Newsletter 2014 01 (1)

NEWSLETTER Newsletter Volume 32/no. 1/August 2014

In this issue, among others: • Sex Education Across Borders • Life Style Diseases in the Philippines • Interview with Prof Elci • The Mepi Initiative

Editorial Dear readers, While our annual conference in Fortaleza is approaching, we could count once again on the great input of our members and readers resulting in another interesting newsletter; a Newsletter that shows that through our networking we can realize things.

I can see projects that were introduced at previous conferences being implemented on other sides of the world e.g. the narratives project (see p 5) I’m very happy to be in contact with the enthusiastic Brazilian students and feel their energy in preparing the student activities.

And as always we had the opportunity to talk with wonderful and interesting people like Silvia Martinez (p 13), Prof Elci (p 21) and Angelo Manalo (p 25) Enjoy your reading!

Julie Vanden Bulcke

In the Newsletter we refer to The Network: Towards Unity for Health as The Network: TUFH. The Tufh nieuwbrief sept 2014.indd 1

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Contents Message from the Secretary General 3 What Role Can The Network: TUFH Play in the Future?

The Network: TUFH in Action 4 Annual International Conference 4 Education for Health

Looking forward to Fortaleza!

Education for Health News

Improving Health 5 Health Promotion 6 Women’s Health 7 Health Services 8 Health Services 9 Health Professions 10 Rural Health 11 Rural Health

12 Integrating Medicine and Public Health

13 Great Stories from Great People

Create a Therapeutic Intervention Route Based on the Use of Narratives Why Women Die in South Sudan?

Primary Health Care in India: Quality of Paramedical Manpower and Services A Clinical Decision Support System for Resource Poor Settings Gender Inequalities among Workers of a Mexican Public University Lifestyle Diseases in a Rural Community in the Philippines Challenges Faced and Lessons Learnt from Working with a Multicultural Community in East Sudan From strange Bedfellows to Ideal Companions: A Community and University Unite to Address Neighbourhood Needs Silvia Martinez

International Health Professions Education 14 Medical Education 15 Medical Education 16 New Institutions and Programs 17 New Institutions and Programs

18 PBL and Community-based Education 19 Interprofessional Education 20 Interprofessional Education 21 Leadership Column

Preparing Students for Bilingual Medical Practice in South Africa The Longitudinal Clinic/Community Attachment programme for Students Low-Cost Simulation Training in Maternal Health Education Leadership Training for Undergraduate Health Professionals as Part of Their Preparation for Community Placement Strengthening Rural Health Systems to Improve Health Sex Education Across Borders Street Outreach and Shelter Care Elective for Senior Health Professional Students Prof Omur Cinar Elci

The Like-Minded Working Together 22 Like-minded Institutions

The Medical Education Partnership Initiative

Student’s Column 23 Out of the SNO Pen 24 Big five

Welcome to Fortaleza Josephine Najjuma

Member and Organisational News 25 26 27 27 28

Messages from the Executive Committee EC Eminence: Angelo Manalo Taskforces Interprofessional Education Taskforces Integrating Public Health and Medicine Taskforces Community-Based Care for the Elderly Taskforces Social Accountability

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Message from the Secretary General The Lancet Commission has Completed their Work: What Role Can The Network: TUFH Play in the Future?

On the 30th of June, Dean Julio Frenk of the Harvard School of Public Health and Doctor Lincoln Chen of the China Medical Board, announced in their last newsletter that the Lancet Commission they had co-chaired has completed its work of launching a framework for 21st century’s health professional education.

The report, “Health professionals for the 21st century”, is a landmark for the development of education for the health sector. The framework is there, but now it has to be put into practice.

The Network: TUFH has been bringing people together since 1979, and was continuously involved in innovation of education. The Network can play an important role in the implementation of the principles that were outlined, using three strategies.

First of all, by bringing experiences together, stories of organizations and people that made a difference. In this Newsletter we look at topics like gender inequalities in Mexico, contributions of Family Medicine residents to improvement of the health of communities at the University of New Mexico, world- wide efforts in relation to sex education, research on the determinants of maternal mortality in post conflict zones in South-Sudan,…. Our annual conferences, our Newsletters and Alerts and our publications in Education for Health (www.educationforhealth. net) document these continuous efforts to be responsive to the needs of populations with special emphasis on those living in underserved areas.

A second strategy is bringing like-minded people together: during recent years, our annual conferences have been meetings where different organizations involved in innovation of education of health professionals meet together and start structural cooperation to make change happen. In this issue, we look at the longitudinal clinic/community attachment programs and at activities of the Medical Education Partnership Initiative. Thanks to its status as an NGO in official relationship with WHO, The Network: TUFH has been involved intensively in the implementation of the WHO- Guidelines 2013: “Transforming and scaling up health professionals’ education and training”.

The third, and most concrete strategy, is that the Network, brings people together that demonstrate their social accountability towards problems of the communities they serve. In the daily struggle for a world that has to be more peaceful and more oriented to social justice, health professionals’ educators know that they can contribute by demonstrating in their daily work how these values are translated into practice serving individuals, families and communities.

We are part of a global community: I write this editorial the day after flight MH17 of Malaysia Airlines has crashed in Ukraine, as a consequence of war in a small part on earth - but there no more “local” conflicts. Our thoughts are with the family of the victims. A part of them committed their lifelong scientific work and societal commitment to the improvement of health and were on their way to an international conference. This tragedy and the other tragedies we face today, illustrate once more that the world is global and that the reaction to the global challenge must be our global effort and daily commitment to the health of populations. This is the only answer to this horrible loss of human lives, and these devastating blasts to the global community.

Your presence at the 2014 Fortaleza meeting will be an illustration of your commitment to the global challenge we are facing. We look forward to meeting you in Fortaleza!

Prof. Dr. Jan De Maeseneer, Secretary General, The Network: TUFH Email: jan.demaeseneer@ugent.be

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The Network: TUFH in action Annual International Conference Looking forward to Fortaleza leza, Brazil from November 19-23. The “One winter night while the theme for this year is “Strengthening soup was boiling in the fireHealth Professions Education as a Poplace, he missed the heat of licy to Improve Health”. The Brazilian the back of his store, the buzhealth care system is undergoing trezing of the sun on the dusty mendous changes. Developing adequaalmond trees, the whistle of te policies in Health Professions Eduthe train during the lethargy of cation is a requisite to grow towards siesta time, just as in Macondo a comprehensive health care system he had missed the winter soup in the fireplace, the cries of the Maarten Declercq, Francisco Lamus Lemus, Henry Campos that takes into account the needs of all people. coffee vendor, and the flee- and Rafael Bezerra ting larks of springtime.” -One The Universidade Federal do Ceara is the co-host for this year’s Hundred Years of Solitude, Gabriel García Márquez conference. It is supported by the Brazilian Ministry of Education.

Time seems to be passing like a waving hand on a train. The The conference will serve as a tribute to Nelson Mandela and past has no return but at times we dwell in nostalgia. However, Maya Angelou; Two personalities who fought across boundaries remembering things of the past is not necessarily a good re- and made a tremendous contribution to human rights worldflection of things as they were. In our actions we keep tracing wide. They represent the kind of leadership we want to nurture the labyrinth of story lines that ultimately will form the lineage with The Network: TUFH. of our face and what we stand for. Let’s keep on working togeSee you in Fortaleza! ther to make The Network: TUFH stronger.

Maarten Declercq, Executive Director, The Network:TUFH We are looking forward to see you at the 2014 Annual ConfeEmail: maarten.declercq@ugent.be rence of The Network: TUFH. This year it takes place in Forta-

Education for Health News – 2014 Pune Visit Michael Glasser, Associate Dean for Rural Health Professions, University of Illinois at Rockford, and Co-editor of Education for Health (EfH), traveled to India June 18-26 for meetings to review progress and set directions for the official journal of Network: Towards Unity for Health. This is a yearly trip made by a co-editor to directly meet with journal managing editors to plan and work on issues central to the continuing operation and success of EfH. Drs. Payal Bansal and Gaurang Baxi of the Maharashtra University of the Health Sciences (MUHS), Managing and Assistant Managing Editors of the journal, met with Michael each day during a brief but very productive visit. Activities included: meeting in Mumbai with Medknow Publishers, who produce the journal online, to discuss ways to efficiently publish EfH’s three issues per year and market the journal to larger audiences as well as receive an update on application for an impact factor; discussions on the day-to-day operations of the journal in a climate of increased submissions to EfH; establishing an Education for Health Student Internship, to provide additional support for journal administration, while at the same time giving a graduate student the opportunity to work as part of an international journal staff; and meeting with MUHS department heads, faculty, and administrators at both the Pune and

Nashik campuses to discuss both the journal and other possible collaborations that could involve Network: TUFH. Dr. Arun Jamkar, Vice-Chancellor of MUHS, expressed continued support for the journal’s publication through the efforts of Drs. Bansal and Baxi.

In addition to increased submissions to the journal, highlights this year include over 43,000 full text article downloads from the journal website in the first six months of 2014 and three special issues of the EfH focused on interprofessional education (guest editor, Dawn Forman), reflecting on educational implications of the Rendez-Vous conference (guest editors, Roger Strasser and Sue Berry), and Brazil papers submitted in Portuguese, to be published in English, with abstracts in Portuguese and English (guest editor, Eliana Amaral).

It has been an exciting year for the journal, with a Pune visit that allowed Michael to sample many of the local foods and teas!

Michael Glasser, Ph.D. Co-editor, Education for Health. University of Illinois – Rockford Email: michaelg@uic.edu

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Improving Health Health Promotion Create a Therapeutic Intervention Route Based on the Use of Narratives Context: A group of students at Universidad de La Sabana School of Medicine were assigned to develop a community health project at CEDESNID Foundation (Integration and development of vulnerable people) during the second semester of 2012.

Setting: The project was conducted with two patients of the CEDESNID Foundation, their families and therapists.

Problem: The expectations of the relatives of CEDESNID´s patients about the development of potentialities in a person with cognitive incapacity as an obstacle or an opportunity of therapeutical intervention at home or in the CEDESNID foundation.

