Health, was in the midst of all these organizations, being the ‘oldest’ of networks in innovative education of health professionals. Some of our members felt a little bit uneasy. Our traditional, well-known way of scheduling conferences could not always be recognized and it was difficult to preserve the ‘personal touch’; the individual ‘mentor-mentee’ interaction that makes the Network: Towards Unity for Health conferences such a specific experience. But on the other hand, we had the opportunity to be a very active player in an important process. We were confronted with the development of the World Health Organization’s global policy guidelines to transform and scale up health education and training. The Network thinks it is very important, for our organization as an NGO in official relation with WHO, to contribute to the implementation of these guidelines. Moreover, the ‘Thunderbay Communiqué’: ‘New ways of thinking from Rendez-Vous 2
2012’ is a document that we have contributed to intensively, and that draws the lines for future strategies in improving the education of those that will take care, with individuals and communities, of the health of future generations. Reflection is needed on the future position of the Network: TUFH in the context of emerging organizations and initiatives in the field of education of health professionals. A ‘cyclus’, where every second year we organize our annual conference in a broader context (e.g. with other local and international organizations,…), and the other year we have the specific ‘The Network: TUFH’-conference, could be appropriate in order to reconcile the need for the membership to feel ‘at home’ at our annual conferences and the imperative, to participate in a broader strategy and to confront our reflection and action with other organizations. This kind of cross-fertilization will help the Network to play its role to bring together institutions that are looking to better serve the needs of the populations. Finally, I was absolutely proud about the input made by our membership: first of all the students, they brought innovative and challenging contributions to the conference, our member-institutions demonstrated how to put social accountability in practice and we were part of the many debates during the conference. Finally, the Thunderbay-experience was also interesting because it was the first time that we had a ‘conference on the move’. We are grateful to the opportunities that were prepared by the organizing committee and the hospitality of the Northern Ontario School of Medicine. Jan De Maeseneer, MD, PhD Secretary-General, The Network: TUFH Email: jan.demaeseneer@ugent.be
Conference Report Annual International Conference Message from the Office conference will be smaller-scale than the past one and this will emphasize the familiar feeling of The Network: TUFH conferences. We will share more details about the program in the Spring of 2013, but you can book the dates in your agenda already: November 16th- 20th, 2013.
Every part is as important as the whole. Therefore, The Network: TUFH is as strong as the engagement of every individual member. As a worldwide community of health workers we strive towards unity in health. This shared mission brings us together in our hearts day in day out. The yearly conference is what brings us physically together. It is the place where we share our experiences, renew our strength and gather new insights.
With a new conference in sight, the Network: TUFH office is also getting a new Executive Director. Kaat De Backer is leaving the secretariat in December 2012 and Maarten Declercq will take over her role. We acknowledge the contribution Kaat has made to advance the organization on a daily basis.
This year we went to the desolate beauty of Northern Ontario, Canada. Rendez-vous 2012 in Thunder Bay brought together over 800 health workers from all over the World. The central theme of the conference was engaging community participation in education, research, service, and the health system. The Northern Ontario School of Medicine was the local host organizing this conference. We deeply appreciate the hard work they put into the organization of the conference. The Network: TUFH teamed up with several other like-minded organizations. It was an inspiration to share ideas across and learn from our differences and similarities. This broadened the scope of the conference compared to other years.
The Network: TUFH needs your active engagement. We hope that The Network: TUFH can keep benefiting from your contribution in the coming future and look forward to seeing you in Thailand! Maarten Declercq, Executive Director, The Network: TUFH Email: maarten.declercq@ugent.be
Next year the conference will be hosted in Thailand. With the impressive temples of Ayutthata in the background, we will be welcomed by our local co-host, the Princess of Naradhiwas University. Together with the organizers and partners we are putting together an experience that our members will enjoy. Many of our members will contribute to building the scientific program of the conference. The feeling of the
Goodbye! When the office of The Network: Towards Unity for Health was moved to Ghent University in 2009, I had the opportunity to join the team. Three years have gone by and not only has the organization changed; it also changed me. Simultaneous with the transition of The Network: TUFH in the past years, the ‘bug’ of healthcare got hold of me. It bit me, quite harsh. I felt inspired by your great stories during the conference, convinced that high quality health care is a basic and fundamental human right for everyone, no matter where they live. With every conference we organized, my motivation to become a healthcare professional myself became stronger and stronger. Last year, the bug bit me full front and I decided to go back to school and I started in a three-year Midwifery Program.
