Newsletter 2015 01 by The Network: TUFH

NEWSLETTER Newsletter Volume 33/no. 1/July 2015

In this issue, among others:

Editorial Dear readers,

• New: Projects that Work

A year goes fast, our Pretoria Conference is rapidly approaching and summer is in the air!

• Leadership Column with Bernard Groosjohan

This newsletter is one that announces changes. Not only a new Secretary General will be elected in Pretoria, also the first steps towards transitioning the secretariat from Ghent to Philadelphia are made. We will try to inform you about this as best as we can in a special dedicated section!

• Transition of the Secretariat • History of the Network: TUFH

Also we were feeling nostalgic during this transition period so no better time to dig into the History of our Network: TUFH, we hope you enjoy an inspiring interview with Gerard Majoor and Pauline Vluggen. Enjoy your reading! Julie Vanden Bulcke

In the Newsletter we refer to The Network: Towards Unity for Health as The Network: TUFH.

Contents Message from the Secretary General 3 Thanks for the wonderful journey

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

Looking forward to Pretoria Visit to Brazil

Improving Health 5 Health Research 6 Care for the Elderly 7 Care for the Elderly 8 Health Promotion 9 Women’s Health 10 Women’s Health 11 Health Professions 12 Rural Health

Neurosensory Stimulation Therapy and Snoezelen Room for the Improvement of Emotional Response in Patients with Mild to Moderate Developmental Disability Competences for the Care of the Elderly Socialization in The Elderly The Sexual Health Promotion in Florianopolis, Santa Catarina State, Brazil: Discussion on the Role of Local Health Units Women and Health Learning Package Gives Birth Strengthening Community Systems to Improve Women’s Health throughout their Lives Frontline Health Professionals Role to Balance the Top Down Hiv/Aids Policy Formulation The willingness of Medical Graduates to Work in Rural Communities in Ghana

Projects that work 13 14

Rwanda Village Concept Project Vector Borne Diseases in India

International Health Professions Education 15 Medical Education 16 Medical Education 17 New Institutions and Programs 18 New Institutions and Programs 19 Problem-based Learning & Community-based Education 20 Leadership Column 22 Interprofessional Education

Use of Medical Narrative for Integration of Theory and Practice in General Pathology Teaching The patients’ Point of View The International Federation of Medical Students Associations (IFMSA) Implementation at Federal University of Amapá Advanced Health Care One health: an Approach to Innovative Community Based Training. A Lived Field Experience Bernard Groosjohan Community-Based with Inter Professional Education Approach in Faculty of Medicine, Universitas Gadjah Mada, Indonesia

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

Visa application: Lessons Learnt Catherine Habel

Member and Organisational News 25 26 27 28 30 31 31 32 32

Transition of the Secretariat Transition of the Secretariat Transition of the Secretariat History of The Network: TUFH History of The Network: TUFH Taskforces Taskforces Taskforces Taskforces

Background: From University of Ghent to FAIMER Q&A with Bill Burdick Reactions of our EC members Founding of The Network: TUFH Previous Conferences & Secretary Generals Social Accountability and accreditation (TFSAA) Community-Based Care for the Elderly Transforming & Scaling Up Health Professional Education and Training Integrating Public Health and Medicine

Message from the Secretary General Thanks for a wonderful journey! Eight years ago, at the annual conference of the Network: Towards Unity For Health conference in Kampala, I have been elected as Secretary General of the Network, succeeding to Prof. Dr. Arthur Kaufman (University of New Mexico-USA), who took this responsibility during the 8 years before. Looking back at the period 2007-2015, a lot of changes occurred in the Network. The secretariat moved from Maastricht-The Netherlands to Ghent-Belgium. The previous juridical structure was replaced by an ‘International not for profit organization, according to Belgian law’. In 2010 the report ‘Health Professionals for the 21st century’ produced by the Lancet commission under the leadership of Julio Frenk and Lincoln Chen, brought a ‘third wave’ of innovations in health professional education. Many of the examples, cited in this report, referred to projects and realizations of member-institutions of the Network: TUFH. The Network, an organization in official relationship with WHO, increased its visibility and is actually represented in the Global Forum on Innovation of Health Professional Education at the Institute of Medicine (nowadays Academy of Medicine) in Washington. Progressively, the strategy to become a ‘network of networks’, was put in practice, with the Thunderbay 2012-conference as an important milestone. In Thunderbay, apart from the Network: TUFH, also the Consortium of Longitudinal Integrated Clerkships (CLIC), Flinders University, Northern Ontario School of Medicine, THEnet: Training for Health Equity Network , FAIMER and Wonca Rural Working party agreed to engage with WHO (Dr. Erica Wheeler) in a process on implementation of the WHO guidelines on medical education: ‘Transforming and scaling up health professions education and training’ in the framework of an open taskforce of the Network. Taking advantage of this kind of synergies, created a lot of ‘win-win’ situations for multiple stakeholders in the process of change of health professional education and contributed to increased social accountability. Through cooperation, the Network became a stronger organization, stimulating synergies between like-minded organizations. Our Student Network Organization (SNO) took a new start and created linkages with IFMSA (the International Federation of Medical Students Associations), contributing to the worldwide student commitment for more equity in health. An operational relationship between the Network and FAIMER was established in 2014, with a view to move the Secretariat of the Network to the premises of FAIMER in Philadelphia-USA. It was a privilege to be involved in all these developments. I am extremely grateful for the inspiring people I had the opportunity to meet and to work with as Secretary General of the Network. Members of the Staff (our executive directors, administrative officers and editor of the Newsletter), the Executive Committee and the “Eminences”, the team of our journal ‘Education for health’, that moved to India for a very successful innovative project, the Task Forces and the organizing committees of the annual conferences in Bogota, Kathmandu, Graz, Thunderbay, Ayutthaya, Fortaleza and Pretoria, and last but not least our members and the participants in the conferences, all contributed to the strength of the Network. It was a journey of working with people, committed to the improvement of health globally and connected to the community they live in and care for. I thank you all for what I learned from you, for your engagement and your support! A special “thanks” to the staff of the Department of Family Medicine and Primary Health Care, always ready to help The Network, and for the important support by The Faculty of Medicine and Health Sciences of Ghent University and the University Hospital! Time has come to look at the future and welcome the new Secretary General! Prof. Dr. Jan De Maeseneer, Secretary General, The Network: TUFH Email: jan.demaeseneer@ugent.be

The Network: TUFH in action Annual International Conference Looking forward to Pretoria ‘Bambanani’!!! ‘Working Together’. This is what The Network: TUFH has always stood for and is still strongly advocating today. To facilitate this collaboration we are strengthening our organization. First, we need strong people at the helm. We are electing a new Secretary-General at our next General Meeting. The Network: TUFH secretariat is also welcoming Marianne and Caroline who are joining Hilde and Maarten here at Ghent University. We are taking the first ?? steps in relocating the secretariat’s home. This will be a gradual process and we are pleased to say that the collaboration with FAIMER is very positive and brings a lot of fresh ideas. Second, members can benefit from an interactive platform to share ideas beyond our Annual Conference. We can also offer a fluid registration process for our Annual Conference.

We would like to invite you to attend the 2015 Annual Conference of The Network: TUFH. This year it takes place in Gauteng, South Africa, from September 12-16. We are jointly organizing the conference with SAAHE (South African Association of Health Educationalists) and University of Pretoria. The theme for this year is “Education for Change”. With this theme we want you to find solutions to changes in health and education systems. In a change process you need to collaborate and we want to see you ‘Working Together’ at the conference. Bambanani’!!! See you in South Africa. Marianne Van Lancker/ Caroline Van Lancker/ Hilde Cnudde/ Maarten Declercq Office, Ghent Email: secretariat-network@ugent.be

Education for Health Visit to Brazil Michael Glasser and Donald Pathman, Co-Editors, and Gaurang Baxi, Assistant Managing Editor, Education for Health travelled to Brazil to attend the Annual Conference of The Network: TUFH held at Fortaleza, Brazil from November 19 to 23, 2014.

During the conference, the editors had fruitful meetings with Eliana Amaral, the guest editor for the upcoming special section with Portuguese papers. Selected papers submitted by authors in Portuguese, reviewed in Portuguese and translated into English when published. The abstracts will be published in both languages.

The Co-Editors conducted two workshops at the confeWe invite readers to register as rence. The first was “How to reviewers for the journal. Those write Useful and Instructive interested can send an email at Peer Reviews for an Academic efh@muhs.ac.in. As reviewers, Journal”, which was attended you provide invaluable assisby 30 delegates at the confe- Gaurang Baxi, Michael Glasser and Donald Pathman tance by giving constructive rence. The next session was “Meet the Editors of Education for Health”, attended by many feedback to help authors improve the quality of their papers, and of the journal’s reviewers and authors. Both workshops were help the Co-Editors select the papers of highest quality. highly interactive and a great opportunity for both attendees and journal staff to interact. Gaurang Baxi, Assistant Managing Editor, Education for Health Email: efh@muhs.ac.in

Improving Health Health Research Neurosensory Stimulation Therapy and Snoezelen Room for the Improvement of Emotional Response in Patients with Mild to Moderate Developmental Disability Background Developmental disability is characterized by incomplete mental development and overall impairment of intelligence. It affects cognitive and social skills, language functions and motor skills, and presents before the 18th birthday secondary to brain injury or disease. Affective response is one of the aspects involved, with frequent auto and hetero aggressive behaviors, defying behaviors and stereotyped self-stimulatory behaviors. Institutionalization is another factor that frequently limits their social interaction, which affects their perception of the environment and restricts the communicative process.

Validated tools used: - 5 point scale (pre and post intervention effectiveness of affective response) - The Hong Kong model (effectiveness in the change of aggressive behavior measured by caregivers). Findings From a total of 50 patients, 16 (32%) met the inclusion criteria. Ages ranged between 13 and 63 years old. Four (23.5%) were female and 13 (76.4%) were male. Approximately 83.9% of the patients participated in the activities.

The aim of this project was to implement a sensorineural stimulation program in patients with mild to moderate cognitive disabilities to achieve an improvement in the affective response and a reduction in aggressive behavior.

There was an average of 15% improvement in the appropriate affective response after the intervention, compared to the pre-intervention measurement. In contrast, there was no change in the average rate of inappropriate affective responses after comparison of the pre and post intervention. Regarding the regular response, there was a decrease of 14.1% at the expense of adequate responses increasing, which is considered as a positive outcome.

So, what exactly is Snoezelen? Multisensory therapy (or Snoezelen) is a therapy developed specifically to meet the special needs of people with developmental disabilities. It originated in Holland in the late 1980s and the word Snoezelen means ‘sniffing’ and ‘drowsy’.

Additionally, a marked effect on relaxation and anxiety reduction (68.75%) and an intermediate effect on reducing the auto and heteroagresive behaviors (56.25%) were observed. As for the marked effect on average 71.8%, reflecting positive results were obtained. Regarding the intermediate effect, the average was 9.5%, and finally only 0.78% had no effect on average.