Objectives: General objective: People with Cognitive Disability with the maximum development of their abilities.

tions of family members and therapists re- mulation.” garding patient’s general development and Results: expected performance were subsequently The family expectations were center in soobtained. cialization, complete improvement, avoid After compiling the data, the group trian- deterioration and not to depend on anygulated the information obtained through body. On the other hand, the therapist exclinical records, family and therapist narra- pectations were center daily everyday actitives. A final timeline was plotted to reflect vities, independence, suitable conduct and the expectations of progress with regards better communication. to patient’s capacities, which could also contribute to clearly organize a therapeutic Clarifying and reflecting around contrasting intervention route applicable to CEDESNID expectations from patient’s parents and Foundation resources and family possibili- therapists, together with reported real advances, allowed therapeutic adjustments ties. and improved family compliance with treNarrative examples: atments, as well as improvements towards - Family member Narrative example: “The future integrated team interventions. expectations are that the child could soConclusions: cialize, but not to give me results, because I amvery clear with the doctor that - There are differences between the expectations of the therapists, relatives the boy is not a patient who will give and what was raised in the clinical hisresults at future”. “First that he is sociatory about the development of potenlized and second that he receive here all tialities’ of the patients with Cognitive the support therapies”. “That he doesn’t Disability. degenerate more because he deterio-

Specific objective: With the collaboration of the professional workforce of the instirates rapidly” tution they conducted a research project using narratives to organize the route of - Therapist Narrative example: “A major services according to family expectations progress is wanted, so we are working against the development of his family living more in daily activities; principally in the with disabilities that would better suit the control of sphincters and in the feeding, cognitive disability of patients and their fawhich will give more independence” mily needs.

Clinical History example: Design: “We expect in a year to develop attention The methodology consists of realization of abilities, memory, executives’ functions, narratives to the families and to the thera- and visual contact with the interlocutors, pists in the foundation to support suitable behavioral digest, to strengthen grasps, to strengthen the stimuand in their houses, review the clinical hislation through manual labors, to develop tories, make a triangulation, analyze the discriminatory skills of communicative stinarratives and finally create a route for the strengthening of the intervention in home.

The compilation of information was taken from clinical records, which gave the type and degree of disability, a global assessment of progress and the level of achievement of goals. Descriptions of moments where greater advances had been achieved both in the institution and within their families were particularly important in the search. Oral narratives about the expecta-

- The families’ expectations affect the therapeutical continuity at home.

- It’s necessary to strengthen and to continue a suitable communication between the institution and the family to achieve the maximum development of the potentialities of patients with Cognitive Disability.

- The creation of the therapeutical route must be realized between the institution and the family.

- The narrative is a tool that generates the change used to strengthen the therapeutical intervention at home.

- The keepers can turn into potential leaders sharing his experiences with the community.

MC. Estrada Lasso, M. Socha Gonzalez; Faculty of Medicine, Universidad de La Sabana, Bogotá, Colombia Email: moni_5110@hotmail.com

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Improving Health Women’s Health Why women die in Sudan For centuries the world has neglected one of the major health problems facing it, “Maternal and Child Health”, denying or not giving it all the attention needed resulted in the death and disability of millions of women and children and still does. The nations agreed on facing the challenge. Conferences were held from 1968 until 1987 emphasizing the importance of Maternal and Child Health, then addressing the issue as one entity in “Mother and Baby Package”. From Nairobi to Brazil, declaration after declaration “Safe Motherhood” followed by the International Conference on Population and Development (ICPD) in 1994 where the participatory countries decided on reducing maternal mortality to 75% below 1990 levels by 2015 .It was agreed on as goal 5 “ To improve maternal health” one of the Millennium development goals (MDG), unfortunately Africa is failing it. Fifty-seven percent of all maternal deaths occur on the continent, giving it the highest maternal mortality ratio in the world.

“Fifty-seven percent of all maternal deaths occur on the African continent, giving it the highest maternal mortality ratio in the world” Sudan experienced two major civil wars in its south part after attaining its independence from British rule in 1956. The first ended in 1972 when the South was granted regional autonomy. The second war in 1983 had been complicated and made complex, by the religious, ethnic diversity and divisions in the country and the region. South Sudan was separated from the rest of the country after the 21 years of civil conflict. The many decades of war have devastated the health infrastructure, affected preventative care and led South Sudan to have one of the highest maternal mortality in the world. The Southern Sudan Household Health Survey (SSHHS) of 2006 estimated maternal mortality ratio (MMR) at 2054/100,000 live births: 1 in 50 women died out of a population of 10 million people in the south.

ning in-depth understanding of the interacting determinants behind maternal mortality and investigating the methods of survival of maternal near miss in crises without professional health care.

The study population being 11 events of reproductive age (1549) whether maternal mortality or maternal near miss allocated purposively and by snowballing. The interviews were conducted with husbands, mothers, in-laws, sisters, midwives of the deceased and in case of survival the maternal near misses. Critical Incidence Technique was applied to qualitatively study the seven events of maternal death and eight events of maternal near miss through in- depth interviews with all witnesses that were part of the event. The data obtained was analyzed using thematic approach.

Findings: The study showed that the determinants of maternal mortality vary according to the different phases, causes and complications.

Different factors interact in health seeking behavior & accessibility of health care services. These could arise as the result of post-conflict conditions they live in, social, cultural and economic factors and scarcity of services. The community considers excessive child bearing as a way of compensation to lives lost due to war and illness. They are unacquainted with the pregnancy and labor danger signs resulting in delay in making decisions, prioritizing expenditure, and accepting available services. The concept of seeking health care does not exist in normal pregnancy and labor. When help is needed during labor the village midwife is not their first option. They prefer to go to traditional birth attendants for many reasons such as trust, acceptance and lower financial burden.

Conclusion: Huge efforts have been done to reduce supply side barriers in post-conflict settings; however, it is clear that utilization of accessible maternal facilities is very low and influenced by cultural, social, and economic context. Health systems need to understand this context in order to improve maternal health.

Ayat Abuagla1, Khalifa Elmusharaf1, 2 Email: ayat.abuagla@yahoo.co.uk 1. Reproductive and Child Health Research Unit, University of Medical Sciences and Technology. Sudan 2. Epidemiology & Public Health Medicine Department. Royal College of Surgeons in Ireland. Bahrain

Design: The study was conducted in South Sudan, Renk County. It hits borders with The Sudan, giving a mixture of tribes. Renk is struggling to build their basic health infrastructure as a priority.

The objective of the study was to identify the determinants of maternal mortality in post conflict fragile settings through gai-

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Improving Health Health Services Primary Health Care in India: Quality of Paramedical Manpower and Services Background The health care system in India is a three tier system, primary health care being the first tier targeted at the vast rural population. Primary health care, a diverse entity encompasses both public sector and private (for and not for profit). Rural health infrastructure, comprised of three types of institutionsSub Centre (SC), Primary Health Centre (PHC) and Community Health Centre (CHC), was developed by the government to provide primary health care services through a network of integrated health and family welfare delivery system (Majumder and Upadhyay, 2004). In addition to this allopathic- based Government system, a large number of private providers from alternative medicinal streams like Ayurvedic, Unani, Siddha and Homeopathy (collectively called AYUSH), and faith healers without any form of training (Rao and Mant, 2012) also operate in the rural areas attracting large clientele for reasons not clearly understood.

scope for improvement of quality of care in rural areas, while noting some exceptions.

A Quasi-Experimental study We designed a tool, based on Primary Health Care- Management Advancement Program (PHC-MAP) for quality assurance (QA) of HAs (and other PHC and SC functionaries). The QA program was an integral component of a model for improving child survival in rural areas through community led initiatives, encompassing all components of care and health promotion, including medical care, women’s empowerment and education, food security, and microeconomics. Using QA tool among HAs in a rural district in a central Indian state (Wardha, Maharashtra), we found many quality parameters to be deficient like inadequate staff strength, absence of a supervisory schedule for ANMs, lack of focus on maternal and child health activities, lack of training capacity and improper reporting of events to the medical officers. Qualitative data revealed that the training of these health workers was inSC is the first contact point between Paramedical health wor- adequate and not organized periodically. A Quality Assurance kers and village community. The national norm of population program of two years, targeted to improve the identified deficicoverage is 5000. The Auxiliary Nurse Midwives (ANM) super- encies, significantly helped to improve the quality of HAs. vised by the Health Assistants (HA) (who in turn, are trained A paper stated that 10% posts for PHC doctors, and 25% nursing and supervised by PHC doctors) are the principal paramedical posts at PHCs and CHCs combined remained unfilled that results staff responsible for providing family welfare services that inin increased sharing of work by manpower in position. Also, PHC clude but are not restricted to child immunization, antenatal doctors have less competence and make less effort than private care, postpartum care, family planning education, growth mosector staff which in part, is responsible for the poor quality of nitoring of children and treatment of common ailments, and the support manpower. Similar reports on health care quality health education in every village. PHC acts as a referral unit from other Indian states reflect and reinforce the need for regufor 6 SCs covering a population of 30,000, is the first contact lar continuous professional development training for knowledge point between the village community and doctor. The activities and skill building of all cadres of health workers in this system. of PHC, besides providing curative, preventive and promotive services, especially concentrated around Family Welfare; also involve training of the paramedical staff and supervising their Dr. Enakshi Ganguly; Dr. B S Garg; Dr. Sushila Nayar School of activities. It has 4-6 beds for patients. Community Health CenPublic Health tre (CHC), a referral center for 4 PHCs covering a population of Mahatma Gandhi Institute of Medical Sciences; Sewagram, 120,000, is equipped with 30 indoor beds, and higher facilities.

Wardha, India India, in an effort to provide Health For All through primary Email: gargbs@gmail.com health care, has channeled its focus on quality of primary health care following studies conducted across the country reporting low utilization due to low patient satisfaction ranging from 23% in low performing states to 75% in high performing states, resulting from non-availability of staff, poor infrastructural quality of the facilities, incompetence of the providers, and unavailability of drugs and lab services, to name a few, compounded by poor accessibility in terms of distance and cost. The National Rural Health Mission, whose key strategy to improve patient satisfaction is through improving quality, integrated AYUSH practitioners into PHCs to optimize the utilization of these resources to meet the needs and to reflect the growing interest of populations in integrative care. However, the Planning Commission reported that there was further

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Improving Health Health Services A Clinical Decision Support System for Resource Poor Settings Fall of 2006. I joined my medical school in the south Indian city of Chennai. We had very few classes in the first couple of months and rest of the time we turned up on the streets to protest against compulsory rural postings. We were all fresh into the medical school, motivated by the humanitarian aspect of this profession. But no one likes being forced and I was no exception. I went back and researched to find that India has only 0.6 doctors for every 1000 people in the country. 2/3 of our population does not have access to specialist health care and 1/3 of us travel at least 30 km before reaching the nearest health facility. But then, it still did not make sense to send a bunch of unmotivated people into villages.

VHW was posed with a number of questions pertaining to the clinical history and a few basic physical findings while encountering a patient. Depending upon her responses, the application was able to offer a classification (like a provisional diagnosis) of the case and suggest an emergency management. The availability of GPRS connectivity routes this data into a central server.

The back end data was used to generate reminders and alerts, to manage health information systems and to do real time biosurveillance. We evaluated a number of hardware devices - like a Point-of-Sale device with a print functionality, also mobile phones. We had separate apps depending on whether the encounter with the patient occurred in a PHC, or at the patient’s door step.

The apps were made available in English, also the local vernacuI was looking to find an alternative solution to the problem. lar language- tamil.