office and trying to get my Midwife degree has become too heavy. It is with mixed feelings, that I will leave the office: on the one hand thankful and happy for all the inspiration and motivation you gave me, but sad that my role here comes to an end. I am sure Maarten Declercq will bring new enthusiasm and ideas to the Network: TUFH and the daily management of the organization is in good hands. I am looking forward to coming to the conference as a participant in one of the future years and see how the organization is continuously growing and fulfilling its goals. May the road rise with you! Kaat De Backer, Former Executive Director, The Network: TUFH Email: kaat.debacker@ugent.be
Unfortunately, the workload of running The Network: TUFH 3
Conference Report Site Visits
Conference on the Move During the conference, participants had the opportunity to explore Canada and the Canadian health care system. There was a choice between a “Conference on the move”, which was organized in conjunction with the local health system representatives and encompassed overnight trips to several Canadian towns or local site visits in and around Thunder Bay. Below you will find individual participant reports providing you insights to their learning experiences! brought us up to date with guidelines on the initiation of opioids in chronic pain and the subsequent management. Treatment of addiction was then discussed using patient scenarios followed by the participants presenting patient problems. The presenters discussed pain management with very practical suggestions. We all left with a much better understanding of the management of chronic pain and addiction with practical tips for our patients.
Marathon Marathon is a small community on the shores of Lake Superior, 300 km east of Thunderbay, Northern Ontario. Ten Rendez-Vous participants ventured on the three hour bus trip with our very friendly hosts, Kim Larkin and Dr Sarah Newbury, one of the family docs in Marathon. The trip took us along the shores of the lake through the boreal forests with the last remnants of the autumn colours. The bus driver was asked to stop along the way for the Africans and Indians to experience a snowball fight using the snow left from the recent snowfall. The participants represented South Africa, Botswana, Belgium, Australia, UAE, Canada and India. On arrival, after a warm welcome from the doctors in the local hospital, our program began with the topic of Pain Control and addiction. Our presenters were Sean Moore and Jim Ducharne, both emergency physicians with a special interest and experience in chronic pain management and addictions. The main message was that chronic pain is a disease like diabetes. Management of pain requires a multiple modality approach not least involving active participation of the patient. Opioids for chronic non-cancer pain is one option but should be viewed as a trial of treatment. After the session some participants toured
the hospital, others left for the local golf club, the venue for supper, but first we had a 30 min “chair yoga” session. Chair yoga involved everyone (including several locals) breathing deeply, stretching and relaxing. We had a wonderful supper with Barbara Zelek, one of the community doctors, who then introduced our hosts. The mayor gave us a short history of the town which was established around a pulp mill permanently closed just four years ago. The local economy now revolves around the gold mine established 27 years ago. The mine’s HR manager described the workforce as very stable, with an average age of 50. The mine’s nurse practitioner told us about screening and health promotion efforts. Carol, a community developer with vast experience in Northern Ontario communities, works in two reserves close to Marathon, Pic Mobert and Pic River. She gave us fascinating insights to the devastation caused by alcohol and opiate addiction in these communities. In one community 50 of the 300 inhabitants are on methadone treatment for chronic opioid addiction. Hope is provided in the belief that the return to cultural customs can generate healing. We booked in at the Harbor Inn for much needed rest. Morning started with a quick breakfast and a walk, for some, in the chilly autumn air to the hospital where our program resumed. Our presenters 4
After lunch we visited the community health clinic. One of the local doctors took one of us on a mountain bike trip on single tracks alongside the lake. On our way back we stopped at Nipigon for a leg stretch and a pickup truck pulled up with a dead moose on a trailer. The unusual site was a delight to all with everyone taking photos using the moose legs as background. Just before returning to Thunderbay we stopped at the Terry Fox memorial. This young man, who’s leg was amputated due to cancer, attempted running across Canada to raise funds for cancer. After more than 5000 miles he had to stop due to recurrence of his cancer. Needless to say he is a Canadian national hero. The conference on the move to Marathon gave us a wonderful insight to Ontario’s rural health challenges and the commitment of the rural physicians. Hoffie Conradie, Associate professor, Division of Family Medicine and Primary Care, Faculty of Medical and Health Sciences, University of Stellenbosch, South Africa Email: hoffie@sun.ac.za
Conference Report Site Visits Conference on the Move
Meno Ya Min Health Centre in Sioux Lookout
performed at Meno Ya Win and the approach to community engagement around research further highlighted the culturally-sensitive ethos of the Centre management and staff.