This concept is based on the assumption that there is a certain basic human need: the seeking of sensory stimulation for sense making of the world as well as for relaxation and enjoyment. This concept assumes that if a person does not meet these needs through the external world, attention is directed inwards, leading to anxiety and the possibility of developing maladaptive behaviors, such as self-injury, self-stimulation, and stereotyping. This multisensory therapy includes visual, auditory, tactile and olfactory stimulation. Design An action-research intervention study was conducted between January 27 and May 5, 2014. We included 16 patients with cognitive disabilities at CEDESNID institution in Bogotá, Colombia. Inclusion criteria were: patients diagnosed with mild to moderate cognitive impairment, participation in the pilot and history of aggressive behavior and maladaptive behaviors in the past 3 months. Exclusion criteria were: severe disability did not agree to participate and / or rejected the pilot.

Conclusion In our study it was possible to identify a short-term improvement in the subsequent emotional response after neurosensory stimulation therapy. We found some studies that have reported improvement in the affective responses and aggressive behaviors after neurosensory stimulation; however, more literature on neurosensory interventions in populations with these characteristics is required. We suggest another intervention with a larger sample including a control group that allows confident statistical inferences. The above is to develop a primary care program for these patients, based on scientific evidence that is appropriate to the local context. Paola Coral Vela; Interna XIII semestre; Facultad de medicina; Universidad de La Sabana; Bogota Email: pao1691@gmail.com

Improving Health Care for the Elderly Competencies for the Care of the Elderly: Categorization of the Attributes in the Nursing Students View During the graduation in Nursing for FAMEMA (MarĂlia Medical School - Brazil) I could experience the process of differentiated formation which looks for the formation of a judgmental-reflective thinking nurse which consequentially implies that the student occupies the position of subject in the formation process. Considering the active methodologies and an integrated curriculum (with the understanding that this one comprises all the cycles of the life) culminated the inquiry of the process of formation for elderly care. It is a fact that our population is ageing and consequently we will need to have competent professionals for eldercare. So we postulated questions of how FAMEMA curriculum is organized inside the model of professional competence. Remembering that the terminology professional competence makes possible several definitions, we opt for the theoretical referential system used by FAMEMA which

In this way, based on the demographic growth that applies for qualified service there is the need for adaptation of the education of nursing professionals, considering that higher education institutions have the responsibility to provide integralized and humanized formation of human beings. This works tries to fill out the gap that allows the reflection of the topic jointly with academics and to propose changes in the curricular womb in the future, to be incorporated in the initial nursesâ&#x20AC;&#x2122; education, contributing to the empowerment of this care and with the progress of the nursing science. The present study acts as a qualitative analysis; a case study. The location of data collection was the installations of FAMEMA. The subjects of this study were two groups of students in the 4th grade in the course of Nursing of FAMEMA in the years of 2013 and 2014. The option for including students happened because these pupils had already attended more than 50% of the course which brings a higher possibility to have had contact with the elderly during clinical teaching and curricular traineeship, which hypothetically would help in the resolution of the objective drawn by the study. The analysis used as instrument of collection of data was a focus group because this technique is based on group interactions when a researcher suggests a special topic. The data were analyzed according to the technique of analysis of content, in the thematic modality, going through the following stages: Preanalysis, exploration of the material, and treatment of the results / inference / interpretation. The analysis of the data made possible the creation of three propositions: 1) The formation in nursing and the Geriatric: what the nursing academics think; 2) Brazilian health model headed to ageing and subsidies for nursing care; 3) Elderly health necessities in nursing academics vision.

Presentation of the project

The process of ageing is being less discussed during nursing graduation which possibly implies a gap in the care formation.

says that to be competent is to present knowledge, skill and This research aspires to contribute to the development of new attitude in diverse experienced situations. studies that could favor the process of care formation oriented Gerontogeriatric nursing is emerging in the gerontology area for competencies, sustaining that the educational process gets and as a nursing specialty. Due to ageing of the population, the part of the professional qualification, consequently for the excelevolution of nursing care makes necessary the development lence in the nurse act in the labor market. We expect to identify of minimum standards of this action guiding the professional the competencies that permeate the academic formation of the exercise. nurse and thereby contribute to the strategies of teaching-apIn this perspective of the necessity of this specialized care it prenticeship through a generalist formation. is necessary that nursing schools develop in their curriculum proposals and models headed to gerontogeriatric teaching Carla Francine de Andrade Perez; Graduation Program in Health with innovatory strategies and technologies of care being able and Ageing of MarĂlia Medical School (FAMEMA), Brazil. to re-signify the attention to the elderly, promoting the social E-mail: carla-andrade-@hotmail.com responsibility of the schools, docents and students in the care of this population.

Improving Health Care for the Elderly Socialization in The Elderly

Concerning the socialization of the elderly, it is generally known they experience social segregation and are often excluded from interpersonal environments, especially when they retire. For the elderly, especially for one who has always been very active, when he doesn’t do what was usual, he may feel depressed, so doesn’t feel useful. Because of this, the levels of government have a responsibility to provide conditions so they can remain in their family and social space. There are tools widely used and one of them is group activity. Regarding the elderly, the activity of group nature assumes great importance in this context, providing a space for listening and socialization exercise between them and the population. Therefore, we began the discussion circles, where they told us what happened with them daily. For example, there are bus drivers that pass right by bus stops where there are elderly, because they do not pay passage in this age group. Also they talked about the fact that their family can not deal with their inability to produce, because the family thinks the older people can’t earn anymore. Another example, told by one of them, was that he wanted to work to help his family, but they couldn’t see it and often treated him as incapable.

and didn’t receive the conditions to work or do something for society. Others, for example, explained that they used to go to parties for the third age, to dance, to exercise, to have fun. After talking, we ended with making carnival masks, with which the elderly danced to the sound of “ Marchinhas de Carnaval”, which encouraged them to be happy. That image made it look like they were reliving those good times all over again. Thus, with this experience, we think the elderly shouldn’t be excluded by society, because they have too much to contribute with their life experiences and skills acquired over time. We, the students, think that society should be looking for the future, but should value the past to learn from it what was right and wrong, so everyone could walk together forward for the beautiful things the future hold for us. We should be grateful for the opportunity the people who came before us gave to find new paths and overcome the boundaries of life. As they shared their feelings and experiences, they have enriched our learning as academics in humane care and we could return the kindness and courtesy with which they treated us. Juliana Oliveira Melo, Medical Student of Christus University Center, Fortaleza, Brazil Email: juliana_oliveira_melo@hotmail. comFrom

During the discussion, some told us that they were depressed for not being able to be part of society as they were

Improving Health Health Promotion The Sexual Health Promotion in Florianopolis, Santa Catarina State, Brazil: Discussion on the Role of Local Health Units The project called Sexual Education Program was born in response to an alarming epidemiological context in which Santa Catarina is among the top five Brazilian states with the highest incidence of AIDS, and its capital city Florianópolis presents a rate of 57 cases per one hundred thousand inhabitants.

Then, students wrote more details about each exposed sample. After that, there was a significant discussion about knowledge brought by the adolescents.

Qualitative and quantitative research and questionnaires answered by the participating schools’ teams conducted the workshop Also, the southern region of Brazil is noted, unfortunately, for evaluation. The Ethics Committee on Human Research approved the high-detection rate in an important group: the teenagers. the project. On the other hand, a survey conducted in 2013 and 2014 shows that a significant proportion of children and adolescents who started their sexual life in public schools of the municipality of Florianópolis is 12 years old or less. Although there are already some guidelines in Brazil for a program on sexual orientation, that urgent situation needs the development of more efficient and preventive strategies directed towards teenagers; especially, when it comes to policies for Local Health Units (LHU) and Public Schools’ articulation through educational activities for sexual health promotion, in the classroom. Therefore, we are trying to: 1) Articulating promotional activities on sexual health with LHU health professionals, taking advantage of school activities’ daily life inserted in schools’ annual planning as well as linking them (teachers and health professionals) to the program. 2) Increasing knowledge among adolescents and school teachers on topics related to sexuality. 3) Creating conditions for the institutionalization and self-sustaining of educational activities at the school. In order to develop the workshops, it was necessary to identify 15 participating schools program’s demands, which now comprises 1,069 children and adolescents between 11 and 14 years old. Later, it was possible to discuss these demands with the local health unit and plan how the workshops are going to develop in the classroom. The present report was the experience of medical students who worked with 35 students of Joao Alfredo Rohr School in 2014.

Group discussion with adolescents

The schools’ teams adhere, in a better way, to interventions that meet local needs. Then, they are adapted to the communities’ teens’ realities in order to promote higher chances of producing habit changes. From that workshop, it is expected that students know better how to use condoms and contraceptive pills correctly. In addition, the research can be the incentive to empower adolescents about sexuality. Finally, it is worth pointing out the creation of a space to discuss fundamental issues of health education, which is a pedagogical challenge that needs rethinking within Local Health Units.

For the workshop development, it was necessary to first identify adolescents’ needs and particular local problems through previous knowledge assessment performed by public school students and teachers. The theme chosen for that particular audience was contraceptive methods. Second, there was an Ligia Claudino Duclós, Under graduate student of medicine at explanation of the importance and usefulness of contraceptive Federal University of Santa Catarina, Brazil. Email: ligiacduclos@gmail.com methods and how they work. Afterwards, the class was divided into two groups, and each group received a brown paper bag with contraceptive samples.

Improving Health Women’s Health Women and Health Learning Package Gives Birth In 2006, the Women and Health Task Force (WHTF) of The Network:TUFH developed the Women and Health Learning Package (WHLP) as a free learning online resource for use by educators, health providers and health sciences students to increase awareness of women’s health issues. Topics covered include cervical cancer; contraceptive practices; female genital mutilation; gender and health; internalization of domestic violence; menopause; men’s involvement in promoting reproductive health; mother-to-child transmission of HIV/AIDS; nutrition and women’s health; safe motherhood; unwanted pregnancy and unsafe abortion; use of medicines by women; violence against women; and adolescent health. To-date, the WHLP has been used to implement programs in different cultural settings. However, the WHLP in its current electronic form is not readily accessible to many school girls in developing economies where use of modern technology is still in its infancy and internet services are epileptic. Only a few have access to CD-ROM compatible computers or other media. To bridge this gap, Babcock University Department of Public Health, with a mini-grant from the WHTF through GHETS (Global Health through Education, Training and Service), worked with young adolescent girls in secondary schools in Nigeria: (1) to identify pertinent issues from the WHLP that they would like to see presented in a simple, easy to read format; and (2) to develop a handbook that could be widely distributed to schools, churches, mosques and other community settings. To achieve the set objectives, 20 female students from each of the two selected secondary schools in south western Nigeria participated in a full day interactive workshop sessions aimed at developing a handbook on women’s health. At the workshop, topics from the WHLP were presented and discussed with the students (Talkshop) by two postgraduate students. In groups of ten, the participants generated handbook topics from the WHLP using the ABC format.

ABC of Women’s Health handbook

A= ABC of HIV/AIDS Prevention B= Body Image C= Child Marriage D= Dysmenorrhoea (Irregular/Painful Menstrual Period) E= Engagement of Men and Boys in Women’s Health Issues F= Family Planning G= Grooming the Girl Child for Leadership H= Helping Girls Develop Healthy Relationships I= Internet Predators J= Justice for Girls K=Keeping Girls in School L= Lifelong Programs to Promote Women’s Health M= Masturbation N= Nature’s Best Food O= Out-of-School Girls’ Health Information P= Peer Pressure Q= Questions on Reproductive Health R= Rights of the Girl Child S= Sex Preference T= Temperance U= Unwanted Pregnancy V= Vaginal discharges and Itching W= Woman/Wife Battering X= Extra Weight Y= Yearly Events to Promote Women’s Health Z= Zero Tolerance for High Maternal Mortality Furthermore, participants developed key questions, stories, and graphic illustrations on each of the ABC topics as part of the handbook. The key questions were designed to prompt thoughtful discussions; stories to help bring into focus the reality of the women’s health issues; graphic illustrations to help create a vivid picture and deepen understanding of the issues; and text box statements at the bottom of each topic to challenge the reader to take action on women’s health issues. The WHLP served as a useful tool for developing new resource materials on women’s health, with girls and for girls.