During community medicine rotations in Primary Health Centers (PHC) in remote villages, I realized that a Village Health This initiative by then had drawn the attention of the National RuWorker (VHW) is the heart and soul of our health systems. She ral Health Mission, Govt. of Tamil Nadu, which agreed to fund a simultaneously engages in a multitude of health verticals run student’s project on building mobile based decision support sysby the government. She caters every day to a huge popula- tems to cater to maternal health and the health of the under-5 tion of patients and has an enormous amount of paper based child. We ran a field trial of the CDSS in a couple of PHCs and record-keeping to do every day. I saw that in empowering a Vil- involving more than 10 VHWs. The technology clearly increased lage Health Worker to take appropriate decisions and making the adherence to protocols and accounted for an increased diagher work easier there lays a potential solution to the unfavora- nostic accuracy of the VHWs when compared to state-of-the-art ble doctor-patient ratio in the country. clinician decision.

I shared the idea with a few engineer friends, then studying at some premier institutes in the country. We set together an inter-disciplinary team with expert physicians from the partnering institutes, a couple of doctors and a few engineers - all students. We started building Clinical Decision Support Systems (CDSS) for resource poor settings. We identified a number of established protocols for Maternal and Child Health to start with and customized them to the local circumstances, e.g.

The Integrated Management of Neonatal and Childhood Illness (IMNCI) protocol for child care. We built decision trees of these protocols and coded them into JAVA based applications. The

We then tried to turn the idea into a sustainable model. We fortunately won numerous grants to start a venture. We started up a company in 2009, based out of the Rural Technology Business Incubator in the Indian Institute of Technology, Madras. Since its inception, Newdigm has won numerous national and international awards and is expanding the purview of CDSS to chronic diseases like Diabetes and Hypertension. The long term impact of such an intervention is of course subject to larger trials and more meticulous evaluation. However, if this article conveys how student initiatives can bring forth potential solutions to health problems in the developing world, I believe it has reached its true purpose.

Dr. Saurav Das, Founder-Director, Newdigm Healthcare Technologies (www.newdigm.com), India Email: sauravdas@newdigm.com

CDSS in action

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Improving Health Health Professions Gender Inequalities among Workers of a Mexican Public University Introduction Mexican women have gained spaces in traditionally male-dominated labor areas but gender inequalities at workplaces are still an unsolved problem. Higher education institutions are not an exception. While some women have attained power and leadership positions, most university women —including faculty, administrative staff, and students— still have to deal with different forms of gender discrimination. According to national strategies, efforts have been done to introduce gender main- Focus group streaming within universities.

In general, however, a lack of knowledge recognition of their intellectual and leaderabout the meaning of gender prevails at ship capacities, and sexual harassment. most universities and gender issues are still Difficulties for balancing work and family considered as only women’s issues. were addressed by one female participant At the University of Guanajuato, a public institution located in one of the most conservative states of Mexico, a first qualitative study was done in 2011 to explore the influence of gender on the working conditions of both women and men. Three focus groups were coordinated: academics at higher decision-making levels, faculty, and administrative staff. Each group included 11 participants of both sexes. Additionally, three semi-structured interviews were done.

Main outcomes Misconceptions and stereotypical assumptions about gender-related issues were observed in both women and men who participated in the three groups; women working at the lowest administrative levels had more difficulties in expressing their opinions. Most men in the faculty group tended to trivialize the role of gender inequalities at university workplaces; only those at higher academic decision-making positions recognized gender discrimination as a major barrier for women’s equal participation within universities. The main problems addressed by women academics included difficulties for balancing their professional and family responsibilities, excessive workloads with negative effects for their health, low

in the group of academics at higher decision-making levels: “At some point in their lives women have to choose between caring for their families and developing a real professional career (…) men don’t have to do it because only their wives, regardless their occupations, are obligated to make such decisions”.

The low recognition of women’s intellectual and leadership capacities was illustrated by one participant in the faculty group“(…) as a woman you must work harder than men (…) you must fight to win a better academic position and you must demonstrate that you are really diligent. Only when you do so, you may expect to gaining respect from your colleagues”.

fall in love with me? ” To complement this humiliating picture, one male participant in the group of administrative staff pointed out that “One common way for women to access to work positions at the university is by pressing them to give sexual favors”.

Final comment Recognizing gender issues as both women and men issues is critical for the construction of a new gender culture at Mexican higher education institutions. Therefore, university strategies to deal with gender inequalities most take into account the gender-specific needs of both women and men including faculty, administrative staff and students.

More workshops are needed to prevent gender discrimination and support structural and cultural changes at the University of Guanajuato. However, changing personal attitudes towards gender-related issues is not an easy task. Gender stereotypes are deeply rooted in the cultural context of Mexico and resistances to gender mainstreaming are common in academic environments; dealing with these resistances requires a strong political will for establishing and sustaining long-term institutional commitments from all members at all levels of higher education institutions.

Finally, higher education institutions are called to promote a new perspective on gender issues among students as well as a better understanding of how gender equality may contribute for the construction of societies where women and men are equalSexual harassment emerged as a form of ly valued in terms of their opportunities, gender-based violence frequently faced by capacities and rights. women at universities. A young woman described a sexual harassment situation when she was interviewed by a male professor to Addis Abeba Salinas*, Rosalba Vázquez **, be part of a post-graduate teaching team: and Deyanira González de León* He said “how beautiful you are!”(…) Then *Metropolitan Autonomous University, he asked about my academic background Xochimilco Campus, Mexico City, Mexico. and said “how interesting curriculum you **University of Guanajuato, Guanajuato, have, but even more interesting is that you Mexico. are a really intelligent person”. Then he kept Email: asalinas@correo.xoc.uam.mx on flirting and asked “do you think you could

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Improving Health Rural Health Lifestyle Diseases in a Rural Community in the Philippines Top causes of mortality and morbidity in the Philippines such as cardiovascular diseases, cancers, chronic respiratory diseases and diabetes account for more than half of all deaths in the country. These diseases are collectively known as Lifestyle Related Non-Communicable Diseases (NCDs) because these diseases have common risk factors which are to a large extent related to an unhealthy lifestyle. For the years 2009 - 2011, lifestyle diseases were consistently identified as the leading causes of morbidity and mortality in Sabangan, Mountain Province, Philippines.

Sabangan is a fifth class municipality with a population of 9,915 in 2011 in 2,047 households. It is primarily an agricultural municipality where 79% of employed residents are agricultural workers. The primary sources of household income are farming, gardening and hog raising. The rising trend of the prevalence of lifestyle diseases has prompted the Sabangan Rural Health Unit (RHU) under the leadership of its Municipal Health Officer (MHO), to conduct a Healthy Lifestyle Advocacy that aims to increase awareness of these lifestyle diseases and to provide ways by which they can be prevented. The primary step to this program is a Lifestyle Screening which involves anthropometric and physiometric measurements to diagnose the presence of common lifestyle diseases.

Members of the health team hike to the farthest village in the municipality, Barangay Gayang

During the Healthy Lifestyle Advocacy program, participants were counseled on lifestyle modifications which they can undergo to lower their risks. Modifiable risk factors as discussed above focused on the participants’ diet and exercise. Cessation of smoking and moderation of alcohol consumption were also highly recommended. During the counseling sessions, many of the participants found it strange that exercise should be a recommendation considering that their occupations require manual labor. Given this perception, there is a need for enhanced information dissemination that will not only respond to misperceptions but that which is culturally sensitive as well. This also goes when making diet recommendations, especially in areas where the availability of certain types of food such as fruits are seasonal.

To assist the implementation of this advocacy, a study was conducted to evaluate the risks associated with chronic lifestyle diseases among one hundred forty three adults aged thirty and above in three villages in the area. Anthropometric measurements (Height, Weight, Waist and Hip circumference) and physiometric measurements (Blood pressure, random blood sugar, urinalysis) and personal and family history were used as predictors of emerging lifestyle diseases such as hypertension, The alarming number of overweight and hypertensive populaticardiovascular diseases, and Type 2 Diabetes Mellitus (T2DM). ons can be attributed to several lifestyle-related risk factors, such as dietary habits, alcohol consumption, and tobacco use. With Of the evaluated risk factors, 88% claim to experience stress, proper counseling and discipline, these risk factors can be modi41% were obese, 25% were known hypertensives, 30% were fied and decreased so as to decrease the prevalence of non-comalcoholics, 21% were smokers, and only two percent of them municable lifestyle diseases in the area. In the socio-economic were diabetic. Family history of hypertension was most pre- perspective, communication and transportation have now becovalent in the population. Upon performing anthropometric me accessible to the rural areas. This has led to changes leaning measurements, 41.1% of the population was overweight and to urban living among the rural dwellers, such as the consump9.2% were classified as Obese I. In addition, 91.8% of the fe- tion of processed food over the usual backyard crops. Primary male participants and 56.9% of the males had abnormal waist- prevention should be highly prioritized by Municipal Health Cento-hip ratio. As an index to predicting hypertension, it was ters as it is the most cost-effective and healthiest routine for the known that 19.1% of the participants were pre-hypertensive prevention of non-communicable diseases. Initiatives such as the and 29.8% were already hypertensive. The alarming number Healthy Lifestyle Advocacy are also recommended to curb the of residents that are overweight or obese, pre-hypertensive rise of lifestyle diseases among communities in the Philippines. or hypertensive who are unmanaged with no follow-up from health care service providers is a looming public health problem that presents a challenge to the skill and resources of Heather Dulnuan rural health workers.

Email: heathergrace.dulnuan@gmail.com

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Improving Health Rural Health Challenges Faced and Lessons Learnt from Working with a Multicultural Community in East Sudan Background: University community partnership Project (UCPP) is a long-term partnership between three partners: 1) Reproductive and Child Health Research Unit (RCRU) at the University of Medical Sciences and Technology (UMST) in Khartoum, 2) University of Kassala and 3) Makali village in east Sudan. The aim of the project is to design and implement innovative interventions capable of improving the health status and developing the village community. Tribes with different dialects, cultural beliefs and traditions inhabit the village. It was vital to understand their unique culture and needs before embarking on community-based research, and designing and implementing contextfriendly interventions.

1. Cultural sensitivity: When first entering the village, researchers were unaware of some of the community’s customs and beliefs. In order to avoid conflicts and misunderstandings, the research team was supported by people from the local community to explain how to behave according to the community culture. For example, the village People’s Committee was made up of a number of men who preferred to address and be addressed by the male members of the research team.

4. Conflict managing Ownership of the data collected was an issue and created a friction between the two main partnering universities. This resulted in delaying the process of data entry and analysis. Conflict management and resolution strategy was applied through more communication, direct negotiation and considering the relationship as a priority.

Resolution of the conflict provided an opportunity to strengthen the bond between the two partners.

2. Community engagement Engagement with the community was one of the biggest challenges. The community was involved through the People’s Committee of the village. UMST trained researchers and data collectors from the local University of Kassala as they are more familiar with this part of Sudan and its culture. They were welcomed into the households and the community willingly shared information with them.

