The Network towards unity for health
VOLUME 25 | Number 01 | JUNE 2006
Holding this Newsletter, in your hands, you may have noticed that it feels a little bit lighter. That is because we reduced the number of pages to 32. Eight pages less, but more diverse than ever, and therefore ever so interesting! We have for you: women’s health, interprofessional education, rural health (professions education), taskforce news, a student story, south-south collaboration, integrating public health and medical education, health authorities, community action, health research, a new skillslab programme, and much more. Thanks to all the authors who now - and in the past - have contributed to the Newsletter. If you would like to be a Newsletter author as well, please send your contributions to the Network: TUFH Secretariat before October 31, 2006.
NEWSLETTER In this issue, among others: Neonates in Cases of Severe Malaria 07 Rural Adolescents With Mental Health Problems 10 Community at the Heart 13 Teaching Public Health During Clinical Clerkships 14 A New WHO Initiative in Africa 18
Marion Stijnen and Pauline Vluggen Editors
In the Newsletter we refer to The Network: Towards Unity for Health as The Network: TUFH.
06 06
contents 03 Foreword Natural Allies 03 The Like-Minded Working Together World Organisation of Family Doctors 04 The Network: TUFH in Action 04 Annual International Conference Ghent: Keynote Addresses | Tell Us About It! | ‘South-South’ Collaboration Mozambique - Colombia 06 Book Review Towards a Global Health Workforce Strategy 07 Improving Health 07 Women’s Health Neonates in Cases of Severe Malaria 08 Yellow Papers Rationalisation of Health Cadres in Tanzania 09 Health Authorities What Would I Change If I Were Minister of Health? 10 Rural Health Rural Adolescents With Mental Health Problems | Health Service Delivery in Rural Canada 12 Health Research Women Empowerment in Life Skills 13 Community Action 13 Community Interview Community at the Heart 14 International Health Professions Education 14 Integrating Medicine and Public Health Teaching Public Health During Clinical Clerkships 15 Interprofessional Education Interprofessional Collaboration: Paradox of Progress 16 Accreditation and Quality Assessment Accreditation in Health Professions Education | Special Quality Award for Ghent Medical Programme 17 Rural Health Professions Education University Departments of Rural Health in Australia | Community Health Worker Network Group 18 New Institutions and Programmes A New WHO Initiative in Africa | Expanding Medical Schools in Sudan | From Master to Skillslab in Vietnam | Joint Master of Health Professions Education 20 Medical Education Best Evidence in Medical Education 21 Partnerships 21 Health Services for Barceloneta 22 Students’ Column 22 Out of the SNO Pen SNO Weblog | SNO Reports Available | Ghent 2006: Extremely Student Friendly! 22 Students’ Speakers Corner “I Will Be a Doctor For My People” | The Girl in the Blue Dress 24 International Diary 2006 and 2007 26 Member and Organisational News 26 Messages from the Executive Committee EC Intelligence 27 Introducing Members Ziauddin Medical University 28 Represented at International Meetings/Conferences Impact of Global Issues on Women and Children | 2 nd Global Health Course / Roundtable Discussion PAMC 30 Taskforces Integrating Medicine and Public Health: Update | New Chair | “A Wonderful Initiative!” | Position Paper News 31 About our Members New Members | Moving on: Changes in Institutional Leadership | Interesting Internet Sites | Tribute to…
FOREWORD
Natural Allies The World Health Organization (WHO) Geneva has considered The Network: TUFH and the World Organisation of Family Doctors (Wonca) to be two effective WHOaffiliated, non-governmental organisations. In many ways, the two organisations have binding similarities and complementary strengths. They are natural allies, with a past, present and future of collaboration.
The Network: TUFH will reciprocate by inviting Wonca to be an official affiliate organisation, and will disseminate key information on Wonca activities relevant to Network: TUFH goals on its own website.
2 5
Both organisations have engaged in cooperative efforts to advance primary care and student-centred, community-based health professions education in East Africa and Southern Africa. This collaboration is cur-
V O L U M E
The future bodes well for the Wonca Network: TUFH collaboration. At its meeting on 16-18 February 2006, the Wonca Core Executive Committee approved the admission of The Network: TUFH with its GHETS affiliate as an Organisation in Collaborative Relations (OCR) with Wonca. As an OCR with Wonca, The Network: TUFH is entitled to send an observer to meetings of the Wonca World Council held once very three years. The next Council will take place 21-23 July 2007 in Singapore.
|
Wonca is made up of national colleges, academies and organisations concerned with general family practice. It has over 106 member organisations in 88 countries. The membership usually is comprised of the organisation that represents the profession of family doctors of a particular country. It also has individual memberships. Wonca links with family medicine practitioners, academics and healthcare delivery systems. Its Secretariat is in Singapore.
0 1
arren Heffron | Regional President, W Wonca Americas; and Arthur Kaufman | Secretary General, The Network: TUFH Email: wheffron@salud.unm.edu; akaufman@salud.unm.edu
N U M B E R
If you would like to read more about the linkage between The Network: TUFH and Wonca, please go to our section The LikeMinded Working Together on this page (also written by Warren heffron and Arthur Kaufman).
N E W S L E T T E R
We are both looking forward to preceding our current successful collaboration, and to strengthening our ties even more in the future.
The Network: TUFH was initiated by WHO and has a long history of disseminating global innovations that increase the effectiveness of academic health centres in meeting priority community health needs. It has over 280 dues-paying member institutions and individuals across the globe, the great majority from developing countries. Its Secretariat is in the Netherlands. Engagement with community stakeholders is critical to the success of these endeavours. A focus on women’s health, care for the elderly, integrating medicine and public health, and the training and collaborative practice of the interprofessional teams are other important components. Because access to effective primary care is central to improved community health, The Network: TUFH produced and promulgated a Position Paper on the importance of primary care in a global strategy for workforce development and practice.
rently leading to the establishment of some Departments of Family Medicine and collaborative teaching programmes. A growing number of physicians are active members of both organisations and this joint representation has helped draw us together. Fortuitously, Warren Heffron (Wonca) and Art Kaufman (The Network: TUFH) work in adjoining office bays in the same Department of Family and Community Medicine at the University of New Mexico. They share strategies and facilitate collaboration on a weekly basis. In addition, Global Health through Education, Training and Research (GHETS), a development arm of The Network: TUFH, has played a central role in helping bring the two organisations together in these collaborative endeavours.
2 0 0 6
The close relation between the two organisations was formalised recently when the Wonca Core Executive Committee approved the admission of The Network: TUFH with its GHETS affiliate in collaborative relations with Wonca. The Network: TUFH finds this an honour, which it hopes to reciprocate soon by inviting Wonca to be an official affiliate organisation to The Network: TUFH.
World Organisation of Family Doctors The Network: TUFH and the World Organisation of Family Doctors (Wonca) are two collaborating organisations with many binding similarities. The differences between the two organisations can be seen as complementary strengths:
J U N E
A wonderful contemporary example of this collaboration is the establishment of some Departments of Family Medicine and collaborative primary healthcare teaching programmes in East and Southern Africa. This project has its roots in both groups and strives to improve access to, and advancement of, primary care world-wide.
THE LIKE-MINDED WORKING TOGETHER
3
THE NETWORK: TUFH IN ACTION ANNUAL INTERNATIONAL CONFERENCE Every year The Network: TUFH organises an international scientific and networking conference. This year the Conference will be held in Ghent, Belgium from 9 - 14 September (co-hosted by the Faculty of Medicine and Health Sciences, Ghent University), followed by a one-day Post-Conference Visit to the Faculty of Medicine, Maastricht University on September 15.