Overall, participants identified women’s health to- Godwin Aja, DrPH, CHES; Department of Public Health, School of pics they considered very Public and Allied Health, Babcock University, Nigeria pertinent to them from Email: gndaja@gmail.com the WHLP; framed and fitted identified topics using the ABC…Z format as follows:

Improving Health Women’s Health Strengthening Community Systems to Improve Women’s Health throughout their Lives In spite of efforts being made globally towards improving healthcare for all, the developing world seems to be carrying the largest burden of maternal and neonatal deaths. Almost all maternal deaths (99%) occur in developing countries, and maternal mortality is highest in rural areas and poor communities. Many women do not receive basic antenatal care or have access to a supportive environment and healthcare support in remote communities. Pregnant women in resourceconstrained settings are generally neglected and isolated which in turn displays fewer options and health care services being provided to these women. In underserved remote areas, women are less empowered and this results in un-cohesive communities which adversely affects health situations in a community.

important aspects of pregnancy, includes ANC check-lists and more importantly, it involves the different women in the community. (Peer women, school girls or known as the ‘Little doctors’, health workers and midwives and the pregnant women). This tool will ensure active participation of individuals in the community which in turn empowers women into improving maternal health outcomes in physically remote regions and granting women their basic human right of safe motherhood experiences.

A conceptual Framework illustrating the mul-

“Research has shown that a woman in a de- tiple dynamics of the Interactive Pregnancy veloping country is 97 times more likely to Notebook (IPN) die as a result of pregnancy than a woman in a developed country.” Kassala. This region is characterized by marginalization and underdevelopment due to The WHO and UNICEF reported that wolow intensity conflict. men living in urban areas were twice as likely as those living in rural areas to report ‘Adopt a pregnant woman initiative’ advofour or more antenatal care visits. It has cates stronger ties to be created between been reported that only 12% of women in health workers and local women, specificalsub-Saharan Africa noted seeing a doctor at ly those living in rural communities, in order any point during their antenatal care. to access better antenatal care services and experience more fruitful and safer pregnan‘Adopt a pregnant woman Initiative’ is a cy outcomes. ‘Adopt a pregnant woman Iniproject that aims to create a more suptiative’ framework recognizes the social and portive environment for women, reduce cultural diversity commonly witnessed with multigenerational gaps and strengthens regards to sexual and reproductive health links between health care providers and issues. ‘Adopt a pregnant woman Initiative’ individuals in the community, all through promotes the collaborative engagement of the participation of community members. multiple women spanning different generaThrough community based participatory actions to ensure continuum of care. tion research, members of the community will engage in field work, reflect and analyze As part of this initiative, community memtheir current situation and later implement bers will be actively participating in creaand transform the health of their women ting an ‘Interactive Pregnancy Notebook’ and families. (IPN) tool. This tool is the heart of ‘Adopt a pregnant woman Initiative’ in which it This project adopts a qualitative research serves as a contextualized pregnancy guide approach and will be carried out in East Sufor women in a community. It highlights the dan, in a village name Makali in the state of

In Africa and many rural communities elsewhere, the use of reproductive health services is low. Low-resource settings need sustainable community-based interventions to be able to thrive and improve maternal health outcomes. Reproductive and sexual health is fundamental to all individuals and to the development of communities. Adopt a pregnant woman Initiative’ aims for maximum synergy following conceptualization and implementation of community based participatory approaches that involve creating a cohesive and empowering environment for women in the community, strengthening links between health care providers and locals and ensuring a continuum of healthcare across generations. Building a frame work that supports community cohesion and empowers community members to build a common vision of improving health outcomes utilizing a collaborative approach is the heart of ‘Adopt a pregnant woman Initiative’. Innovative community interventions and participatory action plans are necessary and will help build a supportive and engaging environment for pregnant women whilst accelerating progress towards the attainment of reproductive health goals. Tamara Abdelmoneim; Reproductive and Child Health Research Unit, University of Medical Sciences and Technology. Sudan Email: tamaramoneim@yahoo.com

Improving Health Health Professions Frontline Health Professionals Role to Balance the Top Down HIV/AIDS Policy Formulation HIV/AIDS is a devastating global pandemic that weakens those health-care systems that are loaded with a high prevalence of HIV/AIDS infection. Sub-Saharan Africa is most affected by the HIV/ AIDS pandemic, hosting two-thirds of all AIDS cases globally. Consequently, an estimated 22.4 million people live with HIV/AIDS in Sub-Saharan countries. A multitude of socio-economic factors have contributed to the aggressive spreading of HIV, including migratory labour, the status of women, poverty, high rates of other sexually transmitted infections (STIs) and ineffective leadership in health systems (UNAIDS 2009). Health professionals working at frontline levels in public health institutions in South Africa bears the brunt of the HIV/AIDS pandemic, as they are the first line of contact with the patient. A vast majority of affected patients are treated at primary care levels due to the high costs involved in treating patients living with HIV/AIDS. There are inherent job stresses in caring for sick people and the increasing number of HIV/AIDS patients leads to an increase in the workload for frontline health professionals. Caring for AIDS patients is time consuming due to increased physical and psychological challenges, such as longer recuperation times and a lack of support from the families of patients (Hall 2003; Minnaar 2005).

phase 1 formed the basis for strategy develop- • Nurses do not have political insight into how politicians visualize and address health proment for frontline nurse-led change to influence blems. HIV/AIDS policy, which was the only objective of the second phase of the research. Some research • Successful policy agenda setting does not sefindings revealed the following information: cure changes in the frontline level practice. • Nurse representation at national level with • Nursing leaders and policy formulators in the reference to HIV/AIDS policy formulation health-care system are not experts at creais unsatisfactory and the top-down policy ting and managing change. approach excludes nurses from the policy table. Frontline nurses are viewed as the • Constant changes in the policy environment implementers of policies and these nurses have a negative impact on nurses and discouthink policy formulation is not one of their rage them from suggesting changes to influfunctions. ence HIV and AIDS workplace policy. • Nurses are unaware that they can refine the national HIV/AIDS policy to suit the HIV/AIDS These findings can be applied to all health proneeds of their specific institution. fessionals in Community Based Services. This will be the way forward to ensure frontline involve• Nurses underestimate the importance of ment in policy formulation and implementation their roles in the health system. for the benefit of the patient in the community. • Current nursing education curricula offered at universities and nursing colleges do not include training regarding the policy process Dr Rina Muller; Senior Lecturer; School of resulting in nurses that are not politically ac- Nursing Science; Potchefstroom; SouthAfrica tive in decisions made.

• Nurses conduct research studies in isolation, thus excluding top-level research scientists from diverse fields, resulting in low-quality nursing research. Research knowledge or In South Africa the ultimate aim of HIV/AIDS postrong supportive evidence are not used to licies is to fight the HIV/AIDS pandemic. Policies drive items on the political agenda to influregarding HIV/AIDS are formulated at national ence health policy. and provincial levels of government. Frontline health professionals experience the top-down policy formulation as bureaucratic and negative because they are absent from the policy table and are merely seen as policy implementers. Involvement of health professionals at all three levels of policy formulation can be of value to ensure sustainable, sufficient and effective HIV/AIDS service delivery at frontline level. This top-down approach of policy formulation can be balanced by a bottom up policy formulation process if health professionals can be trained to become actively involved in the policy process and act as change agents to move frontline HIV/ AIDS challenges into the policy agenda. Research was conducted under frontline nurses. Phase 1 aimed to identify the barriers which led to nurses’ absence at the policy table. A literature review was conducted to identify nurses’ absence at the policy table and interviews with both institutional managers and frontline nurses were conducted to identify the reasons why frontline nurses are not involved in the policy process. Concluding statements derived from

Email:Rina.Muller@nwu.ac.za

Graphical presentation of the phases and objectives of the study to develop a strategy for nurse-led change to influence HIV and AIDS policy in South Africa

Improving Health Rural Health The willingness of Medical Graduates to Work in Rural Communities in Ghana Background Recruitment and retention of healthcare professionals in the rural areas are a major problem worldwide especially in developing countries. There is some evidence that CommunityBased Education and Service (COBES) and Problem-Based Learning (PBL) can be used to prepare and acclimatize healthcare professionals to work in rural areas and bring equity in the distribution of health professionals to benefit rural communities.

health care facility. The students, in groups of 8-10 students per community, spend four weeks each year from July-August for the entire three years. The COBES curriculum is iterative and each year is built upon the previous year while updating the activities of the previous year. Depending on the year group, students are expected to conduct a community health diagnosis, rotations at the primary health care facility and participatory proposal writing. In years 4, 5 and 6 students are sent to district hospitals to introduce them to the secondary level of care. The students also The University for Development studies, School of Medicine stay in these district hospitals for a period of 4 weeks. On the and Health Sciences (UDS-SMHS) which was established in other hand the traditional students are not exposed to the rural 1996, is one of the five campuses of UDS and is located in Taareas until year six where they go for district posting. male in the Northern Region of Ghana. A cross sectional survey was conducted among 56 pioneering graduates that followed the PBL/COBES curriculum. An exit questionnaire that had both closed and open-ended questions was administered to the graduates to assess their willingness to work in a rural area. Almost 43% (n=24) of the graduates were females. Fifty percent and 41.1% of them hailed from cities and urban towns respectively. Of the 56 graduates who took part in the survey, 33(58.9%) of them indicated their willingness to accept postings to the rural community; the majority of them were male graduates 23(69.7%). Again 19 (57.6%) and 12 (36.4%) graduates from the cities and other urban areas respectively, were willing to work in a rural area.

A simple memorable moment during COBES: Students with the Chief of the community, Prof. Nabila

A female graduate from the city wrote: ‘I am more willing to work in a rural area, although I have always wanted to work in the north, I now have the motivation to do so’.

A male graduate from the city remarked: ‘It (COBES) created awareness on the plight of rural northern GhaAfter following classical methodology of medical training the na. I will not refuse a posting to northern Ghana’. UDS-SMHS adopted a Problem-based learning, Community- A male graduate from an urban town remarked: ‘I am willing to based Education and Service (PBL/COBES) curriculum for the work in the district and extend to the deprived areas of Ghana training of its medical students in 2007 in response to reforms because that is where the real problems are’. in medical education. A male graduate from an urban town: ‘My experience in COBES The Community-based Education and Service (COBES) compo- has increased my desire to work in rural areas provided I am asnent of the PBL/COBES curriculum is a platform that enables sured of continuous professional development’. students to learn and also provide to the community. After a first year of participating in the University wide interfaculty Generally, the graduates were willing to work in rural areas. A community-based programme for the students, the COBES PBL/COBES curriculum could serve as a platform to influence meprogramme begins in year 2 for the medical students. The dical graduates’ to work in rural communities. UDS-SMHS COBES runs the entire medical programme span- Anthony Amalba, PhD Student, Maastricht University ning from year 2 to year 7. For the first 3 years (year 2 to 4), Email: aamalba@uds.edu.gh students are sent to communities with at least a primary

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Projects that Work The Projects That Work initiative, now in its third year, is sponsored by FAIMER (Foundation for Advancement of International Medical Education and Research; partner organization of The Network: TUFH) as part of the annual Network: TUFH conference. This year, the Projects That Work competition will showcase projects that have been successfully addressing missions related to the 2014 conference theme, “Strengthening Health Professions Education as a Policy to Improve Health,” for three years or longer. The intent of the Projects That Work initiative is to recognize excellent projects that have succeeded beyond initial implementation and have had a significant impact on health, the community, or the school, as well as to encourage the development, implementation, and dissemination of more such projects. We would like to present two of these projects in our new “Projects that Work” section.