With approximately 40 participants we travelled just under 400km north-west of Thunder Bay, the main Rendez Vous Conference venue, to the town of Sioux Lookout to visit the Meno Ya Win Health Centre. The bus ride of close to six hours took us through the beautiful colored forests of the region of the Thousand Lakes.
The presentations on the approach of the medical withdrawal unit for drug and alcohol dependency were fascinating, particularly the high success rates despite representing a relatively short intervention as well as limited follow-up. The inter-professional team and positive and culturally sensitive approach were cited as being critical to the optimal functioning in this environment.
The excursion was very well planned and presented, and the warm welcome and impeccable hospitality made us feel at home. A very informative program included participation in ceremonies of the First Nation people including a smudge ceremony and the pipe ceremony, a tour of the hospital as well as a number of presentations over the 2 days of the visit. On the second day the group also participated in the inaugural John McLeod Oration by Ian Couper via live feed from Thunder Bay.
Similarly, the presentation on a study on the First Nation women’s perception of menopause, the limitations of the biomedical approach (and the medicalization of events of the lifecycle) offered a nuanced and complex glimpse of what practice in this community entails.
The Meno Ya Min Centre was opened only 2 years ago after approximately 20 years of planning and negotiations and represents a Centre of Excellence in the provisioning of health care for the community of Sioux Lookout and the First Nation communities to the North of the Centre. It is the first such hospital based on the so-called ‘4 partner agreement’ between the federal, provincial and local authorities as well as representation from the First Nation authorities. This required new legislation to be passed by the Canadian government to facilitate the establishment of the hospital.
Overall, a profound lesson from the visit was that the development of appropriate health care services has strong historical and political dimensions, and requires visionary leadership and participatory and inclusive service planning. It is an example of operationalizing the idea of “nothing about me, without me”
The program that had been arranged for us echoed this partnership, both in terms of the content and the range of presenters. It included presentations by Elders from the First Nation people, administrators and medical personal, and the topics all reflected a perspective that acknowledged not only the complex history of First Nation people in the area, but also contextualized this in the current dynamics of service provisioning and care. The challenges of distance to the communities that are served by the hospital vast area were implicit in the approaches in service provisioning.
Bernhard Gaede, Director, Centre for Rural Health, University of KwaZulu-Natal, South Africa Maaike Flinkenflögel, National University of Rwanda, Rwanda Email: Gaedeb@ukzn.ac.za
We would like to acknowledge the Elders and First Nation People of the area, and staff and management of the Meno Ya Win Centre for the warm welcome and hospitality and particularly for the engagement and openness that marked our visit.