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 5
J U N E
2 0 0 6
Ghent: Keynote Addresses
4
September 9 - 14, 2006, Ghent, Belgium: International Conference of The Network: TUFH on Improving the Social Accountability in Education, Research and Service Delivery. In co-operation with the Faculty of Medicine and Health Sciences, Ghent University. During the Conference in Ghent, a number of speakers will deliver a keynote address on content areas relevant to the Conference theme: • John Gilbert (Principal, College of Health Disciplines, University of British Columbia, Canada): Interprofessional Education for Patient-centred Collaborative Care: Here Now - Where Next? • Françoise Malonga-Kaj (Dean, School of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo): VIH/Aids - Prevention of motherchild transmission (experience-case of Lubumbashi DRC). • Jan De Maeseneer (Head of the Department of Family Medicine and Primary Health Care, Ghent University, Belgium): The organisation of the Belgian Health Care System, preceding the site visits. • Ian Cameron (CEO NSW Rural Doctors Network, Faculty of Health, University of Newcastle, Newcastle, Australia and Australian/International team): Round
Table with an Australian/International team on implementation of The Network: TUFH approach in the field. • Freddie Ssengooba (Lecturer, School of Medicine, Makerere University, Kampala, Uganda): at time of publication of this Newsletter, the title of this keynote address is not yet available. • Louis Michel (European Commissioner for Development and Humanitarian Aid, Belgium) and Frank Vandenbroucke (Vice-Minister, President of the Flemish Government, Belgium): keynote addresses during opening ceremony (at time of publication of this Newsletter, the titles of these keynote addresses are not yet available). • Chris Van Weel (President Elect, Wonca, the Netherlands): at time of publication of this Newsletter, the title of this keynote address is not yet available. For more information, please visit the Conference website (www.the-networktufh.org/conference/) and have a look at the preliminary programme (www.the-networktufh.org/ conference/programme.asp). Registrations will be accepted until early September 2006 (www.the-networktufh.org/ conference/registration.asp).
Tell US ABOUT IT! Like the collaboration between the Universidade Católica de Moçambique and the Universidad de la Sabana (see page 5), there are many more opportunities. The Network: TUFH Conferences are the perfect place for learning, sharing and networking. The responses from the follow-up survey after the Atlanta Conference (see Newsletter 24-02) revealed: over two-thirds of the respondents had followed up with a colleague they met through the Conference, for example by consulting each other or by developing new partnerships. We would love to publish more of these ‘success stories’; after all, this is what The Network: TUFH is all about. So, if you have come to new collaborations with colleagues that you met at one of our Conferences, please tell us about it! Write up your story (not more than 600 words, please include a photograph that is in keeping with the theme) and email it to the Network: TUFH Secretariat (address on the back of this Newsletter).
Educ ation for Health Online For the Table of Contents of Education for Health - Vol. 19, No. 1 please visit www.the-networktufh.org/publications_ resources/educationforhealth.asp (click on Table of Content)
‘South-South’ Collaboration Mozambique - Colombia
Dr. Francisco Lamus Lemus working with students from Universidade Católica de Moçambique
0 1 | V O L U M E 2 5
In 2006 a visit is planned from UCM to Bogotá in order to see the community health interventions in a community with a different context, and on another continent.
N U M B E R
Bogotá Experience During a Network: TUFH Conference in
Recommendations The students’ challenge is an academic one and therefore it was recommended to introduce Participatory Action Research (PAR): identification of a research problem by students and members of the neighbourhood, definition of clear objectives and outcomes and preparation of a proposal for funding.
The Faculty will also receive capacity building support for the Family and Community Health Programme at the UCM School of Medicine in: • design, implementation and evaluation of student Participatory action research projects; • service learning and academic programme design to support the implementation the Healthy Bairro Initiative at the UCM School of Medicine.
N E W S L E T T E R
During the first few years, some small projects were executed, including a bathhouse and a drainage channel. However, the organisation of these projects did not always run smoothly. Fortunately, the projects were successfully implemented.
UCM realised that it could learn a lot from the Bogotá experience, and therefore invited Francisco Lamus Lemus (staff member UdlS) for a two-week visit in June 2005. Lamus Lemus was asked to evaluate the family health programme and to make recommendations for improvement. The final outcome was to make a Healthy Bairro Initiative Action Plan for Inhamudima. For UdLS the co-operation with UCM gives an opportunity to have a mirror experience and the chance to develop an evaluation approach of shared principles in a different setting.
What Next The implementation of the recommended changes is now in full swing. Francisco Lamus Lemus will go back to UCM in June 2006 to develop a specific action plan for the implementation of the Healthy Bairro Initiative, including strategic objectives and follow up indicators.
2 0 0 6
Family and Community Health Programme The family and community health programme is based in Inhamudima, a poor neighbourhood situated next to the Faculty. During their weekly visits, students collect data about the composition of the family, diet, health, sanitation, etcetera. The main objective is to know about the family’s health situation and identify health determinants that can be improved. A project is formulated together with the population; the students look for funds, and people from the neighbourhood (plus students) implement the project.
Newcastle, Australia in 2003, UCM came into contact with a staff member of the Universidad de la Sabana, from Bogotá, Colombia. Information was exchanged, and because of interesting- and recognition of - parallel situations of each others community health programmes, the idea of cooperation was raised. The Faculty of Medicine of the Universidad de la Sabana (UdlS) has a long established programme in the favelas of Bogotá and has good ideas about what works and what doesn’t work.
J U N E
The Universidade Católica de Moçambique (UCM) has a young Faculty of Medicine that started in 2000. The first cohort of students is in their 5th year clerkships and will graduate in 2007. From the beginning, problem-based learning (PBL) was used as the instruction method. The curriculum is community-oriented and a family and community health programme was established in 2001.
Students will look for funds and the population will be the work force. Working groups will be formed comprising of circa 15 students, with in each group 1st, 2nd, 3rd and 4th year students. These working groups facilitate the PAR. Now students from the first years can make use of the experience of the older students. The second activity recommended was SOAP (Subjective, Objective, Evaluation, Plan). This approach is being used during the family visits and gives more structure to discussions. In addition, the initial five families for every student should be reduced to three.
Bernard Groosjohan | Dean, Faculty of Medicine, Universidade Católica de Moçambique , Mozambique Email: bgroosjohan@teledata.mz
5
THE NETWORK: TUFH IN ACTION BOOK REVIEW
Towards a Global Health Workforce Strategy
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 5
J U N E
2 0 0 6
Book Review of: Towards a Global Health Workforce Strategy Editors: Paulo Ferrinho & Mรกrio Dal Poz ISBN 90-76070-26-1 Antwerp: ITG Press
6
The newly released book Towards a Global Health Workforce Strategy comes at the right time and is an important addition to the literature. A meeting on human resources for health in 2000 with participation of the World Health Organization (WHO) support from the Belgian Directorate General for Development Cooperation, and the ITG Press has resulted in this comprehensive book on the issue of health manpower. Resulting from the collaboration of several authors from diverse backgrounds and countries, the book covers an impressive array of issues regarding the concepts, application and research on health manpower. The chapters have been arranged around three main themes: human resources management; evidence-based interventions for human resources development; and towards a global health workforce strategy. A preface by Orvill Adams (WHO) and Gilles Dussault, contributions by a multidisciplinary team, and the spectrum of issues relevant to both developing and developed countries make this book unique. Considering the labour-intensive nature of the health sector and its demand for a multitude of skills, the subject of health personnel development and utilisation deserves serious attention. The multi-faceted topic gets that attention in this volume that presents a wide-ranging variety of perspectives. The contribution of this work could be clearer if the volume was better organised. We must proceed through the entire text before we encounter a table of contents, which for some strange reason is placed at the end. The Preface does not provide an adequate explanation of the overall rationale for the volume and the organisation of its individual segments. It gives the impression that the con-
ference that generated the papers (and other recent events) has triggered an overdue interest in health manpower planning. In fact, of course, the topic is one of long-standing concern that has evolved over time. As we work our way through the readings, we find that they are organised into three parts, but the scope of each section is not made clear nor is their intended interrelationship. To illustrate, the first section titled Human Resources Management is quite broad and vague. Many of the papers in this section deal with determination of numbers of personnel required and the need for better planning and policy making in this regard, whereas the title suggests concern for better utilisation of personnel already in place.