Rwanda village Concept Project – Interdisciplinary Health Professions Student Education (Rwanda) Rwanda Village Concept Project (RVCP) is a non-governmental, nonpolitical, nonprofit, voluntary organization run by students. The overall goal of RVCP is to provide sustainable improvement in the living conditions of underprivileged communities in Rwanda using low cost means and to develop the capabilities and knowledge of participating students in development work through sustainable development projects that are community owned, inter-sectorial and coordinated by students. We are a volunteer organization based in Rwanda working with partners and volunteers to achieve our goal. We have set a win-win partnership model; with the community we work with everyone is involved at every stage from the need assessment to project implementation. Students and volunteers benefit from hands on experience, from need assessment, project design, implementation, monitoring and evaluation of the projects.

Rwanda village concept project

We have created and work as one project with micro-projects have supported over 25 target groups in the Southern Provence that run parallel. of Rwanda. We started with HIV/AIDS awareness, reproductive health and Malaria prevention and later we started income generating projects and Hygiene and Sanitation micro-projects. Then we started Initiatives and Gender Empowerment and Youth education under a Pyramid project.

Our volunteers back then became decision makers and role models in their various careers. Many of them have started their own nongovernment organizations. In many ways these projects have changed the lives of its participants since its start. The community members became the community leaders and they are Participants are local volunteers and international volunteers; heading various initiatives in their communities. we also work with international organizations to offer volun- We synergize and link with existing local governance initiatives in teering opportunities. many ways from health education campaigns and development RVCP was founded in 2000 by a partnership between medical initiatives. We build lasting leadership models and lasting netstudents of the National University of Rwanda, the Internatio- work relations. And our administrative structure allows a democratic and skills based model that promotes accountability. nal Federation of Medical Students’ Associations (IFMSA) and the community of Huye District. Following the 1994 genocide, in which more than 1,000,000 people were killed in three months, villages and towns as well as the unified community spirit were destroyed. RVCP was initiated by students hoping to provide sustainable improvement in the health and living conditions for these underprivileged communities whose hope was almost completely gone. To date, we

Our mission statement is to focus on health to promote sustainable and responsible interventions at the village level to encourage self-reliant, community-orientated and informed citizens. Dr Dukundane Damas, Rwanda Village concept project, Huye District, Rwanda Email: damasenator@gmail.com

Projects that Work Collaborative Community Health Program for Control of Vector Borne Diseases in India The healthcare of the city of Mumbai with a population of 18.4 million (60% slum residents) is dependent mainly on three major medical colleges, the peripheral hospitals and 162 dispensaries; all of which are under the purview of the Municipal Corporation of Greater Mumbai. Medical training in these colleges has a traditional curriculum consisting of five and half years of training, the last year being rotating clinical internships. Currently, the curriculum has a few pitfalls like predominance of rote learning, lack of community orientation and teaching in isolation. In this background, malaria became a menace leading to 198 deaths in 2009. In response to this, medical colleges started specific outpatient services and the public health department started active surveillance and treatment of patients with fever in the community. The interns, an important work force, had so far never been tapped before. In this innovative project, the interns were included in the campaign and were to provide service at the doorstep. In turn, it provided them with an opportunity for community based learning which inculcates social accountability, professionalism, teamwork and improves communication skills and problem solving approach. The goal of the project was to reduce incidence of Malaria by vector control and dispense prompt treatment for reducing death rates due to Malaria. An outcome of this was to use the opportunity to improve the learning of interns.

ges on Sundays. This started in the monsoon of 2010 and has been a continuous program since then. The Director of the medical education and major hospitals was in charge of coordinating the same. For the first time there was pooling of resources. Primary, secondary, tertiary health services, local political representatives, public health department and community leaders were all instrumental in providing services. For the interns to be posted in camps, a policy decision was taken and permission was sought from and granted by the Maharashtra University of Health Sciences to consider the posting in camps as an acceptable means of training. With coordination from community medicine departments of respective hospitals, and after an orientation session, the interns were sent to the camps for a fortnight by rotation. At the camps interns were involved in history taking, examination, diagnosing and treating the patients, observing collection of samples, preparation of blood smears, identification of positive slides and treatment dispensed. They also participated in community education programs for awareness of cause of malaria, ways of curbing the vector with actual demonstration of methods such as using guppy fish for larva control.

At the initial stage, a major challenge was ensuring the involvement of all stakeholders. The magnitude of the menace, the able leadership Delegation from the Nelson Mandela of the administration, genuine concern of all School of Medicine involved and the media in its role as an advo- their log book for improvement of their knowIn order to curb the increasing threat of malacate for community needs spurred the stake- ledge, skills, responsibility, behavior with colrial deaths, thorough planning was done in two leagues and others, and on initiative, participaholders to cooperate. phases: tion and involvement in discussions. 1. Analysis of causative factors Another obstacle was the belief that the exis2. Think tank of various stakeholders ting dispensaries and health services should There has been an effective control of malaria be sufficient to tackle the issue creating a re- in the last four years. However all measures The result was a five point program: luctance to engage in this activity. Constant need to continue so as to prevent a similar sidialogue, policy decisions and participation tuation from recurring. of the seniors and administrators in the camp As the project sustains and benefits to the was helpful in eventually ensuring its success. community persist, the learning for interns Other challenges included careful planning, also continues. involvement of local political representatives, allocation of budget, pooling of resources and The project was sustained since it met burning availability of infrastructure. needs of the community, scientific methods were used and there was involvement of all From 2010 to 2013 there was an 86.3% decreThus a comprehensive plan involving health ase in incidence of malaria and deaths due to stakeholders under an able leadership. services, public health, health education, ada malaria decrease of 79.3%. There were 198 ministration, political representatives and the deaths due to malaria in 2009, which came Suhasini Jayantilal Nagda, Director of community was envisaged. One of the impordown to 45 in 2012.The plan was also studied Medical Education and Major Hospitals, tant interventions was conducting community by other state governments. Dean of Nair Hospital Dental College, programs by the public health department with the help of interns on weekdays and re- In these four years nearly 1500 interns have at- Mumbai, India sidents and senior faculty of the medical colle- tended the camps. The interns were graded in Email: suhasininagda@gmail.com

International Health Professions Education Medical Education Use of Medical Narrative for Integration of Theory and Practice in General Pathology Teaching The teaching of General Pathology (GP) in the medical curriculum needs to be adapted towards being more integrated with the medical practice while overcoming the biologist’s view of the diseases. Aiming at family-centered medical education, the students were assigned to create medical narratives from a patient’s story.

chological, biological and environmental aspects of their life and disease process. Through interviews and home visits they were in contact with the volunteer patient and created the medical narratives from a humanist perspective. Using a debriefing process they could reevaluate and improve their narratives. Some students, motivated by a critical incident such as death of a relative or the discovery of a self-disease, were allowed to write about a family member or about themselves as patients. Most of the students had a positive evaluation of the activity and reported great personal growth through the creation of the narratives. Even the ones that in the beginning demonstrated a resistance to the activity, concluded that the capacity of telling their patients stories is fundamental to medical practice. They acknowledged the relevance of narrative skills to the medical student and to the future physician. This activity fomented integration between the teaching of General Pathology and the medical practice itself and to expansion of student’s reflective competency and comprehension of the disease process. It also contributed to creating a rich and productive learning environment shared by teacher and students in a trustful and respectful way. I would like to thank my students who, during this activity, created a great learning opportunity that expanded my comprehension of the singularities that involve the disease process and the patients who so generously shared their lives and feelings with the students. It was a wonderful experience. I believe I’ve learned more with my students then they have learned from me.

Examples of narratives

The medical undergraduate curriculum is organized in a modular structure and has the humanist approach to patients as one of its core values. Fostering a community based learning environment, the students are placed in contact with volunteer patients through home visits. The GP course belongs to the axis that perceives the social, psychological, biological and environmental determinants of health and disease. The medical narratives were used to unify and enhance these aspects of the curriculum, creating a dialogue between theory and medical practice.

Prof Dr. Cristina Maria Ganns Chaves Dias, Univ federal de viçosa, Brazil Email: cristinaganns@gmail.com

As a required and evaluative activity, the students of the GP course were assigned medical narratives. They had to write the life story of a patient of their choice, revealing the social, psy-

Flowchart

International Health Professions Education Medical Education What About Being Part of Practical Medical Classes in a Teaching Hospital? The Patients’ Point of View Humanization in health care is an important subject that should be addressed during medical training. It is of huge importance to discuss humanization and the good doctorpatient relationships during the Medical course. It is known that Medicine is learned, in great part, at hospitals and other health units, and the patient is essential in this process. In fact, “the patient teaches”. It is still poorly discussed by the scientific community how patients feel when taking part of medical classes. What are the patients’ perceptions regarding their participation in practical medical classes? Taking this into account we have conducted research in a teaching hospital to better understand what patients think about being part of practical medical classes. During the year 2012, we have interviewed patients who have participated in medical classes at the Waldemar de Alcântara General Hospital, in Fortaleza city, Northeast of Brazil. This is a teaching hospital where medical students from the University of Fortaleza (UNIFOR) have practical classes. We have included in this research patients that have been in contact with medical students from UNIFOR during their curricular training in the module of “medical skills 5” in the third year of their medical curriculum. In this module the students have the goal to learn how to take a clinical history and to make a complete physical examination in adults and children. A total of 64 adult patients were interviewed (age range 18-87 years); 68% of patients reported having been contacted by 1 to 5 Medical students during the present admission. Only 8 patients (12.5%) reported being bothered when asked to participate in Medical classes. All those interviewed considered the students’ approach (during history taken and physical examination) as good and respectful; 90% of patients considered their participation in Medical classes beneficial, and the main reason for this was the personal satisfaction in helping students to learn Medicine (60% of cases).

• Personal satisfaction for helping in the medical formation (64.1%). • Feeling as a teacher for the future doctors (55.7%). • Learning about their own disease (42.7%). • Feeling improvement in their treatment (37.4%). • Feeling more self-confident about their diagnosis and treatment (32%).

of practical medical classes? To understand this we have interviewed 14 mothers who had their children participating in these classes. All the respondents reported not being bothered when asked to have their children participating in medical classes, but 10% of them would like to have their children examined by the student only in the presence of the professor; 35.7% reported having being contacted by 1 to 5 Medical students during the present admission, and 35.7% reported contact with more than 5 students. All respondents reported that the students had respectfully conducted the history taking and physical examination. About 90% of the mothers considered their children’s participation in medical classes beneficial, and the main reason for this was the personal satisfaction in helping students to learn Medicine (60% of cases).