The presentations themselves explored the ideas of culturally appropriate care and how within the Meno Ya Win Centre has approached inclusiveness and responsiveness to the population it serves. A reflection on both the extensive research that has been 5
Conference Report Site Visits Conference on the Move Sudbury
On Thursday at lunchtime, a group of around 30 delegates left the Valhalla Inn on a bus for a unique Conference on the Move experience. Delegates were able to choose a Southern or Northern route, both ending in Sudbury, Northern Ontario’s largest city. Sudbury was originally a small mining community, but grew in the 20th century and became the world’s largest nickel and copper supplier. Besides employment, the mines brought environmental and health issues, which have been tackled in the last decades. The Southern route to Sudbury followed the beautiful shores of Lake Superior, crossed vibrant forests and even faced a snowstorm. The bus stopped in rural villages along the Highway, such as Nipigon and Wawa, where we visited the local health center. In these centers, the GP is in the core element in the health care organization, with a multidisciplinary team around the GP. They are faced with a huge variety of health issues: obstetrics, pediatrics, cardiac emergencies, surgeries, … Once a month a specialist such as a dermatologist, pediatrician, or cardiologist visits the clinic. Other urgent consultations with a specialist are done through telemedicine. There was even a stethoscope with Bluetooth that instantly sends information to a specialist in Toronto! We were amazed by the endeavors and commitment of the local health care providers. They offered the highest level of care, creative thinking and high-tech support to overcome the challenges of their rural locations. Another important part of the Conference on the Move to Sudbury was the introduction to First Nations’ culture. This introduction was achieved through a visit to a First Nations community along the way and to a Community Health Center in Sud-
bury, aiming specifically on the First Nations’ population. These experiences provided an understanding of how ‘Western’ medicine can go hand in hand with traditional First Nations’ medicine and healing knowledge. The patients in the health center are offered a combination of both treatment modalities, based on interprofessional and ‘intercultural’ teamwork. The demand for this kind of care is huge and until recently, the health care center couldn’t take in new patients. Due to substitution and two new GP’s, the clinic again has space to register First Nations’ families from Sudbury and surroundings. The three days of Conference on the Move to Sudbury were full of eye-opening visits, personal testimonies and interactive discussions amongst the delegates. It was an excellent way to continue the RendezVous 2012 as a ‘fieldtrip’, enjoying the Canadian landscapes and different learning opportunities. Thanks to the Northern Ontario School of Medicine team that made this trip into a unique experience. Also a warm thank you to all the hosts that allowed us to experience how they work and to share their enthusiasm and commitment with us. Kaat De Backer, Executive Director, The Network: TUFH Email: kaat.debacker@ugent.be
Local Site Visits Thunder Bay Regional Health Sciences Centre: Operation Room The group of about 8 travelled by bus to the Thunder Bay Regional Health Center. It’s a very modern facility built in 2004. The group was ushered into a video room and prepared to watch a laparoscopic cholecystectomy live, on video link. The video link allowed the surgeon to talk to the group during the procedure, from the initial anesthetic induction, to the patient’s abdomen being prepped and draped, to the 3 abdominal incisions to introduce the 3 laparoscopic instruments. These inflated the intra-abdominal cavity to allow the examiner to view the organs, then two “arms” allowed the dissection and removal of the gall bladder. The anatomic pathology was very clearly seen on the video screen and the thick adhesions of the gallbladder to the underside of the liver due to old inflammation was apparent. The visit was enriched by the 3 second year medical students chatting with a third year student in the group. The older student plans a career in surgery and could explain the procedure and the students role in surgery to the younger, eager students. Arthur Kaufman, MD, Distinguished Professor of Family and Community Medicine, Vice Chancellor for Community Health, University of New Mexico Email: akaufman@salud.unm.edu
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Conference Report Site Visits Local Site Visits Waabi-ma’ iingan (Grey Wolf) Traditional Teaching Lodge