Many of the papers in Part I deal with the quantitative aspect of manpower planning as if we were dealing with a static system. Considerations of shortcomings in methods of planning and policy formulation to meet defined needs are addressed without consideration for the redefinition of those needs in a changed environment; or for specific methods for improving the planning capabilities. Only in Part III, Towards a Global Health Workforce Strategy, is the reality of a changed environment given explicit recognition. Recent literature has taken an interest in this issue, and the WHO has launched a global strategy for human resources for health (WHO, 2001). International agencies and donors have critical influence, especially in the developing world, over national poli-
cies for human resources and yet this issue does not feature in national development or poverty reduction plans (Marchal, 2004). Human resources are now considered one of the major roadblocks for disease reduction strategies at the global level (Kober, 2004; Mock, 2004). Calls for assistance to generate better quality health professionals in the least developed regions have also appeared in the literature (Beveridge, 2004). The topics presented are appropriately wideranging, and many of the presentations make thoughtful and substantive contributions to our understanding of the subject. It is unfortunate, however, that the reader is not given a better rationale to guide the reading. As might be expected from a series of papers presented at a conference, the presentations are of varying quality, but overall the volume makes a meaningful contribution to our understanding of the field of human resources for health. References BEVERIDGE, M. (2004), Surgical training in East Africa. The Lancet, 363,2196. KOBER, K. & VAN DAMME, W. (2004). Scaling up access to antiretroviral treatment in southern Africa: Who will do the job? The Lancet, 364,103-7. MARCHAL, B. & DE BROUWERE V. (2004). Global human resources crisis. The Lancet, 363,2191-2. MOCK, C., QUANSAH, R., KRISHNAN, R., ARREOLA-RISA, C. & RIVARA, F. (2004). Strengthening the prevention and care of injuries worldwide. The Lancet, 363, 217279. WORLD HEALTH ORGANIZATION (2004). Global strategy for human resources. Retrieved July 23, 2004, www.who.int Adnan Hyder and William Reinke | Department of International Health, Johns Hopkins Bloomberg School of Public Health, United States of America Email: ahyder@jhsph.edu
IMPROVING HEALTH WOMEN’S HEALTH
Neonates in Cases of Severe Malaria
Neonatal Outcome Poor We found that out of the 158 cases studied, there were 65 cases (41%) with low birth weight, 18 cases (11%) were stillborn, and 8 cases died early in the neonatal period (5%). The mortality was 16.4%. At time of delivery, 47 babies showed a significant low Apgar score (30%), and 38 cases delivered prematurely (24%).
| V O L U M E 2 5
Khalifa Elmusharaf and Atif Fazari | Department of Obstetrics and Gynaecology, Faculty of Medicine, Academy of Medical Sciences and Technology, Sudan Email: khalifa_elmusharaf@yahoo.com
0 1
We approached 158 pregnant women to participate in the study; all were in their third trimester, with acute malaria attack proved by severe parasitaemia in peripheral blood film. After verbal consent, questionnaires were administered requesting demographic information on age, parity, gestational age, and history of maternal illness. Gestational age was calculated from the last menstrual period and confirmed by ultrasound. Physical examination - also obstetrical examination - was complet-
Efforts are needed to increase the usage of insecticide-treated bed nets, and to adopt a prophylaxis regimen during pregnancy, especially in endemic and hyper endemic areas. Attention should be given also to improvement of - and increased access to - neonatal services.
N U M B E R
158 Pregnant Women To determine the outcome of the neonates in cases of severe malaria in Sudan, we conducted a study (during the 1st of March 2003 until the 31st of October 2004) in the Academy Charity Teaching Hospital in Khartoum, Sudan, where about 2000 deliveries are registered annually.
These outcomes indicate clearly that the neonatal outcome in severe malaria during pregnancy is poor, even if treated properly.
N E W S L E T T E R
High/Moderate Malaria Transmission In areas of high and moderate (stable) malaria transmission, most adult women have developed enough immunity that P. Falciparum infection does not usually result in fever or other clinical symptoms - even during pregnancy. In these areas the principal impact of malaria infection is associated with malaria-related anaemia in the mother, and with the presence of parasites in the placenta. The resulting impairment of foetal nutrition contribut-
The effect of malaria on the placenta includes degeneration of chorionic villi, formation of deposits of fibrin and malaria pigment, thickening of basement membrane, and accumulation of macrophages in the intervillous space. All those conditions lead to deterioration of the placental functions.
ed to identify signs of severe malaria. Ultrasound was performed to determine the biophysical profile of foetus. The entire study group had not received any form of prophylactic anti-malarial drug throughout the current pregnancy. They received anti-malarial treatment according to the National Malaria Protocol. They were followed during their pregnancy. After the labour, Apgar score and foetal birth weight were recorded.
2 0 0 6
Low/Unstable Malaria Transmission Pregnant women residing in areas of low or unstable malaria transmission (who have therefore not acquired any significant level of immunity) are at a two- or threefold higher risk of developing severe disease as a result of malaria infection than non-pregnant adults living in the same area. In these areas maternal death may result either directly from severe malaria or indirectly from malaria-related severe anaemia. In addition, malaria infection of the mother may result in a range of adverse pregnancy outcomes, including spontaneous abortion, neonatal death, and low birth weight.
ing to low birth weight is a leading cause of poor infant survival and development.
J U N E
Malaria is the leading cause of morbidity and mortality in Sudan. Symptomatic malaria accounts for 20 to 40% of outpatient clinic visits and approximately 30% of hospital admissions. The entire population of Sudan is at risk of malaria, although to different degrees. In the northern, eastern and western states, the incidence of malaria is low to moderate, with predominantly seasonal transmission and epidemic outbreaks. In southern Sudan, malaria is moderate to high or highly intense, generally with perennial transmission. P. Falciparum is by far the predominant parasite species.
7
IMPROVING HEALTH YELLOW PAPERS Between those outstanding publications that were already published in leading journals, and some preliminary notes scribbled on the last page of an agenda, there are also papers or reports that belong to the in-between (‘grey area’) category. Papers that, for whatever reason, have not been published before. Within this ocean of ‘grey’ papers, there are some which by content are most relevant to the Network: TUFH’s mission and aims. We will pick those pieces of gold from the ‘grey’ ocean, change their status to ‘yellow’ (because we can’t print in gold) and publish these in this section. Below you will find such a yellow paper.
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 5
J U N E
2 0 0 6
Rationalisation of Health Cadres in Tanzania The established health system of Tanzania is comprised of a four-tier health delivery system consisting of the dispensary at the village level, the health centre at subdistrict level, the district hospital, the regional health services, and consultant hospitals at national level. The Government is the main provider of health services (60%) and NGOs (35%), as well as the for-profit private health services (5%). In addition to being the main source of healthcare services, the Government is also the main provider of trained human resources for health. It has a total of 106 training schools throughout the country, for the training of 39 health cadres. Policy and Plan The National Health Policy has the goal of improving the health and well being of all Tanzanians, with a focus on those most at risk. In 1987 the Ministry of Health (MOH) developed guidelines for staffing levels at all Government facilities to provide guidance to the human resource development. However, the guidelines were found to be unaffordable and unrealistic given the country’s declining economy. To rectify the situation, the MOH developed a Human Resource for Health (HRH) Policy and a 5–year HRH Plan. While the goal of the HRH policy was to focus the priorities of HRH development on the requirements of primary health care, the HRH Plan proposed a planned, well-trained and appropriately deployed work force. The planned staffing patterns have not been achieved in any single health facility, due to inadequate numbers of appropri8
ately qualified personnel. The MOH uses 39 health cadres, many of these are of lower educational background. It is not surprising that the quality of service provided by the health system is low, as these cadres are not adequately qualified.