The main “problems” with being part of medical classes reported by the patients were: • Type of disease; some patients think they have no physical condition to help students (8.3%). • Being examined by many students (8.3%). • Shame (6.1%). The majority of patients accepts their par• Fear of worsening their disease (3.8%) ticipation in practical Medical classes and Some patients’ speech reporting their ex- feel good in helping teach future doctors. perience during practical Medical classes The importance of training Medical students to have a humanized approach to the were: patient and teaching the main aspects of a “I think it is good because I am helping them good doctor-patient relationship is evident (students), and it is also important to us, to since the first curricular practical classes. our health”. “I feel good, I think it is fundamental becau- Geraldo Bezerra da Silva Junior, MD, PhD; se they are studying my case”; “I feel con- School of Medicine, Post-Graduation Protributing to the evolution of Medicine and gram in Collective Health, Health Sciences Center, University of Fortaleza (UNIFOR). Health”. Fortaleza, Ceará, Brazil. Another question raised during our tea- E-mail: geraldobezerrajr@yahoo.com.br ching experience in this hospital was: and how about the children? What do their mothers think about their children being part

The main “gains” with being part of medical Medical students during their practical classes classes reported by the patients were:

International Health Professions Education New Institutes and Programs The International Federation of Medical Students Associations (IFMSA) Implementation at Federal University of Amapá Federal University of Amapá (UNIFAP) is a public university in extreme northern Brazil, inside Amazonia in Amapá state. UNIFAP has existed for 24 years and its medicine course was founded in 2010. Two years later, a medical student from first year, named Paulo Lacerda had an idea: bringing and implementing the NGO IFMSA (The International Federation of Medical Students Associations) into his university. Thus, he and five other medical students started to work on the implementation process that had several steps, such as: students registering, curriculum analysis, carrying out a social campaign, signing contracts and, finally, candidacy defense in General Assembly. In the beginning the students were a small group, with only six affiliated, nowadays there are fifteen affiliated members and more than twenty volunteers. The idea was born when we realized how poor and needy some communities from our city (Macapá) are. This way we could perform work that would benefit our population. It really is wonderful.

as lectures to certain populations, distribution of educational material, provided medical tests (pap and PSA test) and some other activities. This project reached over 500 people, among cancer patients, their family and interested people. It also provided to medicine students a new view about living with cancer.

through actions and projects that aim to inform and sensitize communities about life quality improvement and prevention of diseases, guiding to lifestyle changes and ending prejudice. For example: Candlelight Memorial Day, an action that aims to honor victims of AIDS and educate populations against stigma and discrimination that HIV infected still suffer; National Day of Hypertension Combat, an action in which we measured blood pressure and checked the weight of passerby in a shopping center. There was also a medical doctor, one of our teachers, that guided people with results outside the normal. Another example is the project Educational Activities on Cancer Prevention in partnership with an institute to support cancer patients, in which we did various actions about cancer prevention, such

We think that working with needy people and helping them is the way not only to improve their health and even community health but is also the way to make the world a better place. So knowing local and global realities is very important because it is the way to know what these people need. Even being just students we already felt responsible about that. It would be great if many medical students around my country and the globe feel like that too.

IFMSA also provides a network that links medical students around the globe, including academic leaders; thereby they can learn from and be motivated by one another. During the year there are some world events that bring together medical students to discuss health issues, to show their own local projects/actions, to minister trainings and to discuss bureaucratic issues. Another important activity of this NGO is the exchange. It takes into account curriculum and participation in IFMSA’s actions/ campaigns/projects for classification of professional or research internships at many affiliated medicine schools around the globe.

All this process and activities provided a bigger interaction among students and community, because many of them could get in touch IFMSA is an NGO that with patients and experiexists in more than one ence problems faced by local hundred countries. It has population, like lack of clean an interesting way of acwater or difficult to access ting, mostly because it public health services and intends to improve both Student at bridges area: houses are built on wooden bridges because of many other issues. Trainings community lives and me- looding and discussions like IFMSA’s dical students’ formation. meetings could bring together students around the globe and This NGO has several goals. One of them is to expose medical this sharing of experiences also could make them grow as human students to humanitarian and health issues, so they can be in beings. This way it should be disseminated to a bigger number of contact with demands of the local population, helping people universities. and also learning for life and profession. IFMSA works mainly

Adriana Bueno, medical student, Federal University of Amapá, Brazil Email: dr1ss@hotmail.com

International Health Professions Education New Institutes and Programs Advanced Health Care: an International Honours Program by Zuyd University of Applied Sciences, The Netherlands, and PXL University College, Belgium This first-rate program is open to professionals from around the world who have a Bachelor’s degree (or equivalent) in health care, such as nursing, physical therapy, midwifery, occupational therapy, speech therapy, pharmacology , medical education, …

process is a central starting point. Transfer of knowledge and the link between knowledge and practice is the main focus of the program. Every module has a practical component (one day a week) by means of internships, job shadowing, excursions, participation in research, etc.

Outstanding students who are about to complete their Ba- The program is taught full-time for the duration of one academic chelor’s degree are also encouraged to apply. year at Zuyd University of Applied Sciences in Maastricht, the Netherlands, with frequent visits to PXL University College in HasThe program is based on an identified need to strengthen highselt, Belgium. The program is unique, ambitious and innovative potential professionals with supplementary competencies in and will be launched in September 2015. an international and inter-professional context. The program comprises 60 European Credits in total. Graduates from this program will be a healthcare leader and are able to act as a role model in their specific professions, to A careful intake assessment is essential for success. The intake link professional practice with scientific knowledge, to create assessment will consist of, among others, Grade Point Average (GPA) (or something similar), evidence of English knowledge and implement innovative ideas for their professions. (TOEFL, IELTS), CV, letter of motivation, and proof of funds. This challenging and exciting program incorporates the latest insights in the development and provision of excellent health Besides strengthening the professional competencies, this care. It is developed and delivered by internationally renow- program can serve as a bridge program to an affiliated master program. Participants can opt for a short preparation course to ned experts from leading universities, hospitals and clinics. smoothen the entry to a master of science program. The program is delivered in English and is based on universal competencies for health care professions (such as the Cana- More information? dian Medical Education Directives for Specialists). To find out more about the program, please visit our website: Since students will have a variety of backgrounds, the program www.zuyd.nl/training/advancedhealthcare has several modules that cover a wide range of topics (such as Or contact a member of the project team: professional methodology, inter-professional health practice, Ruud Heijnen: ruud.heijnen@zuyd.nl evidence based practice, technology in care,…). The program Benny Claes: benny.claes@pxl.be will be problem-based whereby self-direction in the learning Benny Claes, PXL University College, Hasselt, Belgium

International Health Professions Education Problem-based Learning and Community-based Education One health: an Approach to Innovative Community Based Training. A lived field Experience. Strengthening health systems to effectively respond to local and global health concerns has for a long time been a challenge most especially in developing countries. This has seen the birth of many capacity building programmes in the various health sectors with minimal emphasis on multisectoral and multidisciplinary collaboration in training and health service delivery. To address this gap, Makerere University in collaboration with the University of Tufts and Minnesota through One Teaching the young ones about schistosomiasis Health central and East Africa network made it possible for nursing, concern. Furthermore, a screening survey veterinary and environmental health stu- done by the Ministry of Health and USAID dents to undertake a joint field attach- in the Kayanzi fishing village of Bwera Kament in 2013 and 2014 which I participa- sese District in Western Uganda in 2013 ted in. This was in western Uganda and I on Bilharzia showed that 75% of the powas particularly placed in Bwera Kasese. pulation tested positive for Bilharzia. The The attachment was for a period of one majority of community members stated month. It involved one week of orienta- Bilharzia as one of their major health tion which involved debriefs about com- concern with a significant knowledge munity entry, assessment, diagnosis, gap about the disease causes, lifecycle, prioritization of health needs and social symptoms, prevention and treatment. entrepreneurship. Thereafter we were deployed for three weeks in the field to carry out a community assessment, identify and priotize community health needs and an intervention which allowed input from all disciplines.

(76%) of the interviewed residents of the Kayanzi village were now knowledgeable about Bilharzia as regards to the various topics we had taught. The number of people receiving Praziquantel increased from 450 to 537. This compelled the Ministry of Health to suspend its decision to withdraw Praziquantel from the community to other affected areas, because of the hitherto reported non-adherence to treatment. Opportunities for further research on biofriendly regimens to prevent Bilharzia were identified. Well, this experience led to collaborative, innovative and mulitidisciplinary interventions aimed at disease prevention, health promotion and improved health seeking behaviours among others. There was remarkable impact in the communities despite the limited time frame with community involvement in designing and prioritization of interventions. Health concerns were solved in a very short period of time making it possible for the students to appreciate the power of collaboration in solving complex health problems that would not have been easily solved through intervention by individual disciplines.

To fill this gap, the main objective of our community intervention was to increase the knowledge of the Kayanzi village community in Bwera Kasese about Bilharzia focusing on lifecycle, predisposing factors, methods of transmission, signs and Community entry was done through in- symptoms, methods of prevention and Most of the current global challenges in troductions to the local community lea- control and promote adherence to treat- health, food security, disaster, floods and refugees need to be solved through mulders highlighting the main objective of ment regimen by USAID and MOH. our presence. This was followed by com- This was done through community health tidisciplinary and multisectoral collaboramunity assessment that involved archival education using the prepared teaching tions, strategic partnerships, collective dedata review mainly from the records of Aids. Emphasis was put on fishermen, cision making and training. In this regard the hospital, observations in the commu- school children, women who get involved one health approach possesses a great nity, key informant interviews, focus group in the mining of shells and all other lake opportunity for community based training among health professionals through muldiscussions and field visits. These helped users. tidisciplinary universal health coverage us come up with sufficient information to prioritize the health needs of the popula- After five days, evaluation was done to as- and promoting equity for all. tion alongside their involvement. Various sess the impact of the project. Education health concerns were identified which posters still hung at the various dissemiFaith Nawagi, Makerere University Colincluded malaria, worm infestations, HIV/ nation points. Community knowledge on lege of Health sciences, Uganda AIDS, low latrine coverage and bilharzia. Bilharzia regarding lifecycle, predisposing Email: fnawagi@gmail.com Among these, bilharzia was less inter- factors, signs and symptoms, prevention vened on in this community yet a major and treatment was high. Three quarters

International Health Professions Education Leadership Column

Bernard Groosjohan Bernard Groosjohan is founding dean of the faculty of the medical faculty of the catholic university of Mozambique (UCM), from 2000-2007. Innovative learning was introduced from the start (supported by Maastricht University). From 2008 till 2014 he worked at the Eduardo Mondlane University (UEM) in Maputo as adviser of the rector. He was involved in the reform of the university towards a more participatory learning environment. In 2014 he returned to his former university in Beira where he became again dean of the faculty of health sciences.

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

dical graduates to deal in a more proper way with patients, to see them more as clients and deal with them in a respectful way.

For 7 years I was in Beira at the medical faculty of UCM as founding dean, after this I became advisor of the rector at the Eduardo Mondlane University in Maputo. This rector was the former rector of UCM.