Conclusion: Working with multicultural communities and multiple partners under the same umbrella is difficult. It needs flexibility, open mindedness, leadership, communication skills, conflict resolution and critical thinking. Challenges were overcome by collaboration with local institutes, effective communication between group members and ensuring community involvement and engagement from the beginning of the project.

The initial phase of the project included a household survey to explore health and developmental indicators and their relationship with socio-demographic and socioeconomic characteristics. The research team encountered challenges and consequently learnt lessons. The aim of this article is to 3. Language barriers Translation of the questionnaire from Enhighlight these challenges and lessons. glish to Arabic then to simple Arabic local Design: language without changing the meaning The research team was a multi nationality was a challenge. We managed this with team comprised of researchers from other more meetings with partners from the Uniparts of Sudan, Nigeria, Sweden and the versity of Kassala, walking through a long U.S.A. The team professions were medical process of cross checking and piloting the doctors and public health specialists. questionnaire and waiting for feedback from the data collectors.

Findings:

Muaz Hassan1, Amal Khalil1 and Khalifa Elmusharaf1, 2 1. Reproductive and Child Health Research Unit, University of Medical Sciences and Technology. Sudan 2. Epidemiology & Public Health Medicine Department. Royal College of Surgeons in Ireland. Bahrain Email: imuaz12@hotmail.com

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Improving Health Integrating Medicine and Public Health From Strange Bedfellows to Ideal Companions: A Community and University Unite to Address Neighborhood Needs Since the opening of One Hope-Centro de Vida, the community has been able to communicate its needs to culturally and linguistically competent community health workers who live in the neighborhood and manage the clinic. In view of the community’s expanding health needs ECM reached out to the University of New Mexico, Health Science Center (UNM HSC) for help staffing the clinic and to provide a link to resources from the University of New Mexico Hospital. As residents and faculty heard about the One Hope-Centro de Vida project, new insight and ideas took shape. Residents evaluated the assets this community would bring to their medical training and realized that both the community and residency program could benefit from a symbiotic relationship. Improvement of healthcare access to immigrant families, an interdisciplinary educational experience, discovering important social determinants of health through community involvement, research, advocacy and policy work within the community were some of the many opportunities for collaboration Over the last four years, Family Medicine Residents at the Unibetween One Hope-Centro de Vida and UNM HSC. versity of New Mexico in Albuquerque have learned the importance and impact that their participation in the community Currently, One Hope-Centro de Vida provides preventive care, has on social determinants of health. This has not been easy dental care, psychological services, diabetes education and to achieve, but thanks to the perseverance of family medicine Zumba classes. Over time, the residents were joined by faculty resident physicians, support from faculty, and dedication from and students from the College of Pharmacy and College of Nurthe community organization East Central Ministries (ECM), a sing, creating one of the best inter-professional service/learning neighborhood run clinic is now providing basic medical care. models generated by the Health Sciences Center. Some of the ECM is a neighborhood clinic where patients feel comfortable pathology seen is so complex that in an effort to provide better in voicing their opinions because their language and culture patient care, the nearby Southeast Heights Center for Family and Community Health (a university clinic four blocks away) has alare well understood. lowed One Hope-Centro de Vida to refer patients to their facility, Albuquerque, also known as the “Land of Enchantment,” is the so patients that require specialty services can be better cared for. largest city in the state of New Mexico. Like many other large Along with improved medical support, One Hope-Centro de Vida cities in the United States, it has hidden communities that lack has also seen an improvement in its population’s health. Comaccess to health care. This lack of access was first discovered pliance with medications and an increase in diet and exercise

by ECM during a health fair in 2005. ECM is a Christian comin patients with diabetes and hypertension are two of the main munity organization whose mission is to partner with vulneraexamples. The outcomes of One Hope-Centro de Vida have ble neighborhoods to cultivate solutions, while developing and surpassed the expectations of ECM, UNM-HSC and the Family transforming communities by working with existing resources. and Community Residency Program. The take home message is, “One Hope-Centro de Vida-Health Center” is located in the when done with humility and understanding, educational institu“International District” neighborhood in Albuquerque. The tions uniting with community organizations can greatly improve majority of the International District’s population is made up wellness for individuals and families in surrounding neighborof low income immigrant families and refugees from Asia, Eu- hoods. rope, Africa, Central and South America. Many are undocumented. Their income, education and immigration status have prevented many of these families from accessing preventive Agustina C. Garzón López, MD; Erin Corriveau, MD, MPH; Unihealth services. Much of this population suffers from diabe- versity of New Mexico, Department of Family and Community tes, hypertension, obesity, chronic pain, domestic violence and Medicine Email: ecorriveau1@gmail.com depression.

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Improving Health Great Stories from Great People Silvia Martinez Prof. Silvia Martinez Calvo is a consultant professor at the National School of Public Health in Havana, Cuba. She was one of our inspiring keynote speakers at the Ayutthaya conference, so we were very honoured to catch her for this great interview

The most remarkable thing in Cuba is the result in terms of health outcomes. What are for you, as being involved in that process, the main drivers that have led to the results?

Sometimes people say the coming of Cuban doctors has the risk of weakening the development of the health system of that country?

The first condition before anything can happen is the political will.

The second thing is real community participation. People actively participate in all different stages, in all the programs that refer to health. People have an elevated social conscience and political social conscience. They were expecting something for the future and working very hard and enjoy it.

No, this is not true! The health situation is having an epidemiological transition from communicable diseases to chronic diseases. But a doctor from Cuba, moving abroad is focussing more on communicable diseases, he is able to integrate perfectly in the local health system, because of his training he had in Cuba.

About the risk of weakening the development of the health system of our country, it´s concerned to health system authorities, to take care of that risk, improving their management capabilities and, particularly, re-ajusted the health services at different levels.

When I graduated I went to a rural area, very far east of Havana.

I enjoyed that very much because like that I could touch with my own hands the result of the health education.

In a very remote mountain area, one day, a woman came to my desk and said: “Oh doctor, you talk to me about TB but I don’t know anything about that. Can you explain it to me because I believe my neighbour has it!” So finally she took her neighbour to the regional hospital and it turned out he did have TB. I enjoyed that very much and it signifies the importance of health education for everybody!

And the last essential condition is the resource of health professionals, doctors, nurses, technicians, …. We have 300,000 people working in the health system (Cuba has 11 million inhabitants, red) which is a lot! We have very committed staff and that is very very important!

You train a lot of doctors, maybe nowadays too much, and a lot of them are sent out to Africa, to South-America. How do you evaluate their work abroad?

Our doctors are prepared for working in Cuba or other countries all over the world.

We certainly have no shortage of doctors in our own country.

It’s a social movement. If Doctors move to another country and see what they can contribute there and vice versa we can introduce our way of working abroad.

It’s also an important economic resource for the Cuban government.

Community participation is an essential condition in order to improve health outcomes, like we did in Cuba In you keynote speech you stated: do not copy the Cuban system. Can you clarify this a bit more?

It’s my personal opinion. I visited some countries and met a lot of teaching professionals. The environment and the people everywhere are very different so the model has to be adept.

We cannot just reproduce our health system!

A family doctor in Cuba is something very different then a family doctor in England, for example. Health systems are very imbedded in context and culture as is health professionals training.

You can send some individuals abroad but a training program should be very much adapted to the local country.

Thank you very much!

Prof Silvia Martinez Calvo, National school of Public Health, Cuba Email: calvo@infomed.sld.cu

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International Health Professions Education Medical Education Preparing Students for Bilingual Medical Practice in South Africa Language issues in health care in South Africa are complex, and many relate back to the effects of an apartheid-constructed society. Currently, the country has eleven official languages, whilst four are common to the province of KwaZulu-Natal (KZN).

IsiZulu, the most common African language in SA, is spoken by about 78% of the province’s 10.2 million people (figures from the 2011 census). Patients living in rural areas and older patients, particularly, are often monolingual isiZulu speakers.

However, many medical students enter medical training having used English both as a home language and the medium of instruction in their early predominantly urban schooling phases. As a consequence, at least 1/3 of medical students at the Nelson R Mandela School of Medicine in Durban, the largest city in the region of KwaZulu-Natal, are unable to speak isiZulu upon entry to the first year of a 6-year MBChB training programme.

The skill to communicate effectively is a core competency for health care practitioners as affirmed by the World Health Organisation and the Health Professions Council of South Africa. In addition, various studies have shown the benefits of language concordant with health care. It is also vital that medical students become aware of and responsive to the needs of communities in which they will practice.

Similarly, medical schools must demonstrate social accountability. To address this gap, a one-year isiZulu course to teach communicative competence in isiZulu, and assessed in the first three years of training, is currently offered to first year medical students.

An observational, analytical, cross-sectional study conducted in 2012 assessed the knowledge and experiences of a third year cohort of medical students who had completed the module on isiZulu clinical

communication in 2010. The study also tried to assess how prepared students felt to communicate with their patients in the wards in 2012. Knowledge was assessed in a written test and in an oral isiZulu historytaking station in the objective structured clinical examination, while a self-administered questionnaire was used to explore students’ attitudes and practice. Comparison was made with their marks in the first year, and also with the class as a whole.

Students’ comments on their experiences and their recommendations were recorded.

Medical students’ knowledge in isiZulu had improved, both relative to their original marks, and when compared with the class. They were aware of the need to learn isiZulu and indicated a respect for the isiZulu language and culture. Thus they were largely positive about learning the language of their patients. However, the findings were that they seldom used the language in the clinical setting, often avoiding its use or using interpreters. Comments from students were varied, with some indicating that they had benefitted from the teaching e.g. “I thoroughly enjoyed learning isiZulu. I am much more confident when I enter the wards as I know I have some sort of background knowledge in isiZulu.” Others mentioned barriers to learning, and found language acquisition difficult e.g. “It is extremely difficult to be-

come fluent or even competent in the language at this late age of my life especially as a medical student other more important subjects rank higher on my priority list.”

Overall, many students indicated that the current teaching of isiZulu in the programme was inadequate for their needs and that additional inputs would be welcomed. In response to this, academics in the College of Health Sciences are introducing initiatives to support isiZulu language learning with terminology development, simulation-based education, video technology and computer-assisted learning.

New initiatives will be monitored to evaluate their effectiveness in improving students’ communication with their isiZuluspeaking patients.

In conclusion, language and culture have been divisive in SA’s traumatic past. In an attempt to address this, our late president Nelson Mandela stated, “If you talk to a man in a language he understands, that goes to his head. If you talk to him in his language, that goes to his heart.” The intention should be that future students will be equipped with the knowledge, skills and attitudes to ensure that communication in isiZulu is indeed a true competency in the authentic clinical setting, thus contributing to improving doctor-patient relationships and health outcomes, whilst simultaneously improving the social accountability of the medical school.