• to improve efficiency of health service delivery by increasing the quality of training; • and to reduce the multiplicity of health worker cadres from the current 39 to 9 generic categories within the next 5year period. The study was undertaken through documents review, interviews of key stakeholders and observational assessment of service delivery and health training institutions. The core functions of the 39 cadres were assessed to determine how essential they were to the delivery of core healthcare functions.
Study The advent of the Health Sector Reforms necessitated that the MOH streamline its work force by identifying key core cadres that would be critical to the delivery of quality health services. This strategy to improve the quality of service is based on the premise that a smaller and better-paid work force is more likely to improve performance and quality of services. The MOH commissioned a rationalisation study of the health cadres to establish a few, well trained and well-motivated cadres that are able to deliver essential services competently at the various levels of the health system. The study’s specific objectives were: • to develop a set of critical health cadres capable of delivering quality heath services efficiently and cost effectively;
The study recognised the need for the Ministry of Health to come up with better human resource planning based on ‘demand’ rather than ‘supply-driven’.
HEALTH AUTHORITIES
What Would I Change If I Were Minister of Health?
0 1 | V O L U M E 2 5
With regard to specific services, I will need to pay greater attention to mental health, rehabilitation, and the newly emerging diseases, such as HIV and the newer viruses. Unless these are controlled early, they could easily devastate the gains we have pain-
stakingly made over the past years. To achieve this goal, we must work closely with our neighbours and our regional and global partners. Sri Lanka has been torn by a long conflict that finally is showing some signs of being settled. Health can serve as a bridge for peace, and health workers can help to bring greater understanding among the people. The health services in these conflict areas in the North and East of Sri Lanka need to be strengthened a great deal. Finally, I will need to streamline the health work force, which can be far more efficient and productive by planning effectively, making closer links with the education sector, and by improving management practices. I will introduce performance-based incentives, and promote better teamwork at all levels of the service. Sri Lanka is adversely affected by migration of doctors and nurses, and I propose to initiate some bilateral and multilateral work through the World Health Organization and similar organisations to mitigate the losses to my country. None of these goals would be possible unless I communicate my ideas clearly with my colleagues and the people. I will take them into confidence, and constantly review the progress - or lack of it - in our efforts.
N U M B E R
To meet these challenges, my task is going to be inordinately complex, but I like to think in simple terms. First, I will convince my cabinet colleagues of the centrality of health for human development - and that although health is not everything, without health everything else amounts to nothing. Health development would require multisectoral action, and consequently a larger budgetary commitment. Then I will gradually streamline the health system organisation by adopting a primary care model, with a functional referral service. My next priority would be to stress health promotion and increased personal and community responsibility for health.
Dr. Palitha Abeykoon
N E W S L E T T E R
Senga Pemba and A. Inambao | Lecturer and Head, Department of Medical Education, Faculty of Health Sciences, Moi University, Kenya; Management Development Assistance for Health and Population, South Africa Email: pemba@dhrh.go.ug
With good health status indicators for a developing country having a low income per capita, it is easy to be complacent and feel that Sri Lanka does not need any significant changes in its healthcare system. Challenges include the demography and epidemiology transition (resulting in a triple burden of disease and a rapidly ageing population), combined with dwindling resources. Some of these issues are extremely difficult to address. The life style habits and chronic diseases, and attendant advancing technology needs, will demand excessively high resource outlays. Also, the increasing expectations of the people will have to be channelled in a positive way, preserving the long-standing equity that exists in Sri Lanka.
2 0 0 6
The study recognised the need for the MOH to come up with better human resource planning based on ‘demand’ rather than ‘supply-driven’. In addition, the study recommended that there should be a reduction of training schools through grouping and phasing out those that do not have an adequate supportive training environment.
To be the Minister of Health of Sri Lanka is a great honour and privilege, one that I would perceive and treat as a sacred trust placed on me.
J U N E
Results and Recommendations The study revealed a need to rationalise the current pool of health cadre, as there was evidence of duplicative functions, especially at the service delivery level. Most of the cadres created by specific programmes were no longer useful and were not recognised by the Civil Service Department, and many had no scheme of service. Equally, the creation of such large number of cadres necessitated the establishment of several training schools, which the Government could not adequately support. A total of 13 cadres were identified as essential and core to the delivery of health services: medical doctors, dentists, assistant medical officers, nurses, pharmacists, clinical officers, laboratory technologists, radiographers, pharmaceutical technicians, orthopaedics, physiotherapists and health officers.
Palitha Abeykoon | Doctor and Advisor, Sri Lanka Country Office, WHO, Sri Lanka Email: palitha@whosrilanka.org
9
IMPROVING HEALTH RURAL HEALTH
Rural Adolescents With Mental Health Problems
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 5
J U N E
2 0 0 6
Adolescents in rural Australia Although 75% of mental disorders have their onset during adolescence, only about 25% of young people with a mental health problem seek professional help. For those who do receive professional help, the time between the onset of the problem and receiving treatment predicts how effective the treatment will be: the larger the interval, the poorer the outcome. Barriers Significant barriers to accessing mental healthcare exist for young people in rural communities, greater than those encountered by adolescents living in urban areas. Some of the barriers that we have identified in our research include: • lack of public transportation in rural areas; • higher costs associated with public services (in Australia, fewer general practitioners in rural towns charge the government-subsidised fee); • private services that are unaffordable as rural young people tend to be of lower socio-economic status than urban youth; and • lack of suitably qualified staff due to difficulties in recruiting and retaining staff in rural areas who specialise in child and adolescent mental health. In addition to these barriers, we have also discovered that features of the ‘rural culture’ present unique challenges to rural adolescents who seek help for mental 10
health problems. Rural culture promotes self-reliance, a concept of well being that relates to an individual’s productivity, and a view of mental illness that equates to insanity. This set of cultural values work to ‘silence’ mental health concerns in rural communities and make it less likely for a young person to seek professional help. Rural environments are also characterised by social proximity; individuals who may live many miles apart often have intimate knowledge of each other’s personal lives. Exclusionary and inclusionary social practices co-exist in these environments. Consequently, young people with mental health problems will further avoid seeking help because of fear of social stigma, ostracism, or community gossip. Addressing Inequity In 1998, the Australian Human Rights and Equal Opportunity Commission identified rural adolescents as facing significant disadvantage in accessing necessary healthcare and education. This fact emphasizes the need for new policy directions that specifically address the plight of rural youth. Our research group will continue to investigate the sources and nature of disadvantage for young people with mental health issues who reside in rural areas. Our goal is to develop successful strategies to improve access and outcomes for rural adolescents with mental health problems, and to make recommendations to Government based on our research findings.
Based on current knowledge, we recommend the following strategies to maximise help-seeking behaviour and reduce helpseeking delays amongst rural adolescents with mental health problems: • strengthen community-level supports, through mental health first aid and public education, as young people are known to prefer informal sources of help to formal ones in the early stages of a mental health problem; • increase diversity amongst primary healthcare providers in the public sector with an emphasis on selecting professionals who possess the characteristics and credentials which make them suited to working with young people with mental health problems; • invest in flexible modes of service delivery, particularly those that would appeal to young people such as Internet-based services; • integrate tertiary mental health services with general health services; and • develop school-based mental health services. Ultimately, the situation for any rural person with mental health problems will be improved by Government working together with rural communities at the ‘grass roots’ to promote cultural change with respect to social stigma of mental illness and maladaptive self-reliant attitudes.