We started with a new curriculum and introduced it year by year. It has to be said again, against the will of a number of staff members. In particular The Problem based learning (PBL) approach was not accepted by everybody. A lot of the resistant teachers had to be tutors, but didn’t cooperate so it created a really unstable situation. This continued for four years. In the meantime I had to start with all the other faculties. Some were more interested than others. For instance with law and veterinary medicine one was more responsive. I mobilized people from The Netherlands, Belgium and other countries. It was a very tough but at the same time a very dynamic time. The biggest resistance though came from the medical school. I think that medical doctors really don’t like to be told what to do. But we had no choice, the rector wanted us to continue.

He very much saw the benefits of problem based learning, as we introduced in Beira. Graduates were patient focused with a variety of competences to enhance this. So he asked me to introduce participative learning in all faculties of the most established and mother university of Mozambique and he gave me the mandate to mobilize the different faculties. We started with the medical school, because we had that experience in Beira. In 3 months’ time we had to develop and introduce a new curriculum for the first year of medicine, which was very fast and nearly impossible because you have to get everybody on board.

Learn from your environment, from your students, how they perceive your changes

Because of time constraints the approach was too much top down. In general, to modify educational processes is not easy. Education is a conservative domain and complicates the introduction of new learning formats . If you start a new medical school is it relatively simple to do that in an innovative way. Students are responsive for new things and academic staff still didn’t develop habits and traditions. With an established course the situation is very different. Students again mostly like changes that give them more autonomy but this is different from the point of view of the teacher. What is the first step towards a successful change? I invited 6 graduates from Beira and they became incorporated into the faculty of medicine in Maputo. This was controversial because they came from a smaller less renowned medical school.

We had a lot of meetings and gave workshops with the help of Dutch and Belgian experts. We had to oblige the teachers to participate. Finally lecturers got more and more convinced but it was as if they were not allowed to show this. We had a lot of enemies. Together they couldn’t support it. The rector wanted those changes very fast. The top down approach created problems with the council of lawyers, of medicine and of engineers; the whole community started complaining. After

From the beginning in particular the lecturers were not very happy with us, but we had to continue because of the rector wanted us to continue. The experience in Beira was a good one with good result. The rector stood up and said he wanted me-

Member and Organisational News

Leadership Column

four years, the president of Mozambique who nominated the rector removed him because it created too much unrest. After this the process of change slowed down or stopped. 6 months later in the medical school, the old curriculum was reestablished. Then I withdrew myself. Those 6 years were quite energetic and dynamic and one realized that the process of change, if not supported by its leaders, and if done too fast, there is a big chance that it will eventually fail or not become a sustainable event.

this relationship. You can learn a lot about the behavior of the students and the successfulness of interventions. The local population is a mirror of it all which makes sense, the education that you offer. So you should involve them in the evaluation of your programs. I involve quite some external people and make them feel like they have a role there. Experts involved with different backgrounds and different opinions enriches the learning environment.

What kind of leader would you say you are?

Any final advice for our readers?

I am a leader who listen to the others first but when I am convinced about what I intend to introduce then I sometimes can be a little bit harsh in trying to convince the ones who are resisting.

Learn from your environment, from your students, how they perceive your changes. Create an enjoyable learning climate with challenges for everybody. Students are open for innovation, for changes, wherever they come from, whatever there background. Develop a long term vision and know that the ultimate aim is to serve the people, to keep them healthy and offer the healthcare that one needs in a dignified way. There will be a lot of struggles along the way but that is normal. As I said before, education is conservative but as a leader your task is to produce as many â&#x20AC;&#x2DC;agents of changeâ&#x20AC;&#x2122; as possible. Students are in the best position to become those agents. Evidence is there to show you.

At the end you have to be the person who makes the decision. It is very important to identify people who are focused in the same way, who have strong connection with the faculty and who are able to continue when you are not there anymore. A faculty needs ownership and this needs to be created and maintained at all moments. If you feel that you are backed by the students, this makes you stronger. In Beira, where I work now, I meet all students every 3-4 weeks and talk with them to find out about their perception of the learning process, reflect on their observations and make a plan of action. One has to see that there is a follow-up.

Bernard Groosjohan Email: bgroosjohan@gmail.com

As a leader you have to be visible. Not only staying behind your desk. And this is not only for students but as well for academic staff and administration. Do not favor one particular course but divide your attention to all courses that your faculty provides. What role do you give other stakeholders (e.g. staff, students, community leaders, health authorities) in the change process? Every week I have a meeting with all the members of the direction and other faculty staff so we have a system with regular gatherings with all different stakeholders. One of the most important stakeholder is the community. We focus a lot on community health. All students become attached to families in those communities and community leaders are asked to assess

International Health Professions Education Interprofessional Education Community-Based with Inter Professional Education Approach in Faculty of Medicine, Universitas Gadjah Mada, Indonesia Faculty of Medicine Universitas GadjahMada (FM UGM) is the oldest Faculty of Medicine in Indonesia that is always leading in medical education innovations and having a big influence in medical and health profession education in Indonesia. Innovation in medical education started in this university back from 1994, from discipline based curriculum into partial problem based learning (PBL) curriculum. Ten years later, the faculty innovated the curriculum again from partial PBL into full PBL curriculum that consist of integrated blocks. Finally in 2007, the curriculum is designed following competence based curriculum (CBC). These innovations are being followed by most faculty of medicine in Indonesia. Besides, FM UGM has specific characteristics such as this University has very close relationships with the community. Therefore, many activities in the curriculum are integrated with the community. Starting 2 years ago, FM UGM developed an integrated community based program with an interprofessional education approach. The program is established based on evidence that shows the impact of learning together will help practitioners and agencies work better together, and realizing that, students have no opportunity to follow up a family intensively and continuously during their study time. By working and learning together with other professions and closely with the community, we hope students learn how to respect and work collaboratively. Students will also understand more about how the professions work in real situations.

be followed by students since the first semester of education and followed up longitudinally during the study. Activities include lectures, tutorial, skills laboratory and most importantly field visits to the community and family. Students are grouped into small groups consisting of 3 medical students, 1 nurse student and 1 dietitian student. This small group is attached to 5 families that have been defined by the Health Office. In one semester, students can arrange their visit to the families to achieve the activitiesâ&#x20AC;&#x2122; target. During the field visit, students are facilitated by two supervisors i.e. one supervisor from the faculty staff member and one supervisor from a local doctor. The supervisors have to follow a briefing and training session conducted by the faculty before performing as supervisors. In this program, the students learn how to work together in solving family or community problems; apply a conceptual framework for understanding primary health care as a health care team; and demonstrate the concept of community and family medicine in the real setting. As we can see the design of the program below:

FM UGM has three undergraduate programs: medical education, nurse education and dietitian. Together with Health Office and Insurance scheme, the faculty has initiated a structured and longitudinal community based inter-professional education for the three undergraduate programs. The program should

The program is arranged longitudinally from year 1 until year 4, and for each year the topic and activities are designed to match students competence. Since the program was implemented, there are many positive responses from the community, doctors, and also students. Some improvement should be regularly made to meet current conditions of the community. In conclusion, we can see that this program shows that structured comunity based education with an inter professional education approach is possible to be implemented longitudinally in the curriculum.

Students have to learn how to interact with family

Ova Emilia;Vice Dean of Academis affair Faculty of Medicine Universitas Gadjah Mada, Yogyakarta, Indonesia Email: ovaemilia@gmail.com

Studentsâ&#x20AC;&#x2122; Column

Out of the SNO Pen

Visa Applications: Lessons Learnt It was not obvious that I will be part of the students in the Brazil conference. With lots of lobbying and searching, at last I was informed that GHETS was going to pay for my return air ticket to Brazil. This was such good news as it is always a different and awesome experience in the Network: TUFH conferences I have attended. There is a lot to learn and different people to meet, no wonder it is called The Network. I still think it was a miracle that I made it to Brazil last year. Ugandans need visa to go to the republic of Brazil despite the fact that there is no Brazilian embassy in Uganda and the nearest was in Kenya. Remember it was about 3 weeks to the conference. This left me with only two options either to pay a courier agent to take my application forms (which I was not sure were complete) and get the visa after 4 weeks or to travel to Kenya and get the visa after 4 working days. Option two was easier! Though it was a 17 hour drive on a bus to reach Nairobi, locating the embassy was not the only problem, but it was disturbing to realize that I needed more documents to attach on my application, some of these could only be gotten from my University in Uganda and others I could access from Kenya. Ooh and I had to look for the local bank to pay my visa fees. Also the embassy was open for only a few hours in the morning, if you were too late they simply said come back tomorrow morning. But luckily I had everything by the following day in the morning! Josephine (middle), very happy to attend the Fortaleza conference

I spent the following day running all the above errands in Nairobi and the following day I had all that was required for my visa application. I had spent so much already, and it was too expensive for me to wait for the four working days in Nairobi, not forgetting I had to report at my internship site that very day. So I traveled back Uganda.

A few days before my flights, I traveled back to Kenya not sure with I was denied or given the visa. I got the visa, by the time I started my 42 hour travel to Brazil, I was tired though excited! Lesson learnt, if you need a visa for any international travel process it as soon as possible. Najjuma Josephine, Intern Nurse Email: najjumjosephine@yahoo.co.uk

Students’ Column Big five Catherine Habel 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.

for care, such as ethical sensitivity, cultural safety or negotiation of perceptions. And we should go even further, let’s teach community-based learning! 4. 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?

If I was Minister of Education I would… - Align educational priorities around the common good.

1. Why did you choose to study Medicine?

I chose medicine because, like many of my colleagues, I was driven by the desire to make a difference in the world. I wanted to use my empathy and my expertise to work towards improving the lives of the suffering ones. My experience through medical school and my encounters with the health system made me doubt this profession. I only saw obstacles; how could I improve the quality of my patient’s lives with presciptions and time constraints as my only tools? Therefore, I decided to specialize in Preventive Medicine and Public Health, where I could focus on working on the social determinants of health. There are tremendous challenges, but the impacts of success are tremendous too! 2. Can you as a student influence the educational program of your Faculty?

Definitely! As a medical student at Université de Sherbrooke, I was involved with the International Relations Office (BRI). I had the opportunity to share my observations, my experiences and my ideas to bring global health as a theme of major interest and importance for the students. Collaborating around global health with the BRI led to the implementation of a mandatory comprehensive pre-departure training program as well as the creation of an interdisciplinary working comittee on global health in the curriculums. Thanks to the enthusiam and openness of the staff at the BRI, I had the chance to contribute fully and learn a lot from this experience.

- Assure autonomy and independance of the educational system by restricting lobbying by corporations and political organizations. - Develop a universal and free educational continuum from primary schools to universities. - Include mandatory classes about critical thinking, civil rights and democracy, human rights, democracy and social inequities and ethics in high schools. - Favor interdisciplinary and intersectorial teaching in Universities to create a common space of tranversal competences. 5. Do you ever get in touch with the community?

Definitely! One last example of my interaction with my community is my participation in the World Social Forum (WSF) on peace and human security last June. I was taking part in this event as a member of the Civil Society Collective from Quebec, a gathering of engaged citizens, entrepreneurs, NGO leaders and students all moved by values of justice and equity. My discussions taught me a lot about the bridges we should reinforce between the health system, the public health bodies and the civil society. Since I have been back from the WSF, I have kept in touch with the members of the group and reinforce my collaboration with my own community!