A group of about 25 took a bus ride into rural woodlands in a cold afternoon. A documentary video tape was shown on the bus. It discussed, through the memories of indigenous elders, residential school survivors—the experience of young children being sent off to boarding school for very long periods of time—separated from family, friends and culture. We came to the Lodge, a non-profit organization working in the community of Thunder Bay and surrounding region. The information sheet states “There are two spirits who govern the lodge: Waabi-ma’iingan (Gray Wolf) and Ozhaawashko-giizhig (Clear Blue Sky). The Lodge is a place of peace for visitors from all walks of life and serves to preserve the language and culture of the Anishinaabe peoples who inhabit the area. The group was ushered into the Lodge, which is a large, rectangular structure with large, bent birch branches bent to form the inner skeleton of the blue cloth covered Lodge. In the center was a fire with a hole in the ceiling to release the fire’s smoke. The visitors were seated all around the outer perimeter and given blankets to fight the cold. The indigenous leaders spoke of their rituals, their four sacred medicines including sage, their songs and dances. One example was the belief that a woman during her “moon time” (having a period) is especially powerful for she is capable of “self-cleansing.” A peace pipe was smoked and drums beaten by one leader and another demonstrated a “smudge” ritual which every visitor experienced. A small fire of special components—native tobacco and sage among them was made in a shell, then the smoke was drawn of the feet, limbs, trunk and heat to cleanse the body.. Indigenous songs were sung and the visitors were led in a dance outside and back to the Lodge. A welcomed hot vegetable soup, brewing over a log fire outside the Lodge provided sustenance to the visitors. At the end of the experience, visitors left the Lodge walking backwards, out the back end and all engaged in a long, hugging ritual in which everyone hugged everyone else on the trip. Arthur Kaufman, MD, Distinguished Professor of Family and Community Medicine, Vice Chancellor for Community Health, University of New Mexico Email: akaufman@salud.unm.edu 7
George Jeffrey Children’s Centre: Enriching Children’s Lives
The brochure for The George Jeffrey Children’s Centre states they “offer services to meet the physical, communication, developmental and social needs of children from birth to 19 years”. But what would this look like to visitors from Australia, Brazil, Canada, Columbia, Laos, Nepal and the United States? For the student from Canada, it was a place she would like to come back to for an internship. For the Nepalese visitor, it was the opportunity to learn about services that do not exist in his country. To me, the visitor from the United States, it was an eye opening experience into the difficulties faced by children and adolescents who have a range of disabilities and the technology and methods available to assist them with everyday functions such as using a toilet or communicating a need. It’s been two weeks now and the things I most remember about this visit are: - Computers that can talk for patients at a push of a button - A swimming pool with cool lighting that any one in the community can use - A room specifically for teaching independent living skills - Dedicated staff who could make more money down the street at the hospital, but choose to remain at such a wonderful facility I’ve been a member of The Network: TUFH since 1998, and every time I go on one of these site visits, I always wish I had millions of dollars and could write these community organizations a check because they truly are deserving of support for the work they do. Amy Clithero, Lecturer, University of New Mexico, Albuquerque, New Mexico Email: aclithero@salud.unm.edu
Conference Report Students Report Rendez-Vous 2012: The Student’s Perspective! their research with fellow students in attendance. Site Visit Committee The Sleeping Giant hikes and the Thunder Oaks Farm & Gammondale Farm tours were well attended by both international and national medical students alike. About thirty students participated in the long hike to the top of the Sleeping Giant! This was the first such experience for the students from Belgium, Australia, Philippines and Nepal, and certainly for some Canadian students as well. It was a challenging, but fun climb and not one that will be easily forgotten as students were exposed to some of the best in landscapes that Canada has to offer! The shorter hike at the Sleeping Giant was combined with some Wilderness Medicine training. First, Dr. Brent Cutherbertson (PhD), Professor of Outdoor Education at Lakehead University, provided a presentation on Wilderness Medicine. A few simulations run by NOSM’s Wilderness Medicine Interest Group and a shorter hike followed this presentation. These simulations included: hypothermia/ cold-related injuries and wilderness splinting/wound management. There were twenty students who participated in this event and enjoyed it thoroughly! Lastly, twenty-five students participated in a tour of the Thunder Oaks Cheese Farm where they had the opportunity to see how cheese is made and were able to enjoy samples. They then spent the afternoon at Gammondale Farm where they participated in ‘Amazing Race’ styled team-building exercises, a tour of the farm and enjoyed some hot beverages.
On behalf of the Rendez-Vous Student Organizing Committee (RVSOC), we would like to thank all of the students who attended Rendez-Vous 2012. It was wonderful to meet so many likeminded and passionate people! Below is an overview of the student events during Rendez-Vous 2012. Pre Conference Student Workshop The Pre Conference Student Workshop consisted of approximately 100 students, including both international and Canadian delegates. The day was designed to allow students to network amongst one another. The day began with improvisation by Dr. Brian McLeod. The session aimed to address how improvisation can help health care professionals understand that making mistakes are normal. It provided an opportunity for students to meet one another in a lighthearted atmosphere. The session received very positive reviews by delegates in attendance.