Candice Boyd, Damon Aisbett, Krystal Newnham, Kristy Francis, Melinda Kelly, Jessica Sewell, Sarah Nurse, Graham Dawes | Rural Adolescent Mental Health Group, Centre for Health Research and Practice, University of Ballarat, Australia Email: ubramhgroup@gmail.com
Health Service Delivery in Rural Canada
| V O L U M E 2 5
Judith Kulig | Professor, School of Health Sciences, Chair Canadian Rural Health Research Society, University of Lethbridge, Canada Email: kulig@uleth.ca
0 1
Each of these issues needs careful examination, but currently there are insufficient databases to answer pressing questions such as: “What is the relationship between respiratory diseases and environmental factors associated with the logging industry?” In addition, the number of rural health researchers is small in most countries, further decreasing the opportunity to answer such questions as: “What are the most effective models for healthcare delivery in rural and remote communities that are experiencing chronic shortages of healthcare professionals?”
Quality Assurance Systems Concerns about quality of care, access and sustainability of health programmes are real; implementation of quality assurance systems with mechanisms to address concerns need to be instituted. Ongoing research identifies health outcomes related to delivery of care needs to be conducted as an additional check on the healthcare delivery system in rural areas. Adding identifying codes on nurses and other healthcare professionals’ registration will allow for compilation and analysis of factors such as the number of health personnel in rural areas and their employment migration patterns (Pitblado, 2005). Examining the type and number of health-
References MACLEOD, M., KULLIG, J., STEWART, N., & PITBLADO, J.R. (2004) Rural and Remote Nursing Practice: Final Report to Canadian Health Services Research Foundation. Retrieved from www.ruralnursing.unbc.ca/reports/ study/RRNFinalReport.pdf PITBLADO, J.R. (2005, April). How many registered nurses are there in rural and remote Canada? The Nature of Rural and Remote Nursing, 1, Retrieved from www.ruralnursing.unbc.ca/factsheets/ factsheet1.pdf
N U M B E R
Shortages of healthcare professionals are a current reality for most rural areas of Canada and are not easily resolved. Bursaries for rural residents to receive their education and return to their home communities has been one successful strategy. Interprofessional teams spread over geographic areas but connected through technological innovations will become commonplace out of necessity. Full scope of practice for all health professionals, whether they be nurses or physicians, will allow for more appropriate use of education and skills while implementing an evidencebased healthcare delivery system.
Working With Community Members There has never been a better time for health professionals and community members to work together in recognising their community’s assets and challenges. In addition, these two groups have the opportunity to use community development processes to develop unique programmes. This involvement will enhance empowerment and capacity building while increasing individual and community health status. Finally, health professionals need to be policy change advocates, working with community members, to identify and address their most important issues through rural-specific policies.
N E W S L E T T E R
Rural Health Issues There are numerous health issues associated with the rural landscape, including equitable access to a sustainable healthcare delivery system and the appropriate type and number of healthcare professionals to deliver care and meet the needs of a diverse group of individuals and communities within a range of geographic settings. Living in rural settings has also been associated with specific health challenges such as occupational accidents related to the natural resource industry (e.g. mining, forestry) or increased incidence of particular diseases associated with particular environmental variables (e.g. farming and asthma).
care professionals is required in order to plan appropriate recruitment and retention strategies.
2 0 0 6
Rural Nurses What we do know is that healthcare professionals, for example, nurses, who work in rural areas, need a variety of knowledge and skills in order to competently meet the diverse needs of their clients. They often lack resources (either people or equipment) and hence work in less than ideal circumstances. Rural nurses do not perceive that nurses and other healthcare professionals in urban areas understand the challenges they face (MacLeod et al., 2004).
J U N E
Although ‘rural’ is a term that is commonplace in our conversations and discussions, its meaning is not often clarified. In academic circles, attempts at defining it have led to lists of indicators to identify rural settings or to objective criteria such as distance from essential services. Individuals who live and work in rural communities are more interested in having the complexity of their life and work in such communities better understood, rather than determining if their location is indeed rural!
11
IMPROVING HEALTH HEALTH RESEARCH
Women Empowerment in Life Skills
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 5
J U N E
2 0 0 6
In recent years, Iran has embarked on a mission to make health research more equitable by addressing the needs of an entire population. While this approach is necessary, the challenge lies in turning this ideal into concrete, practical and effective action (Kahssay & Oakley, 1999) (Asefzadeh, 2003). Priority Setting Since 2001, Qazvin University of Medical Sciences (UMS) policy has been revised to redirect research resources towards community health priorities through partnership. The university was given the responsibility of leading the development of community coalitions. This effort involved the mobilisation of a broad variety of stakeholders to define the community’s critical issues, then prioritise them and propose solutions. To realise the new policy, Qazvin UMS organised a committee of medical specialists, local governors, teachers, medical care providers, NGOs and community advocates. The community health problems were assessed and health research priorities were set through the process of partnership (Asefzadeh, 2003) (Asefzadeh, 2003, Newsletter). One strategy was to empower the women of the Qazvin region by developing their knowledge and skills (to help them increase their mastery of life changing decisions, for example decisions that affect their health). A previous project about priority setting in Qazvin had revealed that the majority of the house wives - who are at the centre of the family - needed to be empowered in life skills, in order to cope with their health problems. Needs in Skills A community-based participatory research initiative was carried out in the north of Qazvin city (population of approximately 12
50,000 people). The objectives were: to identify specific women’s needs in skills; to determine women capabilities in life skills; to produce learning modules according to the needs of the target population; to empower women in life skills such as family management, household economy, critical thinking, problem solving, communication, healthy diet and nutrition, prevention of diseases, oral health, mental health, family relations, skin health and beauty, parenting, adolescent, coping hopelessness; and to assess the role of empowerment in skills promotion. Participatory needs assessment established the women’s special needs: family management, family economics, oral health, coping with stress, beauty health, healthy nutrition, first aid at home, human skills, social skills, and heart disease prevention. Approximately 120 volunteers were trained to communicate these issues to other women in skills workshops and educational modules. Evaluation To evaluate the effectiveness of the programme, both quantitative (experiment and control group compared through structured self-administered questionnaire) and qualitative (focused group discussions and extended interviews, in which strengths and weaknesses of the empowerment programme were discussed) methods were applied. According to monitoring and reports done by the volunteers, more than 4000 women (about 1/3 housewives) have been participating in the educational programmes through workshops, learning groups, face-to-face teachings, familial meetings, religious groups etcetera. The results of the qualitative and quantitative evaluation revealed that the programme has been effective. For example, women who were qualitatively studied have said that they have been practicing
and using the new skills in their everyday life. Results of comparison of the experiment group before and after the programme revealed that average values of application of these skills were promoted by participation in the study (p> 0.0001). Results of comparison between the experimental and control group revealed that average scores of these skills in the experiment group were higher (70.4 vs. 54.1 p<0.0001). Conclusion Results of the WELS project revealed that the women were empowered in life skills. They gained experience and information that would help them to gain better control of their own lives. They have changed their poor health behaviour; their lifestyle and their family health is being improved through their participatory actions. References KAHSSAY, H.M & OAKLEY, P. (1999). Community involvement in health development: A review of the concept and practice. Geneva: World Health Organization. ASEFZADEH, S. (2003). Working towards equity in health in Iran: Setting health research priorities through partnership. Newsletter of COHRED, 32:7. ASEFZADEH, S. (2003). Building up partnership: Setting health research priorities. Network: TUFH Newsletter, 22:13.