3. What is your opinion about innovative educational formats like problem-based learning (or the education format that your own Faculty uses)?

Problem-based learning is for me a first step only. I think we can go further and contextualize these learning tools in community experiences. As an example, I had an incredible internship where the patients seen in the morning were the basis of the shared learning experience of the afternoon. It then became patient-based learning, not problem-based! As we knew the patient, we could think about him relating to his neighborhood, his family, his social and economic context, as we would normally do! This approach emphasizes other necessary tools

Member and Organisational News Transition of the Secretariat Background: From University of Ghent to FAIMER In 1979, 19 schools were convened by the World Health Organization (WHO) to address alignment of health professions education with community health needs. “The Network” formed from that meeting. The Network merged with another WHO project, “Towards Unity for Health,” in the late-90s. For the first 25 years, the Secretariat of The Network: Towards Unity for Health (The Network:TUFH) was at Maastricht University in the Netherlands. Six years ago, the Secretariat moved to Ghent University in Belgium. Ghent has provided an excellent home for the organization, but that relationship will be ending in 2016. Informal discussions began in 2012 about the future home of the Secretariat. The Executive Committee of The Network:TUFH analyzed a range of possibilities at their meeting in Ayutthaya, Thailand in November, 2013. The group agreed to articulate a business plan for The Network, incorporating the concept of locating the Secretariat at FAIMER (Foundation for Advancement of International Medical Education and Research), Philadelphia. In February, 2014, a business plan for The Network was reviewed and approved by the Executive Committee. It delineated The Network’s mission, current strategic assets, future plans, and the potential advantages of re-locating the Secretariat to FAIMER: Advantages for The Network:TUFH • Access to FAIMER community

Advantages for FAIMER • International platform: opportunity to convene other entities • Advocacy: accreditation, social accountability, inter-professional education • Access to broader market for Masters in Health Professions Education, Institute, consultations, webinars • Convening point for FAIMER community • Capacity building in assessment, accreditation • Greater engagement with WHO • Potential synergy with Global Education in Medicine Exchange (GEMx) On June 13, 2014, the Board of Directors of The Network:TUFH sent a letter to FAIMER formally requesting that FAIMER become the home for the Secretariat of The Network:TUFH. In July, the FAIMER Board of Directors voted to accept the invitation to become the Secretariat starting January 1, 2015. There will be a transition period and January 1 2016, the secretariat will be definetly relocated to FAIMER; The transition of the Secretariat is intended to strengthen and sustain the role of The Network:TUFH as a global organization which mobilizes individuals and institutions committed to improving health through community-oriented education, service and research.

• Stable Secretariat location independent of Secretary-General’s home institution • Possible synergy with faculty development initiatives • Improved integration with Projects that Work • Access to online application for grants • Access to IT infrastructure for membership support software • Access to ECFMG mailing list

UNIVERSITEIT GENT 25

Member and Organisational News Transition of the Secretariat Q&A with Bill Burdick Q: How can we be convinced that FAIMER won’t impose American values on The Network: TUFH?

William “Bill” Burdick is the Vice President for Education and Co-Director, FAIMER Institute. We did a Q&A with him in order to clarify some misunderstandings! Q: Is Bill going to be the new Secretary General of The Network: TUFH?

A: No, the new secretary general will not be from within FAIMER or from North America. Standard procedures for election will be followed.

A: For 15 years FAIMER has run programs with the very specific goal of not imposing American values and the testimony of Fellows shows we have been successful. It is a core value for us to use the wisdom of Fellows and not use presumed values of America. Q: Why is FAIMER interested in hosting the secretariat?

A: No, The Network:TUFH and FAIMER will remain two separate organizations.

A: FAIMER and The Network: TUFH have similar missions. While Faimer is improving health through education, The Network: TUFH is improving health through education, research and health systems improvement. We think it’s a terrific opportunity to support such a valuable organization with a very broad network and influence.

Q: Will the staff of the Secretariat be employed by FAIMER?

Q: How long will FAIMER support The Network: TUFH?

A: Yes, but it won’t be someone from within. It’ll be an external recruitment. They can be from anywhere in the world who meets the qualifications.

A: FAMIER is providing monetary support for 3 years for the Director and a ½ time administrative coordinator. The goal is for The Network:TUFH to be self-sustaining in several years. If this doesn’t happen in 3 years, we may be able to ask for funding from the FAIMER Board of Directors. There is a 6 to 7 year projection for The Network: TUFH to be self-sustaining.

Q: Is FAIMER taking over?

Q: Will bank accounts be merged?

A: No. The organization bank accounts will remain separate and under own organization control. Q Where will The Network: TUFH be incorporated in the USA?

A: Currently it’s in Belgium. This question is under study by leadership of The Network: TUFH for the most appropriate place. We have no answer yet but this will be done in the best interest of the organization.

Q: What is being done to make The Network: TUFH self-sustaining?

A: Software Upgrade is under construction: a customer relations package, an event management package, a financial payment package and a community discussion package. This will allow for the uploading of resources in a members only area and newsletter software among other features. The software packages will make it more effective for The Network: TUFH to meet its needs such as finding collaborators and resources. It is a way to increase membership by increasing value to members. This new website and software will be tremendous; members will be able to search for each other by names or key words or interest. Also the Projects that Work Competition: We have 4-7 winners of projects that have been developed over a 3 year span with innovation in community and we bring them to The Network: TUFH conference to share their projects.

Bill Burdick

Member and Organisational News Transition of the Secretariat Reactions of our EC members We also asked some of our EC our former EC members what they thought about the transition. You can read some reactions of Arthur Kaufman, former secretary-general; Ian Cameron, EC eminence; Mohamed Moukhyer, regional representative; and Fernando Mora, EC eminence. .Q: What is the primary purpose of the mer- tution which deals with politics which can be ger? very complimentary to FAIMER. By nature the two organizations are complimentary. Both orArt: Stability of the Secretariat with a funding ganizations exist of idealists in the good sense source that doesn’t vary with various adminiswith common ideas. tration changes; funding streams within academic centers tend to be vulnerable. Q: What are the advantages and opportunities of moving The Network: TUFH to FAIMER? Ian: My hope is this will lead to a broadening beyond education towards increased involve- Art: Economic stability; Strengthen and tapment in service health professionals and ser- ping into existing and growing international vice organizations. We need stability across networks; Total alignment of goals of both ortime without having it tied to the Secretary ganizations as opposed to goals of an academic General position. I hope to retain what we le- center. arned from Ghent/Maastricht merger and preMohamed: Financial support. FAIMER Fellows vious Secretariats. will join as members Q: FAIMER – via its name and mission stateFernando: Improvement of membership will ment seem to focus on medical education hopefully be a big advantage. FAIMER can conwhereas The Network: TUFH is interprofessiovince their members to also join The Network: nal education, community and research – will TUFH the two compete with each other? Q: Are there any disadvantages members Art: FAIMER has demonstrated it has emshould be aware of? braced and supported The Network: TUFH and even subsidizes fellows to attend meetings, Art: There is an understandable concern and supports organizational administration financi- perception that a base in the United States ally and the Education for Health Journal. would be influenced by global U.S. policies that will be eliminated when action is observed. Ian: The Network is looking towards the mission statement. We should look to facilitate Mohamed: Now we have the flavor of the dechange in a changing world across education veloping countries. We don’t want to be a “deand service. FAIMER does that with its’ Fel- veloping country organization.” There is a perlows. This is complementary between these ception that it will be a U.S. organization. We two organizations. need to be careful in spreading our message to new members that we are still The Network: Fernando: I don’t think we risk a change in viTUFH and focus on supporting communities sion or mission because The Network: TUFH is and developing countries. an institutional and FAIMER is an individual’s organization. They come from different back- Ferndando: That The Network: TUFH loses regrounds. The strength is that the The Network: levance and conferences become just a meeTUFH has a world plan, and is a political insti- ting for friends.

Arthur Kaufman

Fernando Mora

Q: Are there lessons we can learn from the previous transition (Maastricht to Ghent)? Art: Importance of smooth transitions and building on successes and finding new allies and partners without losing previous commitments. Mohamed: Transparency is critical. Have clear objectives from the beginning to avoid any future conflict Q: Who should be the new Secretary-General? Ian: We need to look to someone from the undeveloped world – but do they have the capacity in time and resources to fulfill the role? Mohamed: Be from a developing country. Committed to the objectives, mission and vision of The Network: TUFH. A person who has attended 5 or more conferences previously and is fully aware of what is happening within our organization. Fernando: I think it should be a mix of Jan De Maeseneer and Bill Burdick. Q: Is there anything you would like to add? Art: The process with FAIMER has evolved over years by FAIMER proving themselves; for example, attendance at all meetings, aligning its programs with The Network: TUFH and providing support. FAIMER has made many links with organizations and initiatives and has integrated with The Network: TUFH. They have proved to be a good neighbor and partner. Mohamed: I hope the relationship between The Network: TUFH and FAIMER will be implemented as both parties decided to reach the common goal of The Network: TUFH

Mohamed Moukhyer

Ian Cameron

Member and Organisational News History of the Network:TUFH Founding of the Network Who else could we better interview about the History of our Network: TUFH then Pauline Vluggen and Gerard Majoor. Both for most of you well known from the Maastricht office but for those who don’t: Pauline Vluggen had been involved since 1981 and was Executive Director from 1990 till 2009. Gerard Majoor, involved since the 1989 Kerkrade conference, was Associate Secretary-General from 1995 till 2001, then six years Chairman and Past Chairman and eventually again Associate SecretaryGeneral from 2007-2009 How, when and by whom was the Network founded? The Network was founded in 1978, the year of Alma Ata, in Kingston, Jamaica by representatives of ten medical schools from all over the world, brought together at the initiative of Tamas Fülöp, who at that time worked in the World Health Organization as Director of the Division of Health Manpower Development, to think out a strategy to change existing curricular practices.

What was the evolution throughout the years? We can see two major developments in the evolution of the Network. The first one , as alluded to above, was the aim to broaden the scope of the Network from medical faculties to ‘educational institutions of health sciences’. Realization of that goal proceeded slowly, but may have been boosted by the second development: the focus on innovations in health provision as advocated by Charles Boelen and his colleagues. The adoption of this new focus was eventually formalized by the merger of the Network and ‘Towards Unity for Health’ into The Network: TUFH

The primary goal of this Network was to make medical education better orientated towards the health needs of the broader population, i.e. its ‘communities’. It was soon realized that this ‘community-orientation’ could never be accomplished by medical faculties alone, so the scope was soon broadened to ‘educational institutions of health sciences’. Hence, the name of the Network became: The Network of Community-Oriented Educational Institutions of Health Sciences.

How did different universities/organizations that held the Network Secretariat come in contact with the Network: TUFH? Maastricht was invited to join the 1978 Jamaica meeting because it was the second medical school (after McMaster, Hamilton ONT, Canada) that had adopted problem-based learning as its educational format. Problem-based learning was considered particularly suitable to confront students with local ‘community-based’ problems as a starting point for their learning. Wynand Wijnen, the educationalist representing Maastricht in Jamaica, offered that school to become the first to host the (then envisaged rotating!) secretariat of the organization. Later Maastricht’s medical dean Co Greep was elected first Secretary-General of the Network; Ine Kuppen initially performed the work later ascribed to an ‘Executive Director’, who was Pauline Vluggen. To avoid the practical hassle of moving the secretariat every two years to another place on the globe, the idea of a rotating secretariat was dropped when Maastricht agreed to continue acting as its host institution.