Dr Margaret Matthews; Head SCM Clinical Skills; Undergraduate Education; Nelson R Mandela School of Medicine Email: matthewsm@ukzn.ac.za

Delegation from the Nelson Mandela School of Medicine

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International Health Professions Education Medical Education The Longitudinal Clinic/Community Attachment programme for Students (L-CAS) Background and introduction The Longitudinal clinic/Community Attachment programme for Students is a major undergraduate education initiative of the School of Medicine at the University of Pretoria in South Africa that arose from the awareness of the importance of context in learning and the necessity to learn and practice primary health care outside hospitals and in communities. Through this initiative, each student was exposed to primary care learning and practice at clinics and in the community. Through LCAS it was possible to contribute an aggregate of approximately 13,000 clinic/ community contacts at up to 52 Tshwane clinics and many community sites per annum.

Initially the programme focussed on clinic visits, but subsequently the programme has been adjusted and refined in response to local context changes within the primary care setting as well as within the University. LCAS is now a formal module (LCP) in the curriculum and runs from year 1 to year 4 across all MBChB blocks. With the development of COPC and Ward Based Outreach Teams in Tshwane, in 2011 students are placed in communities, with community health workers who they accompany into schools, crèches, shelters and old age facilities as well as into people’s homes. Through mutual practice and peer education, students both learn from and contribute to the learning of community health workers.

Timeline: 2008: Project started in July with medical and dental 1st year students visiting clinics (n = 300 students, 8 visits in 4 months per individual) 2009: January: Program extended to include all medical students from year 1 – 5 (n=1200 students) and dental students from years 1 and 2 (n=120 students number of visits per student ranged from 8 – 16 per year) 2010: clinics clustered together due to limited mentors available. A Participatory actionresearch program to re-evaluate and further develop L-CAS was launched. After the initial round of evaluations the following changes were planned for the L-CAS program: 1. To develop inter-professional learning by including other students from the School of Health Care Sciences and other faculties with medical students in the program; 2. Adapting the concept of “mentors” to “community-based facilitators”. This will mean that community-based wor-

kers from different disciplines will act as Activities and impact at sites: facilitators for students from different • home visits: students visit community memdisciplines doing inter-professional learbers in their homes with CHWs to ning in communities; o Collect health data (health status assess 3. Creating a more diverse platform by ments on hand held devices), further expanding it to go beyond the o Do Post natal visits and Road to health clinics to other community based instichart reviews tutions and services e.g. old age homes, o Consult patients (medical interview, physihospices, places of safety, home based cal exam and limited special investigations) care projects, schools and especially with identified health problems and refer COPC sites; if indicated 4. Exploring partnerships with programs o Counsel patients – HIV, TB, Chronic Disease and students from other faculties worManagement, compliance, etc king in the same communities; o Address identified economic and other 5. Continue the research about the expechallenges for e.g. Students identified parience and impact of L-CAS, the Healthy tients at home that were unable to take Schools project and add research on the their medication because they don’t have process, experience and impact of Interfood, so they arranged for them to be acProfessional Learning. commodated at the feeding scheme at the local school.

2011: COPC introduced with all students going • Educational talks to health care workers out to health posts clusters instead of clinics about chronic diseases - HT, DM, Asthma, Three major changes: Epilepsy, HIV/AIDs and any other identified

- context: moved from clinics to commulearning need nities • Health talks and education to community

- curriculum: Moved from curative to members at the local schools, clinics and preventative focus community centres

- facilitators: moved from mentors to re• Participation in research projects of the Unigistrars and HCWs versity and other institutions in the commu2013 and beyond: new CoT COPC project for nities for e.g. Students collected more than Tshwane with further development of lear100 TB sputum samples in an identified TB ning sites. Each student linked to a Communihotspot in 2 days. ty Health Worker with learning and identifying • Treat identified problems, under supervision, learning needs as a priority. when the mobile clinics are there to provide medication Philosophy of project: • Assist the facility managers of local organisaOur philo­so­ tions like crèches and old age homes to deal phy is that in with identified health risks. order to cre• Support the Local Authority and Government ate health initiatives in the communities for e.g. Establicare professhing a very successful vegetable project for sionals fit kids in pre-school and vulnerable/poor peofor our sople in the community, assisted in the health ciety, today day doing s-gluc and BPs on community and for the members future, the • Support staff in the related clinics with seepractice of ing HIV testing, general health assessment teaching and learning must enable students to etc, seeing chronic patients, vaccination cambecome expert generalists paign and deworming children when needed • who deliver research-informed community L-CAS is an ever changing program that offers oriented primary care • to individuals and families in their homes and students the opportunity to be part of a Ward Based Outreach Team and visit patients in their communities context, where they can practice care of patients • through collaborative practice • that is integrative of the multiple bio-psycho- under supervision. social factors that complexify human health Marietjie VanRooyen and well-being

Email: Marietjie.VanRooyen@up.ac.za

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International Health Professions Education New Institutes and Programs Low-Cost Simulation Training in Maternal Health Education Highly realistic simulation training has been shown to be a gold 1. The use of a low-tech, low-cost birth simulator (PARTOPants), standard for training health care professionals in high resource worn by a patient actress to simulate birth. Each simulation is settings. To date, the use of simulation in low-resource setfilmed and the majority of the learning takes place during the tings has been limited to low-fidelity skills stations and models. video review and debriefing sessions. Both the participants Low-tech, highly realistic simulation is possible and can be an and trainers review the simulation videos, which provide the effective tool for improving the quality of care through both basis for the competency-based facilitated debriefings immein-service and pre-service training. diately after the scenarios.

PRONTO International (www.prontointernational.org) trains 2. PRONTO trains teams, not individuals. We believe, supported interprofessional teams using a simulation-based approach for by evidence, that an effective emergency response requires a improved management of obstetric and neonatal emergenwell-functioning team following established teamwork rules cies. Simulation-based training opportunities reinforce knowand tools. ledge gains and ensure those gains translate into action. The 3. PRONTO goes to where the emergencies occur. We train inuse of a low-tech simulator (PartoPants™) allows participants situ using only available resources (personnel, equipment, in the trainings to act as the patient, emphasizing kind and resmedications) forcing provider teams to seek, develop and pectful care of the patient. practice their own solutions to overcome limitations.

To date, PRONTO International has trained over 1,000 provi4. PRONTO empowers local provider teams to establish and ders in Mexico, Guatemala and Kenya. Our process indicators achieve specific system change goals to improve care. show significant improvements in knowledge, self- efficacy, and achievement of critical system changes related to key 5. Through simulation, we reinforce National guidelines and norms for the management of normal birth as well as emerobstetric and neonatal emergency care. Implementation trigency care. als are ongoing to measure impact on maternal and perinatal indicators, with initial results from Mexico showing significant The poster presentation at the Ayutthaya Network conference improvements in evidence-based maternity care and impacts was PRONTO’s first time in attendance at the Network Confeon perinatal mortality (data to be published). rence. However, it was clear from the other posters and preDuring a PRONTO training, participants participate in highly re- sentations that the Networks emphasis on the use of innovative health professionals education and focus alistic birth simulations that (sometimes) on the patient through patient and cominclude an obstetric or neonatal emermunity centered care, harmonize well with gency. During these simulations, particiPRONTO’s goals of improving the quality of pants experience the same kind of stress clinical and interpersonal care received by they would experience in a real emergenmothers and their families. cy situation; a mother crying and asking for their infant, while providers manage The Ayutthaya conference was a wonderhemorrhage, neonatal resuscitation or ful opportunity to network with individuals both (or other emergencies). Following and institutions, particularly in the Women the simulation participants and obserand Health Taskforce, dedicated to imvers are debriefed on what happened in proving the lives of mothers and children the simulations, including the important through innovative training programs. question to the mother “How did that feel to you?”

The program consists of two modules; module I is two days (16 hours) and module II is one day (8 hours), occurring three months later. This training program stands out as a truly innovative approach aiming to translate knowledge and skills into practice. The program is unique because:

Julia Dettinger Email: jcdettinger@gmail.com

A patient actress simulating birth

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International Health Professions Education New Institutes and Programs Leadership Training for Undergraduate Health Professionals as Part of Their Preparation for Community Placement After attending the 2013 Network-TUFH international conference, I might be right to come up with a conclusion; that almost all universities training health professionals has a community placement component in their curriculum. Though preparing students for these placements is one aspect that might not cut across and if a university prepares students how is this done?

Mbarara University of Science and Technology (MUST) is one of the public universities found in southwest Uganda, whose mission is to provide quality and relevant education at national and international levels with particular emphasis on Science and Technology and its application to community development.

“The most dangerous leadership myth is that leaders are born - that there is a genetic factor to leadership. That’s nonsense; in fact, the opposite is true. Leaders are made rather than born” —Warren Bennis

Multi-disciplinary student groups during the training

and also carrying out focus group discussions to explore students’ opinions and attitudes.

It was discovered that despite the lack of leadership skills among the health workers as the main challenge identified by the ministry of health (Uganda) and researcher, affecting the health sector, before this leadership training only fourteen out of every one hundred students had ever attended any form of leadership training. And since the training is compulsory for all students, every student had a chance to attend the course, thus training in leadership and management skills. It was also found that there was significant change in students’ leadership skills, task accomplishment skills and relationship skills. Students reported changed attitudes about rural communities and interpersonal relations.

Every year a multi-disciplinary group of health profession Skills obtained were very important during the community and undergraduate students take part in the Community Based after placement.

Education Research and Service (COBERS), a platform for training leadership and research related medical education wit- The training is significantly important for giving students the leahin Uganda. Before students are sent to the community, they dership required while in the community, after the community, spend a week of intense interactive training in leadership and and in the future as professionals. The same skills reportedly are management skills (pre placement leadership training) at the used in their conduct during health care delivery as a long term university. Leadership and management modules are used to benefit of the training. equip students with skills in leading and managing practices From the findings of the research project carried out by the using the Challenge Model. mentored students, preparing undergraduate students for comI lead a group that wrote a competitive proposal that won a munity placement by giving the trainings in leadership training grant from Medical Education Partnership Initiative-Medical significantly affect their stay in the community and will affect the Education for Equitable Services for All Ugandans (MEPI- health care delivery after graduation.

MESAU) undergraduate mentored research. We evaluated the effectiveness of the pre-placement leadership training course at MUST and identified the gaps in the program for impro- Najjuma Josephine, Student; Mbarara University of science and vement. This was accomplished by giving students the same technology; Uganda questionnaires to be completed before and after the training Email: najjumajosephine@yahoo.co.uk

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International Health Professions Education Problem-based Learning and Community-based Education Strengthening Rural Health Systems to Improve Health In 2007, the Community Health and De­velopment program or CHDP was inaugurated as the unit of the University of the Philippines Manila (UPM) mandated to forge partnerships with rural government Dengue program units and communities to set up and maintain community based health programs. These programs would then become the sites for the student community immersion programs of all UPM academic units, namely the Colleges of Medicine, Nursing, Public Health, Dentistry, Pharmacy, Allied Medical Professions (occupational, physical and speech therapy) and the Arts and Sciences. Two colleges of another university campus in Diliman, Quezon City namely the College of Social Work and Community Development and the College of Home Economics, specifically the Department of Nutrition, also joined the program.