Saeed Asefzadeh | Corresponding author, Professor, Department of Health and Social Medicine, Qazvin University of Medical Sciences, Iran Email: sasefzadeh@qums.ac.ir
COMMUNITY ACTION COMMUNITY INTERVIEW
Community at the Heart This interview was conducted with Linda Wittevrongel, coordinator of the community health centre Botermarkt in Ledeberg-Ghent, Belgium, which is a multidisciplinary primary healthcare service with a low threshold. She has been working at the centre as a social worker since 1986 and was one of the founders of the consultative body for health/welfare workers working in the Botermarkt community. She also has ties with the Ghent medical school, where she teaches about handling social problems, and interprofessional co-operation.
N U M B E R 0 1 | V O L U M E 2 5
Do you as a community have influence in: the curriculum, the healthcare policies, health services? If so, in what way? We are part of a good network of health services, which enhances co-operation. The consultative body for community health/ welfare workers (who gets together once in
Sometimes the Faculty does research in the community. Does the community get feedback on the results of such research? Do those results have any consequences for the community? Of course we give feedback to the community regarding research results, but we do more than results. They are the basis for our projects, and they also motivate us to critically examine our own findings.
N E W S L E T T E R
What (dis)advantages are there for your community in your relationship with a Faculty? We seek co-operation with the university, especially for academic research, and when we need support in health promoting initiatives and campaigns in the community. For example, our 2006 initiative to also offer dentistry at our community health centre, was supported by the results of a university research on dental medicine in the community: 18,5% of the children showed toddler tooth decay, and 12,2% showed a serious decay. No form of decay had been treated, which only strengthened us in our decision to include dentistry.
three months) offers us great help in health promotion. Via this network we got a foot in the door with a lot of Government bodies, and we were able to engage in local, social policy planning. More local coordination offers a better guarantee for a strong policy that is accessible for community members.
2 0 0 6
doorstep, involving a young schoolgirl, made us start a traffic safety project together with authorised traffic agencies. Statistic data of traffic accidents in that community showed that children were often traffic victims; they lived in small houses and had to play outside a lot. Together with a group of volunteers we build a playground, and at the same time we signalled the local Government about the shortage of playing space in the neighbourhood. While working on the playground, we found some more problem groups: the adolescents, migrant women, and underprivileged women. The foundation for new group initiatives was laid.
J U N E
Do you and/or the Faculty (Faculty of Medicine and Health Sciences, Ghent University) develop activities in the community that have led to a better general welfare of the people in that community? Which one(s)? In its 28 years of existence, the community health centre has always â&#x20AC;&#x201C; together with the community members â&#x20AC;&#x201C; served as a pioneer, following the Community-oriented Primary Care (COPC) model. Being community-oriented was essential, as we wanted to deal with community health problems, with an eye on social-economic environment. After all, health improvement can only be successful when you are simultaneously working at several community issues, such as town/country planning, housing, traffic safety, multiculturalism. When detecting the community needs, we always followed this strategy: we started with signals from our own practice (subjective signals) and analysed these signals using statistical data, research results, and network evaluation. Next, we collected data for a proper target group analysis and problem definition. Sometimes we worked on the solutions ourselves (and in the end we passed the baton to others), but we always raised the matters with the authorised instances to make them accountable. An example: A traffic accident on our own
Mrs. Linda Wittevrongel
Health promotion works best when all stakeholders work well together, and that is something that we fortunately have!
If you were in charge, what changes would you make in the relationship between community and Faculty? We prefer to look at what is positive in our relationship, and that is foremost our successful co-operation. As it is, health promotion works best when all stakeholders work well together, and that is something that we fortunately have! 13
INTERNATIONAL HEALTH PROFESSIONS EDUCATION INTEGRATING MEDICINE AND PUBLIC HEALTH
Teaching Public Health During Clinical Clerkships
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 5
J U N E
2 0 0 6
During the 2005 Network: TUFH conference in Vietnam, a mini-workshop examined how to teach public health concepts through clinical teaching activities. Although many medical schools require students to learn certain theoretical and practical aspects of public health, few have integrated the teaching of public health in clinical clerkships. The aim of the workshop was to suggest ways public health teaching can be incorporated into the clinical stages of training. This article covers some of the main ideas to come out of the workshop. Curriculum The curriculum should be based on the health needs of the population and the organisation of the health system. The graduating student should be competent in diagnosis and basic treatment of conditions commonly found in the community and should be able to identify optimal pathways of treatment. To achieve this goal, public health and clinical objectives should be integrated. The objectives should be precisely defined, concrete and relevant to the future professional activities of the student. Without necessarily realising it, most clinical practitioners use public health concepts in their work, although they may find it difficult to convey their thought processes to their students. Much of the challenge of integrating public health into the curriculum in general, and into clinical teaching activities in particular, lies in helping clinical teachers to make explicit their implicit competencies. Teaching Activities Clinical teaching tends to be patientcentred, but there are plenty of opportunities to introduce public health. During ward rounds and outpatient clinics, the teacher can require students to include the physical and socio-economic environment and patient lifestyles in the medical history. The student’s treatment plan should take account 14
Participants at the mini-workshop in Vietnam of this expanded history, include appropriate health promotion and protection and illness preventive interventions, and demonstrate efficient and effective use of health system resources. Journal clubs are an excellent opportunity to highlight notions of epidemiology and statistics. Clinical reasoning sessions can highlight the health determinants and disease patterns in the population, and - in cases of environmental and infectious disease - the actions required to protect the community’s health. Faculty It is important for teachers to use all clinical teaching activities as possible opportunities for including the public health can be a challenge. At the very least, the faculty development programme should include public health content and the pedagogical content necessary for public health teaching. Staff job descriptions and the criteria for academic promotion should value the public health elements of practice, teaching and research. Clinicians who integrate public health in practice should be recognised as role models and rewarded. Finally, residents should also be expected to include public health in practice. Students Medical schools should make an effort to attract and retain students from vulnerable and underserved populations. These students should be encouraged to return to practice in their community of origin after graduation, and training should reflect the needs of these populations.
Evaluation Evaluation of the curriculum should include the tracking of graduates, if their choice of specialty and practice situation meets community needs. Evaluation of students’ learning could include systematic debriefing of students, log books, and patient records, as well as the more traditional forms of evaluation of learning. No matter what form the evaluation takes, it should always include assessment of students’ acquisition of the public health aspects of medicine. It should also be rigorous and meaningful. While the mini-workshop left many questions unanswered, the ideas that came out of it can form the basis of action plans aimed at increasing the public health content of clinical clerkships. Denise Donovan | Associate Professor, Department of Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Canada Email: denise.donovan@usherbrooke.ca
During ward rounds and outpatient clinics, the teacher can require students to include the physical and socio-economic environment and patient lifestyles in the medical history.
SEXUAL
INTERPROFESSIONAL EDUCATION
Interprofessional Collaboration: Paradox of Progress Without going into the debate about terminology, or the linguistic debate about the meaning of words, we want to focus on the pragmatics of what most people understand by interprofessional collaboration. We will briefly state why interprofessional collaboration is necessary, and then say something about the paradox of the progress we have made towards achieving it.
N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 5
There are several issues regarding evidence and progress. There is little doubt more evidence of the effectiveness of interprofessional collaboration is needed. Interestingly, amongst any plausible evidence ought to be several that throw light on the patientâ&#x20AC;&#x2122;s journey through the interprofessional route. If the experience of the patient turns out to be mostly negative, then that might highlight the paradox of progress. Assuming interprofessional collaboration can be enhanced through the pre- and post-qualifying curriculum, then we encounter another example of the paradox of progress. At the pre-qualifying stage most barriers seem to relate to: professional identity issues (professional ethnocentrism); admission pre-requisites; nature of the common programme and related placements; clinical supervision and assessment; interprofessional attitude and perceptions; and resources including funding. There is no doubt progress has been made in interprofessional collaboration. There are international initiatives and projects that exemplify progress. Paradoxically, there are pragmatic issues such as evidence of effectiveness of interprofessional collaboration and professional identity that militate against complete progress.