Social Events Tuesday October 9th marked the date of an epic battle. For years, The Northern Ontario School of Medicine’s West and East campuses have been feuding over who has the best skills in Canada’s favourite sport – HOCKEY! The only way to settle this rivalry was through the annual Strasser Cup Hockey game. The teams fought for their pride and bragging rights with medical students from across the globe witnessing the spectacle. Around seventy fans participating in viewing this event and dressed up in their team’s colours: yellow or blue! The Canadian national anthem was played on the bagpipes to start off the event. Throughout the game crowds banged on drums, did the The Wave and cheered on their team. In the end, Dr. Roger Strasser himself to presented the cup to the winning team, the West Campus. A tremendous time was had by all- both those new to hockey and those quite familiar!
This was followed by small-group breakout sessions that provided students from across the globe to discuss current health care issues affecting people worldwide. Objectives for this session included: • Exploring the health care issues that are prevalent in different parts of the world, realizing how they are different and yet how they are similar among different areas • Through dialogue, the various delegates from all health care professional backgrounds could share their knowledge and experiences • Identify how the WHO 12 Social Determinants of Health are applicable to the various health issues that are discussed The student delegates connected via video conference to the opening ceremonies during lunch hour. This was followed by a keynote speaker address.
On Wednesday, October 10th, a student-run, Alter-Gala formal event was held for all students! This classy night was full of well-dressed people, good music, great food, and new friends. Over seventy people danced the night away in their very best!
The afternoon consisted of small breakout sessions, outlined below. 1) Structured Clinical Skills: a clinical encounter designed for delegates to explore the diversity of approaches to clinical encounters. 2) Grand Rounds: case presentation by a medical student, which was interactive in nature and encompassed health care in a holistic manner. 3) Global Health Presentation: session was designed to discuss current global health issues across the globe. 4) Student Led Research Presentations: student delegates shared
Thank you again for your participation in these events! Vanessa Ellies, Derek Bos and Emily Robinson RVSOC Co-Chairs 2011-2012 Email: emrobinson@nosm.ca 8
Conference Report Great Stories from Great People Erica Wheeler Dr. Erica Wheeler is a technical officer at the department of Health Systems Policies and Workforce at the World Health Organization (WHO). In Thunder Bay she gave an inspiring and innovative key note speech about her work on the global policy guidelines developed by WHO to transform and scale up health professional education and training. Afterwards we were lucky to catch her for this interview! Is it true that WHO counts on organizations in medical education like The Network: TUFH, THEnet ,.. to translate their guidelines on medical education into operational actions? That is absolutely correct. Because WHO has facilitated the development of these guidelines we can’t be personally responsible for implementing them. They are for the individual countries and because of that we are working with development partners like USAID but also with organizations like The Network:TUFH to implement them on country level. They are crucial in the implementation process!
It is crucial to better understand the outflows of health professionals to other parts of the world, so we can better influence policy and advocate on a global level but also work with countries on the national level! And what is your opinion on internal brain drain? In some countries more than half of their own trained health professionals work for disease specific programs like HIV. We recognize that also has happened. All we can do from the WHO perspective is to recommend to the government that they improve working conditions, salaries and incentives for health professionals so that they want to remain in the government service. But also we have changed the dialogue on the discussion on HIV, to say that countries should invest more in health systems so you don’t have that case where they skew the priorities towards one disease. This is a work in progress because any big donor that comes along in a developing country there is always that danger that everybody will go towards that particular disease and that other areas would be neglected. A health system approach should be able to avoid that.
In your speech you made a strong emphasis on the link between education and the problem of human resources and health personnel. Who are we training, where are they going to work and how are they integrating in the health system. Why is this link so important? We look at 3 outcomes of interest as quantity, quality and relevance because while we are saying to countries that they need to scale up the numbers of health workers, we also must pay attention to the quality of their training and to the relevance. That is why social accountability is such an important part of what we are doing; health workers that are trained should be socially accountable to their communities. This influences the development of the guidelines.