The CHDP’s two main objectives are: (1) to provide teaching and learning opportunities for the faculty and students of the University of the Philippines in the principles and practice of community health and development; and (2) to assist local governments and communities improve their local health systems through the Primary Health Care approach. The main principles underlying this approach include: the recognition that health is a basic human right; socio-economic development that requires intersectoral collaboration is needed to attain health for all; and that people should participate in their own health care and development.

Following the approval of the creation of the CHDP, UP Manila entered into a memorandum of agreement with a rural municipality 160 kilometers south of Metro Manila for the implementation of a community based program geared towards the attainment of the objectives stated

above. After several meetings and discussions with all the stakeholders both from the academe and the community, a common goal was agreed upon, and that was to decrease the illnesses in children 0-12 years old by 50% by the end of 5 years.

Children’s illnesses in the municipality (pneumonia, diarrhea and malnutrition) were subsequently subjected to a problem tree analysis by the same group, and the root causes of illnesses of children in the municipality were determined. This problem tree served as the guide for the various activities of the different colleges in the implementation of the program in the area.

At the end of five years, municipal reports showed more than 50% decrease in the incidence of pneumonia, diarrhea and malnutrition in children. Through focus group discussions, village health workers and midwives reported that they gained significant health and leadership skills from the university students. We did a population survey to ask what changes the people perceived in the villages as a result of the program. 40% of the community people perceived a significant increase in knowledge about health, while another 27% answered that the village officials had become active in health activities as a result of the program.

A 5-year plan was likewise developed from the problem tree. University students, under the guidance of the faculty and in close partnership with the Rural Midwives and village health workers became the primary implementers of the plan. Trainings were conducted to upgrade the skills of the Rural Midwives and village health workers in the prevention of illnesses, in the promotion and maintenance of health, and in the integrated management of childhood illnesses, among other trainings. Additional services were also initiated including rehabilitative services for the disabled, and preventive and restorative dental services. Through the program, the university also assisted the local government council in improving health governance. Special projects were started in response to other needs articulated by the local government unit and community people.

Notable among these projects was a municipal wide Dengue Program where the university students collaborated with village councils to set up Dengue task forces in all villages and schools in the municipality.

Students also assisted in supporting and strengthening livelihood groups. Our students were thus exposed to the actual conditions in communities in a rural primary care setting.

Implementing the program in the last five years has deepened the CHDP’s experience in working with local governments.

University faculty also gained much knowledge and experience in interprofessional education and collaborative practice. Our students have also learned to understand what the indigent patients they see at the university hospital go through within the health system to be able to reach the hospital.

Elizabeth Paterno, MD, MPH; Director, Community Health and Development Program; Associate Professor in Community Medicine, Department of Family and Community Medicine; University of the Philippines Manila Email: ecregaladopaterno@up.edu.ph

Village assemblies

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International Health Professions Education Interprofessional Education Sex Education Across Borders As 2015 quickly approaches, the global community is reminded of the work that still must be accomplished to achieve the Millennium Development Goals (MDGs). While significant progress has been made in reducing poverty, providing access to clean drinking water, and providing increased access to education, the MDGs that will not be met by the 2015 deadline continue to be those issues directly affecting the health and well-being of women and girls. Reproductive health and access to family planning and contraception remain some of the most pressing needs in women’s Aricia De Kempeneer health. Globally, over 200 million women desire to use safe and effective family planning and contraceptive methods. However, an overwhelming majority of women worldwide lack access to reproductive health and family planning information and services. Many women also lack the support of their husbands and communities in using contraception.

First meeting during the 2012 Rendez-Vous Conference in Thunder Bay, Aricia De Kempeneer and Meenakshi Menon began working together on a GHETS project to combat some of these issues. Together they formed CRISA, or Culturallyadapted Reproductive health: Interactive Sex education Across borders. Both women come from diverse and interesting backgrounds. Aricia is a midwife from Belgium who has worked on reproductive health and sex education in Belgium, the United Kingdom, Finland, and Gambia. She is currently completing her Master of Science degree in Health Education and Health Promotion at Ghent University. Meenakshi is the Executive Director of Global Health through Education, Training and Service (GHETS), and has worked on primary care capacity building and reproductive health projects in eleven countries in Latin America, Africa, the Middle East, and South-East Asia.

Meenakshi Menon

Aricia and Meenakshi strongly believe that CRISA’s “train-thetrainer” and interprofessional collaboration values are among the most important aspects of the project. Rather than implementing a “one size fits all” sex education program, Aricia and Meenakshi believe that reproductive health and sex education programs must be tailored to individual communities, and must also be implemented by members of the community. Seeing themselves as facilitators rather than project implementers, Aricia and Meenakshi hope to share their organizational resources and sex education techniques with community-based physicians, nurses, midwives, and community health workers who are working on reproductive health and sex education programs. By working with community leaders to develop reproductive health and sex education trainings specific to local contexts, Aricia and Meenakshi also hope to allow communities to quickly take ownership over their programs, leading to greater community engagement and long-term sustainability.

CRISA is currently working with the Jinja School of Nursing and Midwifery in Eastern Uganda to develop a sex education and family planning training for nurses and midwives. Within the next year, CRISA also intends to expand its programs, conducting pilot projects in Mexico, India, and Bangladesh.

Sharing the vision and philosophy of both the Network: TUFH If you are interested in learning more about CRISA or in working and GHETS, CRISA has four core values: with CRISA, please contact Aricia De Kempeneer (aricia.dk@hot1. CRISA is a train-the-trainer project mail.com) or Meenakshi Menon (mmenon@ghets.org) for more 2. CRISA utilizes community-based sex education practices information.

3. CRISA adapts sex education to local contexts 4. CRISA promotes interprofessional collaboration

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International Health Professions Education Interprofessional Education Street Outreach and Shelter Care Elective for Senior Health Professional Students As educators, researchers, and clinicians, we can play a critical role in implementing curriculum that cultivates social responsibility and introduces students to effective models of interprofessional collaboration that promote improved health outcomes in vulnerable populations. University of New Mexico Health Sciences Center implemented a fourth-year elective for senior medical and pharmacy students addressing the needs of our nation’s most marginalized population, those experiencing homelessness.

Homelessness has a strong negative effect on health. Poor nutrition, inadequate access to appropriate hygiene, exposure to violence, crowded shelters, and competing needs for food, Students in action housing, and income that take precedence over needed healthcare contribute to higher levels of ill health among the homeless. Many homeless persons are not only burdened with inadequately treated chronic disease states, but also mental illness, substance abuse, fractured social networks, discontinuity of care, and mistrust of the healthcare system fostering further marginalization. Mortality rates are three to four times higher in the US homeless population than in the general population.

During the elective, students engage in faculty facilitated weekly discussions allowing them to reflect on their experiences.

The rotation ends with a session focusing on the health professionals’ roles and responsibilities in addressing health inequities and solution-based strategies that promote ongoing advocacy.

Student evaluations uniformly reflect the transformative nature of the rotation, resulting in many graduates’ ongoing participation in addressing the needs of homeless populations. Comments have included: “I was able to learn about the specific struggles and resources available for people experiencing homelessness in our community.”

“As a pharmacist, I can help advocate for the homeless by first identifying them, educating them on various aspects of their health, and encouraging them to be their own advocates—from housing to their medications to clean syringes.”

“This rotation allowed for a great deal of diversity in the patient populations and helped me to evaluate care plans based on the larger circumstances that the individual lives in.”

“Priceless experience! Rounding with pharmacy students was awesome. They know so much about how to manage medicatiThe Street Outreach and Shelter Care elective is designed to ons.” sensitize senior pharmacy and medical students to the challenges faced by homeless and other impoverished populations. “This was a wonderful rotation. In one month, I learned so much The overarching goal of this elective is to provide transforma- about the city around me and the people in it. I feel that it has tive service learning experiences that enable students to 1) prepared me to be much more open and understanding of those value an integrated team approach to addressing the needs experiencing homelessness and of those using IV drugs. I feel that of vulnerable populations; 2) participate in interprofessional it will enable me to better care for all patients.” service learning opportunities; 3) apply advanced practice and It is our belief that this senior elective can serve as a model for advocacy skills in the care of marginalized populations; and 4) addressing the complex needs of vulnerable populations and can identify resources as well as gaps in our current systems and be implemented in any health professions’ educational institute. public policies.

Key components contributing to the success of this elective have Faculty from across disciplines collaborated with multiple community partners to develop, implement, and teach this senior elective for health professions students. The rotation commences with an in-depth orientation covering topics on the unique healthcare needs of homeless individuals, shelter care, available community resources, and personal safety issues. Senior pharmacy and medical student teams round on patients in 2 homeless men’s shelters and provide ongoing individualized treatment plans. Student teams also conduct health education sessions for homeless teens and families and participate in outreach programs for those living on the street.

included a planning committee comprised of diverse faculty and community partners, weekly faculty-facilitated reflection sessions and a rich variety of service learning opportunities across a continuum of homeless populations.

Cynthia Arndell, MD, FACP; Associate Professor; University of New Mexico School of Medicine Email: carndell@salud.unm.edu

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International Health Professions Education

Leadership Column Omur Cinar Elci

Dr Elci has more than 25 years of public health, epidemioilogy, and occupational health field experience and over 20 years of research and teaching experience including National Institutes of Health (NIH) and Center for Disease Control (CDC).

Dr Elci is a medical doctor with a PhD in Public Health. Since 2008, he has been employed by the St. George’s University and currently he is a Professor and Chair of the Department of Public Health and Preventive Medicine.

A great leader therefore the subject of this years leadership column!

What Change processes have you been part of in the past?

One of the significant change processes I’ve been the archtitect of, was back in 1988, when I set up primary health and safety services to tea plantation and tea processing workers in the North-East corner of Turkey,which is one of the most important tea plantation processing areas in the world.

More recently the transformation of the department of public health and preventive medicine and establishment of a new public health program has been another change I made.

What would you define as the first step to take towards a successful change?

You need to know what you’re doing and you need to include important critical role players, espescially if you’re aiming for a real change, out of the mainstream and building something as we built in Grenada, unprecedented, unplanned and unthinkable.

You need to bring partners who understand your vision and your passion and who can work with you to produce that change.

Are there other essential conditions to make a change? How do you have to act as a leader at that time?

Change brings a lot of questions and succesfully convincing your target audience of your community that this change is going to be good and succesfull for them is essential. You need to build strong partnerships with the community and not arrive there as a stranger and expect that your changes are going to be successful. It doesn’t mean you have to live for years in this community, but through your partners and team members.

Benefit from their position and the community leaders, the trusted members. That partnership can bring your knowledge, your

skillset, your vision, into action.

What kind of leader would you say that you are?