The primary goal of this Network was to make medical education better orientated towards the health needs of the broader population, i.e. its ‘communities’

Ghent initially contacted the Network through Jan de Maeseneer. After almost 30 years Maastricht decided to interrupt its financial support to the Network Secretariat and of course it was a relief to the Network when Ghent offered to take over. Faimer representatives (including Norcini, Sutnick and Boulez) have been attending Network conferences for many years. For them the Network conferences and the journal Education for Health have provided a quite unique platform for their fellows to share and publish the outcomes of their research. This functional link has now prompted Faimer to offer to host the Network Secretariat.

In the first years, the focus was principally on organizing workshops and conferences all over the world, intended to disseminate ideas and help schools in adapting their curricula to the new requirements.

Member and Organisational News History of the Network:TUFH

How was the communication done? In between conferences, communication was kept up by means of The Network Newsletter, which has been in existence since 1982 and is still very popular. Later the journal Education for Health was founded. This became the forum for the dissemination of more scientific information that The Network had to share. We did not have our own telex but we could use the University’s machine. Even when the first fax was installed at Maastricht University this was an enormous improvement! I think that Education for Health is in many ways unique in pursuing the Network’s mission. There is no other journal that addresses health professions education with the mission of providing more appropriate, tailor-made healthcare to those in need. Education for Health publishes articles about modest attempts to improve health professions education and healthcare and articles in which the impact of these efforts is evaluated. Education for Health has always carried contributions from authors from all over the world, which is another unique characteristic. Many of the authors of important work from developing countries have very little experience in writing for publication in an international scientific journal, so Education for Health has always put much effort into guiding and assisting relatively inexperienced authors towards writing publishable papers. What changed throughout the years in terms of mission statement, organization? An important change in the mission statement of the Network resulted from the merger with TUFH, discussed at a meeting in Caltanisetta, Sicily. In fact at that meeting the pre-existing Network mission statement was amalgamated with that of TUFH as drawn up before by Charles Boelen. The organization of the Network remained stable, with the General Meeting with representatives of all member institutions as the constituting body, the elected Executive Committee to lead the organization and the Secretariat for its day-to-day management. When Zohair Nooman in Ismailia became the Secretary General it was decided to back up the Secretariat in Maastricht with another officer on site: an Associate Secretary-General. Henk Schmidt was the first to take this position; later he was succeeded by Gerard Majoor.

Pauline Vluggen and Gerard Majoor

What is importance/role of annual conferences The annual conferences represent the tangible link between the organization and (representatives of) its membership. The conferences provide a low-threshold platform to share experiences and offer possibilities for networking at global scale. The Network also pioneered new formats for meetings this size by reducing time for formal presentations to give more space to interactive sessions like thematic poster sessions, plenary ‘surprize’ sessions (Henk Schmidt’s speciality), PEARL sessions and ‘fire-side chats’. The unique format of the Thematic Poster Sessions, where poster presenters have the opportunity to elaborate on their work, respond to questions and learn from the feedback and comments of others. Site visits in the conferences offer participants unique possibilities to see local health professionals and/or their education ‘in action’. We feel the format and spirit of the Network conferences have been pivotal in attracting new membership.

Member and Organisational News History of the Network: TUFH Previous Conferences & Secretary-Generals With its aim to host the annual conference every year in a different WHO region, The Network: TUFH has an impressive palmares of past conferences.

1999 Linkรถping, Sweden 1994 Sherbrooke, Canada 2012 Thunder Bay, Canada

1984 Maastricht, the Netherlands 1989 Kerkrade, the Netherlands 2006 Ghent, Belgium 2011 Graz, Austria 1981 Bellagio, Italy

1998 Albuquerque, NM, USA 2004 Atlanta, GA, USA 1997 Mexico City, Mexico 1983 Havana, Cuba 1979 Kingston, Jamaica 2008 Chia-Bogota, Colombia

1985 Ismailia, Egypt 2010 Kathmandu, Nepal 2000 Manama, Bahrain 1995 Madras, India 2005 Ho Chi Minh City, Vietnam 1991 Ilorin, Nigeria 2007 Kampala, Uganda 2002 Eldoret, Kenya

2014 Fortaleza, Brazil 2001 Londrina, Brazil

1995 Manila, the Philippines 1987 Pattaya, Thailand 2013 Ayutthaya, Thailand 1993 Penang, Malaysia 1990 Yogyakarta, Indonesia. 2003 Newcastle, Australia

1996 Durban, Republic of South Africa 2015 Pretoria, South Africa

2016 TBC

Secretary-Generals:

1988 - 1995 Zohair Nooman (Ismailia, Egypt) 1980 - 1988 Jacobus (Co) Greep (Maastricht, the Netherlands)

1999 - 2007 Arthur Kaufman (Albuquerque NM, USA) 1995 - 1999 Esmat Ezzat

2007 - 2015 Jan De Maeseneer (Ghent, Belgium)

International Health Professions Education Taskforces Social Accountability and Accreditation (TFSAA) The TFSAA was unable to have a formal meeting at the 2014 Network conference in Brazil because neither of the cochairs were able to attend. However, that does not mean that activities relevant to the Task Force mission and terms of reference have been dormant. The original vision developed in Kampala and Ghent has guided a range of activities with a range of organizations in countries around the world. It is in the nature of networks that these activities are not always under the banner of the TFSAA but they adhere to the direction of the Network. For example, the co-chairs and some members are very active in the development and expression of the ASPIRE process under the banner of AMEE. Workshops at various national and international venues including last year’s Ottawa Conference helped to maintain momentum on the animation of the Global Consensus for Social Accountability (GCSA). Plans are well underway for a major World Congress on Social Accountability in 2017.

This will be focused on drawing together the many initiatives and organizations involved in the cause of social accountability and their application to accreditation systems. Further information will be forthcoming as events unfold and the TFSAA will be meeting formally in Gautang in September where we hope to gather and develop an inclusive strategic plan to maximize the potential of the 2017 meeting in conjunction with the Network TUFH meeting that year. We also celebrate the generosity of the Boelen family in establishing the Charles Boelen Award for social accountability and its inaugural recipient--THEnet. The award was presented at the Canadian Conference on Medical Education meeting on behalf of the Association of Faculties of Medicine of Canada (AFMC), the home of this international award Charles Boelen and Bob Woollard, Co-Chairs Email: Email: woollard@familymed.ubd.ca/boelen.charles@ wanadoo.fr

Community-Based Care for the Elderly Moving towards geriatrics training in medical schools Once again the elderly task force reaches out to keep you updated on the activities that have happened as well as those that are ongoing since the publication of the previous newsletter. There were a number of interesting posters on elderly care during the TUFH conference held 19-23 November in Fortaleza Brazil. As is required, the Chair was able to attend the strategic discussion by task force Chairs prior to the opening of the main conference where she advocated for the promotion of geriatric activities within the taskforce The Director of Global Health through Education, Training and Service (GHETS), David Egilman, responded to the call by awarding the taskforce with $10,000. That was really exciting for the taskforce! We are extremely grateful to GHETS for this generous gesture. We have since embarked on projects in Nigeria, Kenya, Uganda, and India that are aimed at promoting geriatrics training in medical schools. I believe many of the results from those projects will be presented at this year’s Bambanani conference in South Africa. The next generation of physicians needs to be competent to handle issues of the elderly given the increasing population of this age group

worldwide. I hope you are able to contribute to the discussions that these projects will stimulate. At the taskforce meeting, we had a bigger representation of individuals interested in the taskforce activities. This resulted from our request to have the taskforce meeting held at an earlier time. We brainstormed on a number of issues surrounding the role of TUFH in care for the elderly; highlighting the importance of innovation in pushing forward the task force agenda. This also included the move from a disease model to a goal oriented approach in patient care. It is important to work with communities both in the prevention of disease and the promotion of health that would result in healthy living and successful aging. We concluded the meeting by agreeing to the following • Community care model to be further explored. This will include the teaching of students about elderly concerns • Change of curriculum to encompass elderly through: 1. Increase on elderly empowerment 2. Music therapy 3. Advocacy of communities’ e.g. yearly checkup, teaching family members about the elderly Noeline Nakasujja, chair Email: drnoeline@yahoo.com

International Health Professions Education Taskforces Transforming & Scaling Up Health Professional Education and Training This past year has witnessed a significant topic presence of transformative learning / education and scaling up the health professions as a percolating theme at global, national and local conferences, workshops, and general conversations. Anticipating that this rise in attention will lead the pathway to policy developments and ongoing dialogue with key stakeholders in how we are preparing health professionals for the 21st century globally will become ever so more critical as part of those conversations. We have witnessed regional and individual country innovations in the health professions that have begun to address the quality, quantity and relevance of a future health workforce.

interactions share evidence and stories of transformative education initiatives around the world. And in doing so, advocating dialogue to action. The latest videos include Myanmar’s health assistant: Serving rural communities and Interprofessional grand rounds: A student led initiative. Share your story and innovation!!

Transforming and Scaling Up Health Professional Education and Training: We are reminded of the excellent dynamic interactive resource created by the 2013 World Health Organization Guidelines on “Transforming and Scaling Up Health Professional Education and Training,”: http://whoeducationguidelines. org/ in addition to the “Policy Brief on Monitoring and Evaluating the Education of Health Professions.” http://whoeducationguidelines.org/content/policy-briefs

Transforming health professional education is one of seven themes for the upcoming The Network: TUFH and SAHEE’s Bambani conference September 12 – 16th 2015. This theme invites contributions that focus on the professional development of faculty and on learning strategies and philosophies such as competency-based education and outcomes-based education. Do submit your abstracts and share your innovations in education and research addressing this key topic of importance around the world.

Do take time to check out the interactivity of http://whoeducationguidelines.org/ where blogs, tweets, and facebook

Sue Berry, Chair Email: sberry@nosm.ca

Other rich resources for building capacity and priority strategies in addressing transformative learning and practice worldwide: http://www.capacityplus.org/guide-for-applying-the-bottlenecks-and-best-buys-approach The Network: TUFH and SAHEE’s Bambani conference September 12 – 16th 2015:

Integrating Public Health and Medicine Ten active, engaged people attended the Integrating Medicine and Public Health Task Force meeting in Brazil, 2014. The attendees discussed the responsibility of health professionals to respond to the social determinants of health that affect their patients. It was suggested that ethical codes should be expanded to include this responsibility. The Task Force will be producing a position which will show how public health can be relevant to clinical practice, the public health dimensions of ethics as it relates to the care of individuals, in particular to the social determinants of health, and the role of health professionals in advocacy for improving health.

Newsletter Volume 33/no. 1/Augustust 2015 ISSN 1571-9308

At the next annual conference in South Africa, the Task Force is hoping to generate discussion which will contribute to finalising the position paper. This will be done by submitting a number of abstracts including a panel discussion and workshops on different aspects of the integration of medicine and public health, including teaching, research and services, ethical aspects of population health in clinical work, upstream professionals, behaviour change and, via collaboration with members of the Interprofessional Education Task Force, interprofessional aspects. Denise Donovan, Chair Email: Denise.Donovan@USherbrooke.ca

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