2 0 0 6
Question of Evidence It is easy to see how the above approach can create greater interprofessional understanding, greater potential for collaboration, and betterment of patient provision. It is also easy to see how the above can minimise tragedies and fatalities such as the Victoria Climbie case, which in part was caused by poor interprofessional collaboration. The sceptics among us may well ask what research evidence there is to suggest interprofessional collaboration improves the patientâ&#x20AC;&#x2122;s experience of seeking help and regaining psychological well-being? The question of the evidence of the usefulness of interprofessional collaboration will become more and more pressing as more initiatives and policies are unveiled. The American Association of Colleges of Nursing has suggested that educators be responsible for assessing the results of an interdisciplinary approach to assure that collaboration is enhanced, the delivery of care is facilitated, and patient outcomes are improved.
Discussion among IPE students
J U N E
Necessity In terms of its necessity, most professionals accept that the majority of patients see several different professional people when seeking help. Being a patient is often the time when most of us would psychologically be at our most vulnerable. It therefore, would make eminent sense that the different professional people involved with helping such potentially vulnerable patients demonstrate true interprofessional collaboration. Such interprofessional collaboration would not only benefit patients, but also the professions themselves. After all, in many interprofessional projects (nationally and internationally), interprofessional collaboration is almost synonymous with patient-centred practice. For example, the Centre for Collaborative Health Professional Education (Canada) states that collaborative patientcentred practice in interprofessional teams has been identified as an essential focus for healthcare and health professional education now and in the future. In the UK interprofessional collaboration is an important part of the new NHS Plan. We think there is a realisation among most professional groups that collaboration is important, if only because of the new patientcentred approach and the need to improve communication and avoid unnecessary duplication of services. We think there is also greater agreement now that the main source of job satisfaction for healthcare professionals is seeing patients regain their well-being or maximising recovery and well-being.
Synergistic Effort To this, there has been much progress towards the interprofessional collaboration ideal. Furthermore, the practical implications of progress towards this ideal are well understood as requiring some sort of synergistic effort by those involved. Such synergistic effort may be critical in the following interprofessional collaboration aspects: learning together to work together for health; developing or having teamwork skills; developing or having good communication channels; understanding roles and responsibilities of other professions; awareness of areas of overlap or cross-over in responsibilities and expertise; valuing other professions and awareness of differences (e.g. terminology); and working towards one super-ordinate goal (the well-being of patients) regardless of professional boundaries.
Dawn Forman and Lovemore Nyatanga | Dean; Principal Lecturer in Psychology, Faculty of Education Health and Sciences, University of Derby, United Kingdom Email: d.forman@derby.ac.uk
15
INTERNATIONAL HEALTH PROFESSIONS EDUCATION ACCREDITATION AND QUALITY ASSESSMENT
Accreditation in Health Professions Education
Egypt as Example To achieve this aim, the EMRO launched a project aiming at establishing an accreditation system for health professions education (HPE) based on national and/or regional standards. In Egypt, as an example, the EMRO has contracted the Medical Education Department of the Faculty of Medicine at Suez Canal University to manage this project at the Egyptian national level. This project is now in its third phase.
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 5
J U N E
2 0 0 6
The Eastern Mediterranean Regional Office (EMRO) of the World Health Organization (WHO) has taken the initiative to conform with the global mandate to deliberate the case for standards in medical education and reach consensus about better healthcare of populations for educational problems. Led by the World Federation for Medical Education (WFME), this effort is carefully tailored to address the real community health needs.
The main goal of the first phase was to launch an awareness campaign to spread the culture of quality assurance and accreditation in HPE among all HPE institutions in Egypt. In addition, during this phase, a taskforce was assigned to adapt the WFME global standards to the Egyptian national context. The main focus of the second phase was to provide technical assistance to all involved HPE institutions to conduct, produce and disseminate self studies that reflect their vision, mission, objectives, educational strategies, and methodologies, as well as their strengths, weaknesses, opportunities, and threats. In the third phase of this project, a number of representatives from several state and private HPE institutions were trained as
16
peer reviewers, to help conduct peer reviewing site visits. These visits have been paid to those complying with the WHO policy and ‘road map’ for accreditation. Adopted, Adapted, Piloted The level of awareness of the HPE community in the Eastern Mediterranean Region has been recently raised towards inducing quality in education and establishing a sound system for accreditation. The WFME set of standards for accreditation in HPE has been adopted at the regional level. It has also been adapted, adopted and piloted in certain countries in the Eastern Mediterranean Region. Serious steps have been taken in a number of countries in the region to establish accreditation systems, some of which had the privilege of political and legislative support. Conclusion Accreditation in the Eastern Mediterranean Region is pertinent and badly needed for the survival and development of health professions education institutions. The EMRO has recently launched a campaign to establish an accreditation system in the Eastern Mediterranean Region. Encouraging results have been achieved so far. Serious steps are expected to be taken to endorse these efforts. Wagdy Talaat and Fathi Maklady; Ghanim Al-Sheikh and B.Sabri / Faculty of Medicine, Suez Canal University, Egypt; Eastern Mediterranean Regional Office, WHO Email: watalaat@ismailia.ie-eg.c
Community visit in the 3rd year Special Quality Award Every seven years, the medical training programmes of the Flemish Medical Faculties undergo a quality assessment in the framework of an accreditation procedure. The previous assessment (1997) of Ghent University’s medical curriculum reported several problems. Following the advice of the report, a fundamental reform of the medical curriculum took place, coordinated by a curriculum development committee chaired by Jan De Maeseneer (EC Member of The Network: TUFH). A classical discipline-based curriculum was replaced by integrated ‘units’ and the ‘lines’ problem solving, skills training, scientific work, and exploration & ethics. Skills training was developed (and faculty trained in it), and communication training was introduced in every study year. Two blocks on health and society, and scientific work led to the writing of a master thesis by all students. The new quality assessment report in 2005 was very positive about all those innovations: “… this is a qualitatively excellent, extra and relevant realisation of the objectives of the medical programme of Ghent University, and gives it a national and international profile, …this project gives an excellent example on how a training programme can teach medical students to think and act in a community-oriented manner”. The international jury was impressed by the structural changes in the programme, the problem orientation, and the patient-centredness. Moreover, for the first time in Flanders and in the Netherlands, a training programme received a ‘special quality award’, namely for ‘social accountability’ and ‘community orientation’. The jury particularly commended different curriculum elements: the follow-up visits to a family with a newborn baby (year 2, 3 and 4), the clerkships in the community, and especially the oneweek ‘community-oriented primary care’ experience in the 3rd year. Jan de Maeseneer and Anselm Derese | Professor in Family Medicine and Primary Health Care; Professor, Director Centre of Education Development, Faculty of Medicine and Health Sciences, Ghent University, Belgium. Email: jan.demaeseneer@ugent.be
RURAL HEALTH PROFESSIONS EDUCATION
University Departments of Rural Health in Australia Australia is one of the few remaining OECD (Organisation for Co-operation and Development) countries, which rely predominantly on primary industries for its balance of trade. As such, it is imperative that it continues to offer high-level healthcare for the sparsely populated rural and remote areas.
0 1 | V O L U M E 2 5
Community Health Worker Network Group A number of groups have expressed an interest in setting up an internal network group within the broader Network: TUFH for community health workers. This includes such groups as Aboriginal, Native American, and Indigenous Health Worker Groups from a range of countries. The goals of the network group are to advance and explore the roles of community health workers within The Network: TUFH, and the education and training of these health workers to meet the needs of rural and remote communities internationally. If you have an interest in being part of this group, please contact Gayle Dinechacon (gdchacon@salud.unm.edu) and Tassy Parker (tparker@salud.unm.edu).