I embrace different ideas and young brains.

I’m not a leader who believes that succes has to be produced from one person. I am a team player and I like to give young people e.g. students opportunities. You need to listen carefully to people but also you need to be firm with your arguments and accept that every change is a step in the evolution. During this change evolution you need to step forward as a leader and take responsibility.

Every change process has its successes and failures. Can you give us some examples?

In our department the succes has been enormous in terms of building this new vision in the Public Health department. It has been very successful in terms of having community partners, students, and faculty members included in this decision making process and establishing a team. It’s been quite a reward for me to observe that.

Unfortunately during that change process, no matter what you do, you can not have every single person on board. Sometimes you lose people, and that is not easy but you need to accept that, but it still feels like a failure.

What role do you give to stakeholders like students, staff, community leaders,…?

As I said before, I want them to be in the decision making process. Often students are not taken seriously which is a pity because they come with great ideas which are going to be part of the evolving change.

How do you convince those who are against change, how do you obtain their support?

For me rejection against change is a natural component of a change process. As a lea-

der you need to bring everybody on board.

How can we work together, what do you need, how can I gain your support, is there any part that we can modify so we can work together? Share your leadership and your vision. Give people specific responsibilities.

Sometimes it works, somtimes it doesn’t, but you can always learn from your mistakes!

How do you make sure that your changes are sustainable?

First, listen carefully to your stakeholders, give them decision making power and share your leadership with them. The second thing is to look at the opportunities to evolve your goals and your objectives. And the last one is to establish strong evaluation and workforce development. Because with evaluation you can look at those changes, what is needed, how am I doing, what is missing, and if you link that evaluation with the workforce development you also succesfully develop the coming leaders. In my department I’m currently pushing some young faculty members towards their doctoral work because I observe their potential leadership qualities. They are going to be the leaders of tomorrow to sustain and evolve this change.

Any last remarks to our readers?

This has been my first conference and I feel bad that I joined this meeting only after 26 years of working experience. It has been fascinating and I enjoyed it very much. I met amazing people and built partnerships.

I listened to great ideas. I’m going back to my department and share this with my faculty collegues and student organisation and encourage them to join next year in Brazil!

Prof Elci Email: omurcinar@gmail.com

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The Like-Minded Working together

Like-minded Institutions

The Medical Education Partnership Initiative The project is monitored by NIH, HRSA and the Coordinating Centre through: yearly site visits, an annual survey and a yearly symposium. At the Symposium held in a different country every year, the schools meet to share ideas and showcase their innovations in Medical Education.

MEPI is a 130m USD Project. It is a grant by the US Government to 13 medical countries in Sub Saharan Africa. It is administe- Successes Schools have been able to do what they have always wanted to red through PEPFAR, NIH and HRSA. do but before had been limited by funds. The funds have breThe countries include Ghana, Nigeria, Ethiopia, Uganda, Kenya, athed new life into schools. New south-to-south collaborations Tanzania, Malawi, Zimbabwe, Zambia, Botswana, Mozambique have risen out of the project. Technical working groups have been and South Africa. Each country has a principal grantee school, created to strengthen collaborations; these include E-learning, SA has 2 schools. In most countries these schools have netCommunity Based Education, Competency Based Medical Educaworks with other schools as sub-grantees. They have formed tion, Tracking Graduates, Medical Education Research and others consortia like Uganda-Medical Education for Services to All that are still being formed.

Ugandans (MESAU), Nigeria-Medical Education in Nigeria (MEPIN), Ethiopia has also formed a consortia and Mozambique Challenges is working with other schools too. At the same time, all these The main challenge is to ensure that the momentum created by schools have one or more partner schools in the region. This this project continues beyond the project. This has been anticihas formed a large network between the African schools, Mi- pated. Therefore the schools are ensuring that the activities have nistries of Health and Education. They also work with partner been integrated into the school programs. The school leaderships schools in the U.S. and Ministries of Health and Education have been informed and There is a coordinating Centre with two arms , one at George engaged from the beginning. It is believed that this will therefore Washington University in the U.S. and another at the African lead to country ownership and sustainability of the projects.

Centre for Global Health and Social Transformation (ACHEST) Conclusion in Kampala, Uganda. At the first symposium in Johannesburg All in all, this project is going very well and promises to make an in SA, the PIs formed a PI council to help with the leadership impact on Medical Education in the region. of the project.

Elsie Kiguli-Malwadde and Francis Omaswa*; African Centre for All projects were written by African Principal Investigators and Global health and Social transformation. are led by them based on the needs of their countries. The Email: kigulimalwadde@gmail.com grants were awarded through a competitive process. Five the- * The authors acknowledge the USA Government, PEPFAR, NIH, mes have emerged from all the project names HRSA, all the MEPI schools and their Principal investigators as 1. Increasing Capacity i.e. improving quality and increasing well as all members of the MEPI Coordinating Center at GWU and ACHEST. numbers 2. Improving retention of health progressions in areas where they are most needed 3. Improving locally relevant research 4. Sustainability 5. Creating communities of practice

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Students’ Column Out of the SNO Pen

Welcome to Fortaleza!

At the last conference of The Network: TUFH held in Thailand, a group of students gathered in order to plan student activities for this year’s conference that will be held in November in Fortaleza, Ceará, Brazil. During our meetings, we realized the need and the importance of active participation of future health professionals within The Network: TUFH thus, with the support of organization’s representatives, we decided to reactivate the Student Network Organization - SNO. The Network conference allows participants to have an excellent scientific and personal experience. It is a unique opportunity to learn how the community health issues are dealt with in many different realities of the planet, providing an unmatched exchange of experiences. In addition, through local visits and evening programs, it is possible to meet and experience the culture of a different country.

Since the beginning of the year, the current members of the SNO are committed to promoting the conference, encouraging student participation and serving as a liaison to assist the conference registration and abstract submission of students around the world.

“We realized the need and the importance of active participation of future health professionals within The Network: TUFH.” In Fortaleza, students may attend the main conference scientific program, but also have exclusive sessions, such as the Student Poster Session. This conference has the theme: “Strengthening health professional’s education as a policy to improve health”, giving emphasis to the training of health professionals, especially us students. Therefore, we believe it is of fundamental importance to expose our views as subjects of the educational process, taking advantage of the rich exchanging environment of the conference to propose improvements related to objectives and teaching strategies in health. In due course, we will also begin to lay the foundation of student activities in The Network.

“Work dignifies men”, but not only if it is possible to live... Therefore, we are organizing a series of activities that allow the interaction between students, meeting a little about the culture and way of Brazilian life, the local rhythms and cuisine, the typical warmth, fun and joy of Brazil!

As members of the SNO, we encourage professors to tell their students about the conference and to help support them to come to the conference. We are excited to connect and network with other students! So come to Brazil and already feel welcome!

Janaina Leitão Vilar; President of Student Network Organization; Medical Student (5th year) Faculty of Medicine; Federal University of Ceara (Brazil) Email: janainalv@hotmail.com

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Students’ Column Big five Josephine Najjuma How do students from all over the world perceive the educational programme at their Faculty, or the educational system in their country? How do they see the future, for their nation and for themselves? And what changes would they make, if they had the chance? We wanted to know. Therefore, we will ask one student five questions for the December issue of the Newsletter.

This interview was conducted with Josephine Najjuma,24, Nursing Student at the Mbarara University of Science and Technology in Uganda.

1. Why did you choose to study Nursing?

I choose to do nursing because I like helping people. Not only the sick but also to assist the healthy ones to prevent disease.

My Dad always said, “the best way to be healthy is not to become sick”. As a child I thought this was not right. Due to the challenges in the system in Uganda, lack of health professionals, high work load, with lack of supplies and facilities, it now makes a lot of sense. I choose to do nursing to learn the preventive measures so that I can teach those I can reach so that they can prevent disease. More, to use my nursing skills and knowledge, to assess, treat and advocate for the sick. It is so rewarding to see a face that was very sad yesterday smiling because of an intervention in my area of influence.

2. What part of your study was the most educational to you, what was the best learning experience in your studies (e.g. internship, research or being ill yourself)?

Teaching practice! In the department of Nursing, students are given teaching skills and a chance to practice diploma or certificate nursing in a nursing school. I was teaching 121 first-year students first aid and 67 second-year students teaching medical nursing. It was so hard to explain to the first year students’ simple first aid techniques. First, because of the numbers, and second and most important they had not covered the preclinical subjects. So the only way I would achieve my lesson objectives was teaching nursing students as if I was giving a health talk to some village teams; that worked. But I was puzzled as to why they were punished! I suggested to the Principal tutor of the school that the subject should maybe be shifted to the second year. She informed me that the students do national exams, and it is in the national curriculum that they should cover first aid in the first-year first term. I had no control and very little influence if any, though I learnt so much from this.

3. What would you change if you were Dean of your Faculty?

Or on a national level if you were Minister of Education in your country?

As a Dean, I would make sure there is exchange of students and faculty among the four public medical Universities in Uganda, though I would encourage the international exchange too. I would encourage all lecturers to take up a course in health professions education, to improve their skills. As the minister, I would make sure that the curriculum of nursing students at all levels is uniform. More I would set a policy that would favor health professionals working in rural areas to upgrade their work. This would be a strategy to solve the challenge of health professionals not willing to work in rural communities.

4. Imagine if you were to choose: a practice in a town or in a rural area. What would you choose and why?

Rural provided I can speak the language spoken there. From my experience, people/clients in the rural setting appreciate whatever you do for them however little it might be. And this plus will keep me satisfied and going.

5. Do you ever get in touch with the community?

In first year, nursing students offer a course unit called nursing in the community, where we visited primary schools and families. Second year, I was attached to a family (in a rural community about 45 minutes drive from the university) with two children below 4 years for 14 weeks. Third year I went for community placement about eight hours from the university. This year I visited my father’s friend who has Parkinson’s syndrome. His feet had pitting edema and were very cold, but the attendants informed me that they assisted him to walk around. I showed them how they could just raise his legs and in 24 hours they could not believe the results.

Najjuma Josephine, Student; Mbarara University of science and technology; Uganda Email: najjumajosephine@yahoo.co.uk

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Member and Organisational News Messages from the Executive Committee EC eminences: Angelo Manalo We had the exceptional opportunity to meet with Dr. Angelo Manalo, former Dean and founder of the college of medicine of the Mindanao State University in Iligan, Philippines. He retired in 2006. Dr. Manalo is one of our Network’s “Grey Eminences”, one of the founders of what The Network: TUFH is today!

Can you tell us something about your back- life: conception and pregnancy. We started ground? our first new class in 1993. We had some protest from the faculty; how can a pathoI’m a medical doctor, and I specialized in gelogist teach about obstetrics? But I said, neral surgery, before I went into academics. we are not supposed to teach, we are supMy wife was an anesthesiologist and she posed to guide and learn from our students. was also a member.

Did your new approach have good results?