The Network:TUFH, founded in 1979, is the oldest network working on innovation of health professionals education and we are very proud to be an NGO in official collaboration with WHO. What would be the main contribution to make these educational guidelines work? Together we can define certain areas and The Network:TUFH can certainly help to implement changes at the country level. You have strengths coming from universities all over the world in research and education and I think especially in the areas of the guidelines like inter-professional education, accreditation and regulation you could contribute. You have the comparative advantage and expertise that we need in WHO, as we are not a research institution. You are in the field so you have more understanding about what happens at the country level.
How does WHO looks at the problem of brain drain. Should Western countries change their policies and are they not responsible for training enough health care providers in their own countries? In 2010 we had the World Health Assembly resolution on the migration of health professionals so that is part of the corner stone of the work of the Human Resources for Health team. In terms of how we view it, we very much support the fact that countries, especially developed countries, have to be able to train enough health professionals to address the needs of their own populations. We are now working with our regional counterparts and gathering data on the flow of health professionals across the world. So more detailed work is now being done on that subject by the national institutions. WHO is setting up the framework for countries on how they should be gathering data and national designated authorities are responsible for this.
So let’s make that the subject of our negotiations! Thank you very much for this interview! 9
Conference Report Conference Declaration • to train and retain adequate numbers of health workers, with appropriate skill-mix, including primary health care nurses, midwives, allied health professionals and family physicians, able to work in a multidisciplinary context, in cooperation with non-professional community health workers in order to respond effectively to people’s health needs • to encourage that vertical programs, including disease-specific programs, are developed, integrated and implemented in the context of integrated primary health care. To address this imbalance and ensure health equity we assert that: Institutions for health professional education including medical schools should be socially accountable. Underserved communities must be supported to grow in their ability to identify and voice their health needs and work to guide institutions educating health practitioners in providing targeted training to address those needs.
Thunder Bay Communique New Ways of Thinking From Rendez-Vous 2012 Northern Ontario School of Medicine, Canada We, as members of communities from all over the world, health professional students, health professionals and trainers of health professionals have met in Thunder Bay during the Rendez-Vous 2012 conference to discuss community participation in health professional education, research and service. We recognise the particular disadvantage of Indigenous peoples, those living in rural areas and those in poor and underserved areas. Addressing past disadvantage requires attention to equity – the right of every community, no matter where they are, to fair access to health care and equal health outcomes – which will mean directing specific focus and resources to rural, remote and other underserved communities.
Communities must be part of generating solutions to their own health care needs and enabled to be actively involved in implementing these solutions. “Nothing about me without me” should be the guiding philosophy of community involvement for all institutions, research centres managers, and service providers. Accreditation of health professional education institutions should include measurement of • the responsiveness of these institutions to the needs of their communities • the training of generalist practitioners who can work in both primary and secondary care • the patient and community centredness of their graduates • the safety and wellbeing of students
We recognise that an important factor in health inequity is the lack of access to skilled health practitioners. This needs to be addressed with sensitivity to the historical disadvantage and the cultural context of the community and can only be effectively righted by increased access to health practitioners with knowledge skills and attitudes responsive to community needs and operating in a socially accountable and equitable health system. Such services should provide coordinated, effective and joined up care by generalist practitioners including primary health care nurses, midwives, allied health professionals and family physicians,that are integrated with specialist service providers. These teams provide opportunities to include students in longitudinal integrated clinical learning experiences.
We would encourage institutions to self evaluate their response to community need by using THEnet evaluation framework (see www.thenetcommunity.org ). The education of professionals should be scaled up to provide the needed numbers of practitioners who are likely to work in underserved communities by: • Assisting students in these communities to obtain sufficient basic primary and secondary education to be able to enter health professional training • Recruiting students from these communities • Training students in generalist practice • Training students in Primary Health Care • Training students in team based contexts with interprofessional learning • Providing innovative training initiatives that create community links such as longitudinal integrated exposure in communities of need
We recognise that the existing workforce shortages, burden of infectious disease, the increasing burden of chronic disease and disability, and the burden of the global financial crisis fall most heavily on these already disadvantaged communities. We support the World Health Assembly’s Resolution WHA62.12 (2009) which urged member states 10
Conference Report Conference Declaration The Melbourne Manifesto and subsequent WHO Global Code of Practice on the International Recruitment of Health Personnel should be implemented and reported on by governments. There should be processes whereby reparative measures are used to recompense the countries that lose practitioners to more developed nations.