There was a small medical school in Marawi City, about an hour away from Iligan, Yes! When our students were doing the a mainly Muslim city in mostly Christian Ili- medical board exam in Manila, they were gan. passing and furthermore, they were getMy wife and I were recruited to help out ting better results compared to medical with this college of medicine and to start up students from other medical schools across a clinical program. the country.

At that time we didn’t have any academic background. But we started and created the curriculum from scratch, remembering our own education, and trying to think what we could do different from the other schools. We discovered that we needed more community health practitioners.

Did you face a lot of problems?

We faced financial problems to sustain the College and at times had to resolve logistical issues ie moving the School from Marawi to Iligan, constructing a school building, improving our facilities and other practical problems with staff recruitment.

We often had to self-manage our problems without higher support yet we had a 95% passing rate in the medical licensure exams nationally.

Were you practicing medicine at the same time?

So everybody started to realize that we I stopped my clinical practice but we were were doing something good. officers of the Philippine Medical AssociaWe became a member of the Network: tion. That was also one reason they asked TUFH and they were very helpful and sup- me to resuscitate this school. I was already portive. We didn’t have any guidance back involved in medical education with UP (Unihome, because we were the first ones in versity of the Philippines, Manila). the Philippines doing this PBL and commuWhat do you think of the network activiHow did you came in contact with The Net- nity based medical program. ties today? Can you compare it with when work: TUFH? You were also an EC member? you were a member?

At that time universities mainly focused on During the group discussions at the confe- It has evolved a lot. I can see that nowadays hospital based medicine. rences I became a chairman and I took up different organizations are having their conSomehow I heard about problem based more responsibilities. In Linkoping I got ferences at the same time and I wonder if learning (PBL) and as a coincidence at the elected for a 3 year period. we don’t lose our focus that way? same time there was a Network meeting How many students did you have in your Well when I was a member - a big help for about PBL at Penang, Malaysia, around school? our school was a network meeting held in 1987. That’s how I came in contact with Manila.

Initially we started with 20 but it slowly The Network: TUFH. grew. We were a government school which What are challenges for health care in the They asked me there what I was doing so I is cheaper so a lot of our students were Philippines? brought the log books of the students and a coming from lower socioeconomic classes.

Brain drain to the USA is a big challenge. Afposter of what we were doing. And it was Critics said we were just going to produce ter training abroad only 20% return to the during that meeting that I really learned bare foot doctors and they weren’t going Philippines. what PBL was all about. A student centeanywhere. But we wanted them to stay red approach to teaching. That was how it with us, in our community. That was our I, too, was trained in Boston. got started. And that’s how we reformed goal and we succeeded!

Finally medical tourism has become popuour curriculum from traditional to problem and community based which was very inno- Nowadays our school enrolls 50-60 stu- lar in the Philippines, so some universities vative at that time. We had to adapt the dents per year. My wife and I were alter- are really focusing on that. modules we had access to and we thought nating with each other as Dean for a few it was logical to start with the beginning of 3-year cycles.

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International Health Professions Education Taskforces Interprofessional Education This year has seen an increased interest in interprofessional education and collaborative practice internationally. We hope this provides you with a brief update on developments: Australian colleagues have received funding and carried out research which has led to the development of a new framework to aid the review of interprofessional education and practice a summary of which is provided in the diagram below:

Elizabeth Paterno, Francisco Lamus, Simeon Mining, Payal Bansal And which Prof. Jan De Maeseneer kindly endorsed stating: “This book teaches us how to implement leadership in interprofessional education and practice at the nano-level (the patient-provider interaction), the micro-level (interprofessional care teams in the community), the meso-level (supporting organisations and institutions) and the macro-level (global health policy). Moreover, it takes a transformative approach to respond to the actual challenge: building health systems, based on relevance, equity, quality, cost-effectiveness, person- and peoplecenteredness, sustainability and innovation�.

We have been asked to edit a further book which will again include chapters from around the world.

Finally we are really pleased and proud that Educating for Health has included 6 international interprofessional articles in the April 2014 Volume 27 Issue 1.

We hope you have enjoyed reading them and would love to hear your views.

More information about this and a new interprofessional capabilities assessment tool which is being piloted internationally can be found at http://www.aippen.net/ There is now an international group which oversees each of the networks of which TUFH is a key member. We aim to continue to collaborate with all interprofessional networks to the benefit of health professionals, communities and individuals internationally.

Sadly after many years of co-chairing the task force Betsy and I feel we need to step aside to let someone else take the lead so if you are interested please contact Maarten Declercq: secretariat-network@ugent.be Professor Dawn Forman and Professor Betsy Van Leit; Co- Chairs of the IPE Task force Email: dawn@ilmd.biz

Following the successful publication of Forman, D., Jones, M. and Thistlethwaite, J. (Eds) (2014) Leadership Development for Interprofessional Education and Collaborative Practice. Palgrave MacMillanwhich has chapters from colleagues from around the world many of who you will know including:

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International Health Professions Education Taskforces Integrating Public Health and Medicine During the Network: TUFH annual conference in Thailand, the Integrating Medicine and Public Health Taskforce focused on two main issues. The first was the tension between public health and primary care.

The problem probably arises due to the overlap of roles and responsibilities. This is compounded by differences in vocabulary and, on a global basis, the variation in tasks assigned to public health and primary care.

The other major issue, and, perhaps, the solution to the tension between public health and primary care, was how to integrate public health into the teaching of health care professionals as well as its relationship to the teaching of global health. The knowledge bases of global and public health are similar, but, in general, public health is applied to local populations whereas global health is perceived as health outside one’s own country. Basing

the teaching of both on a common curriculum is likely to be the most efficient approach.

There has been some work around the integration of public health in medical teaching. South Africa has a Public Health Education Workgroup that is working on the best methods to integrate public health in the clinical science curricula. The American Association of Medical Colleges has also joined forces with the Centers for Disease Control to improve teaching in public health. Among the results of this are a theme issue of Academic Medicine on Population Health Education (April 2008) and an American Journal of Preventive Medicine Supplement on Patients and Populations: Public Health in Medical Education (October 2011). With a funding agreement from the Public Health Agency of Canada, a Task Group and subsequently the Public Health Educators Network of

The Association of Medical Colleges of Canada has also been working on the theme.

They have produced an environmental scan of best practice as well as a Primer on Population Health aimed at students of clinical sciences (https://www.afmc.ca/ social-public-health-e.php).

One of the major obstacles to true integration of public health in medical teaching is the need for faculty development for clinical teachers. Public health is just one of many subjects competing for the attention of clinical teachers and can be seen as less relevant for their task. The challenge to teachers of public health is to show how public health is one of the sciences of clinical medicine as well as essential to good clinical practice. The Task Force will continue to create exchanges that address these issues.

Denise Donovan, Chair Email: denise.donovan@usherbrooke.ca

The Elderly Taskforce, What is New? At the last TUFH conference held 16th – 20th November, 2013 in Ayutthaya Thailand, a number of activities were held that included participation of the elderly task force.

The chair for the taskforce was partly facilitated to attend the conference by Global Health through Education, Training and Service (GHETS) and Medical Education Partnership Initiative/Medical Equitable Services for All Ugandans MEPI/ MESAU. Among the events attended was a strategic discussion by task force chairs prior to the opening of the main conference.

Luckily, this year the task force was able to hold a workshop addressing the concerns of the elderly women; specifically the physical ailments that come with age. We summarize the outcome of that workshop in the following brief.

Among some of the issues discussed was the importance of emphasizing the care that should be exercised in handling chronic conditions among the elderly. These inevitably come with age for the majority of elderly individuals. The second was how TUFH should advocate for projects that put elderly care foremost in the education curricula of health professionals.

With an increasing world population, access to care needs to be improved ensuring that there are barrier free systems in place that allow for easy access; free of competing long waiting lines with a younger and more fit population.

Even when not medically or mentally ill the issue of isolation is a major risk factor for ailments in both realms. Putting in place activities that bring out the elderly from their homes is very much encouraged. Often times they lack stimulation without having even the most basic of a normal conversation with another human. Interestingly sometimes they are within households where they may be totally ignored.

Lastly, the role of government support to activities involving the elderly needs to be advocated for in many countries.

It was envisioned that at the next conference taking place in Brazil a bigger group of individuals would participate in the task force activities giving room to share ideas and put in place strategies for the training and care for the elderly.

Noeline Nakasujja, Chair Email: drnoeline@yahoo.com

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International Health Professions Education Taskforces Social Accountability and Accreditation (TFSAA) Over the past year the Task Force has continued its involvement with the increasing numbers of initiatives from around the world that are carrying forward the important work of embedding the ideas and actions of social accountability in medical and other health training schools. This has involved the co-chairs and many members taking part and contributing to relevant work ranging from the ASPIRE initiative of AMEE, the Ottawa Conference, through the work of the Global Consensus for Social Accountability (GCSA), the International Association of Francophone Deans of Medical Schools ( CIDMEF), the International Francophone Society of Medical Education ( SIFEM), the International Association of Deans of Schools of Pharmacy, and other regional and national initiatives ranging from Canada to Kathmandu.

In these various venues the TFSAA is variously represented and our work is primarily in the initiation and support of matters specifically related to accreditation and social accountability. The relationships are generally informal in keeping with the Taoist perspective that “true leadership is shown when the people accomplish a great deed and say, we did it ourselves�. Thus specific recognition is secondary to getting the job done. However, the following specific highlights are worth mentioning: 1/ the ASPIRE winners of this year, among which is a historical member of the Network TUFH: the University of New Mexico School of Medicine; 2/ the fact that two main francophone organizations have officially recognized SA as their key priority: The International Association of Francophone Deans of Medical Schools

(CIDMEF) and the International Francophone Society of Medical Education (SIFEM). The President of CIDMEF is invited as a keynote speaker at the Network TUFH conference; 3/ the creation by the Association of Faculties of Medicine of Canada of a new International Social Accountability Award in the name of Charles Boelen, that will be awarded for the first time in April 2015. It is hoped that the Network TUFH will actively disseminate this information and participate in the selection process of the first awardee.

4/ The invited keynote presentation on social accountability at FIP, World Congress of Pharmacy & Pharmaceutical Sciences in Dublin.

5/ Participation in the recent initiative undertaken with THEnet to bring together the major international organizations involved in SA to coordinate our activities and impact.

The TFSAA looks forward to Fortaleza and a chance to regroup and do some forward planning now that the main tasks of the strategic plan developed at Kampala have been accomplished.

It is expected that this is likely to focus on engaging accreditation bodies at the national and regional level in more focused standards for social accountability across the spectrum of lifelong-learning; something that is already developing in Canada through the SFMC. Charles Boelen and Bob Woollard, Co-Chairs Email: Email: woollard@familymed.ubd.ca/boelen.charles@ wanadoo.fr

Newsletter Volume 32/no. 1/Augustust 2014 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: Anja Peleman Print: Drukkerij Focusprint

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