and their progress evaluated during the implementation of new educational models and programs • Teach an understanding of human rights, equity, including gender equity in communities • Work together internationally to share education resources and research tools openly • Provide generalist training Health systems should be strengthened through universal • Facilitate interprofessional learning for interprofessional coverage leading to improved access. The gap between what practice professionals can do and are doing should be addressed by: • Provide transformational educational opportunities that • Removing of barriers to practice maximise the length and strength of relationships with pa• Implementing relevant technologies to assist and integrate tients, supervisors and communities and create authentic care workplace learning and identity formation • Providing facilities that match the needs of the community and the skills of the practitioners especially birthing and pal- The Way Forward liative care services • Enabling primary care doctors to address and coordinate The organisations commit to the implementation of these care for chronic disease undertakings, each within their purview. • Ensuring that ethical behaviour is taught, supported and regulated We call on governments globally to foster and support these initiatives. The effectiveness of systems such as capitation, fee for service and pay for performance should be rigorously assessed as the We commend to governments and training institutions the basis for an evidence based approach to health care financing. WHO Global Recommendations on Increasing Access to Health Workers in Remote and Rural Areas through ImproHealth services should be delivered whereever possible by lo- ved Retention. At the same time we wish to note our concally based health care teams that include generalist practiti- cern regarding the diminishing focus on human resources for oners who are empowered to deliver and coordinate compre- health in WHO as evidenced by the reduced budget and small hensive care and to integrate the implementation of disease numbers of people now available for this area in WHO, in conbase programmes where they exist. Visiting and local speci- trast to the number of people in the more vertical programs. alist services should be integrated with these teams as they form an important resource that must not be wasted. We support the resolutions of the World Health Assembly regarding the need to scale up and transform health profesThe improvement of the health of communities requires the sional education (WHA EB128.R9 and EB 128.R11, 2011) and empowerment and involvement of women and improving the Lancet Global Commission on Education of Health Profestheir safety and social, educational and economic standing. sionals for the 21st century recommendation for transformative learning and interdependent health systems. The process Those of us in universities and academic institutions resolve of implementing guidelines for transforming and scaling up to: health professions education is critical, and, as organisations • Have communities guide us in the implementation of represented in this conference, we express our willingness health professional education that addresses their needs and commitment to be involved in assisting the development • Strengthen communities to address their own health needs of such guidelines. These guidelines should provide an opporthrough participative research and evaluation tunity to steer the direction of health professional training glo• Develop programs and new methods of education that bally that should not be lost. maximise the immersion of students in communities throughout their training • Ensure that students are properly prepared and supported Sunday, 14 October 2012
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Conference Report Rendez-Vous: Impressions We asked participants to describe in one word what they thought about this year’s conference. This is the result:
Great
Exhausting
Interesting
Success
Connect Fantastico Inspiring Diversity Practical
Experience Fascinating
Learning Newsletter Volume 30/no. 2/December 2012 ISSN 1571-9308 Editor: Julie Vanden Bulcke Language editor: Amy Clithero The Network: Towards Unity for Health Publications UGent University Hospital, 6K3 De Pintelaan 185 B-9000 Ghent Belgium Tel: (32) (0)9 332 1234 Fax: (32) (0)9 332 49 67 Email: secretariat-network@ugent.be Internet: www.the-networktufh.org Lay Out: Marijke Deweerdt, Sofie De Backere Print: Drukkerij Focusprint
Unity
Intriguing
Medical
Well organized
Exciting
Different
Awesome
Fantastic
Unusual
Exchange
Continuity
Less familiar
New ideas
Invigorating
Interactive
Engaging
Fabulous
Special
Fun
Amazing Awakening
Unique
Innovative
Academic
Sharing Less identity
Meeting people
Above expectations
Engaging
Disparate