N U M B E R
Unique Structure and Relationships The structure and relationships of each UDRH are unique and the result of a number of factors: the nature of the communities within which they exist; the organisational structure and relationships within which the UDRH exists; and the staffing mix and drivers for change within the UDRH. The influence of communities upon the structure and activities of many UDRHs reflects community health needs, types of health provider, and
Dennis Pashen, Louis Peachey, Stephanie de la Rue, Lisa Crossland | Mt Isa Centre for Rural and Remote Health, Australia Email: dennis.pashen@jcu.edu.au
N E W S L E T T E R
A range of educational and training programmes are delivered, which include: rural and remote undergraduate clinical placements; bachelor and post-graduate degree courses; vocational training; professional development; indigenous health worker; and Diploma in Nursing Training through the non-tertiary (Technical and Further Education - TAFE) sector. In essence these programmes are multidisciplinary, vertically integrated programmes designed to provide health pro-
UDRH locations in Australia
Combined outcomes of the UDRHs in Australia now show over 13,000 student weeks of experral and remote communities each year.
2 0 0 6
Shared Performance Indicators A shared set of common contractual obligations developed by the Commonwealth sees the UDRH programme having shared key performance indicators against which the UDRHsâ&#x20AC;&#x2122; activities are measured. These occupy the domains of: workforce development through education and training; indigenous health; population health; and research. Each UDRH addresses these issues in ways that suit its region and context.
Population health has been a key feature of the remote and indigenous landscape within Australia. The insertion of primary healthcare principles into training across disciplines is now mandatory. Research programmes across population health, indigenous health, and the development of a culture of research and evidence has been enhanced by the additional funding from the national Primary Health Care Research, Education Development Programme (PHC RED). This has assisted growth in the capacity of UDRH and health service staff to become involved in remote health research. The aim of influencing policy development at state and national levels has been a particular focus of the research programmes of a number of UDRHs.
the direction of programmes and research projects. Although some UDRHs have strong ties to their communities, others do not. However, these have been replaced by other organisational linkages such as professional organisations, health service providers or the Royal Flying Doctor Service. The relationship with the parent university has provided additional direction to UDRH structures and activities. Some UDRHs are intimately incorporated within one university, others have a Board of Governance that has a membership of between two to five universities. J U N E
For the past ten years, Australia has trialled a model of University Departments of Rural Health (UDRHs) as a means of addressing workforce shortages in the vast expanses of rural and remote Australia. This model was conceptually based upon the premise that the academic underpinning of the disciplines in rural health would allow the development of an intellectual capacity within under-serviced rural communities. Initially, the Australian Government agreed to fund seven such units and subsequently raised the number to 11 with a mooted 12th awaiting funding (see figure).
fessionals with career pathways and clinical exposure to rural and remote communities, which will translate to workforce recruitment and retention.
17
INTERNATIONAL HEALTH PROFESSIONS EDUCATION NEW INSTITUTIONS AND PROGRAMMES
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 5
J U N E
2 0 0 6
A New WHO Initiative in Africa
18
Acquired Immunodeficiency Syndrome (AIDS) has killed more than 25 million people since it was first recognised in 1981, making it one of the most destructive epidemics in recorded history. Although HIV infections are decreasing in several countries, global number of people living with HIV continues to rise. The WHO/UNAIDS report of December 2005 shows that a total of 40.3 million people were living with HIV. This accounted for 38 million adults (17.5 million women) and 2.3 million children under 15 years of age. Three million people died from HIV/ AIDS in 2005, and those newly infected with the virus reached 4.9 million globally. Since HIV/AIDS remains a major public health problem, control efforts will require coordination of different approaches. Prevention, treatment, care and impact mitigation goals will have to be pursued simultaneously. Countries need to focus on programme implementation, including strengthening of human and institutional resources, and initiate strategies that allow for the greatest possible level of integration of services. Goal and Objectives The goal of the WHO project Strengthening the Educational Capacity in the Prevention and Treatment of HIV/AIDS in Five African Countries (SEDCAP in HIV/AIDS) is to strengthen the human and institutional resources of schools of health professionals in five countries in Africa (Botswana, Burkina Faso, Malawi, Mozambique, Uganda), and to graduate individuals who are better equipped to prevent, treat and care for HIV/AIDS. We include in ‘schools of health professionals’ any institution that is offering pre-service education to any type of health worker. The specific objectives in selected schools are: to determine the educational capacity including faculty preparedness, teaching methods, and curriculum content; to assess the performance needs of graduates; to up-
date the curricula with a standardised, competency-based training programme; to strengthen and update the knowledge and skills of faculty members in HIV/AIDS care; to empower the faculty members with training skills to ensure better transfer of learning; and to monitor and aid in the early stages of the implementation phase of the new curriculum.
or by faculty members working with trainers to improve their skill base. Work with countries will be directed to support sustainable changes through fostering cohorts of enthusiasts and nurturing examples of success.
Assessments The project will incorporate a phased methodology, which will begin with two assessments: Educational Capacity Assessment (ECA) for the schools, and Performance Needs Assessments (PNA) for their graduates. ECA will give valuable information about the school, its current status, curriculum, infrastructure, capacity to expand, etcetera. PNA will, on the other hand, provide information about performance gaps of graduates (expected versus observed performances in HIV/AIDS-related services) and identify areas that can be improved by training. Obtaining stakeholders’ consensus at this stage, the curriculum revision and faculty development committees in each school will evaluate the revision and strengthening needs of the curricula and the faculty, in order to address the performance gaps identified by the assessments. Each school will decide about the type of curriculum change they would like to incorporate; WHO and partners will provide technical and financial support for the changes to take place.
Hande Harmanci, Barbara Stilwell, and Manuel Dayrit | World Health Organization, Department of Human Resources for Health, Switzerland. Email: harmancih@who.int; stilwellb@who.int
Focus The main focus will be on competency-based training, which will decrease the amount of orientation training necessary for the graduates to start functioning effectively when they become part of the healthcare delivery system. While the focus is on pre-service education, it is anticipated that those training skills learned by faculty can also strengthen in-service training, either directly
The project has been launched with a meeting in May in Botswana with participation of deans and faculty members from project schools, WHO, and partner organisations.
Expanding Medical Schools in Sudan Recently Sudanese Government expanded medical education with 20 new medical schools, as a reaction to the countries brain drain. Professor Elsheikh Mahgoub (Department of Microbiology, Faculty of Medicine, University of Khartoum, Sudan) comments: “The expansion was perhaps intended to make for the shortage of doctors, resulting from brain drain, and to extend services to remote areas. However, this vast expansion was made without substantial increase in resources. Neither financial nor human resources were effectively increased. The defect was mainly in basic sciences teachers, who were already few. Most Faculties rely on teachers from the University of Khartoum. Out of the 25 medical schools, 13 are in Khartoum state with a limited number of hospitals. Hence, the shortage and defect in clinical training. Some remedial actions are being taken, but they are not enough. Certainly evaluation is much needed to judge the outcome and standards of graduates, which has dropped in some of these medical schools, and suggest effective solutions.”
From Master to Skillslab in Vietnam Medical skills training, as a part of medical training at Vietnam medical universities, has undergone a major change. The curriculum did not provide a pre-clinical skills training for students in a medical lab five years ago. Traditionally, the students acquired their skills by observing their ‘Master’, the experienced physician. The ‘Master’ assessed and decided when students had enough knowledge and skills to stand on their own two feet.
This master programme is the first in its kind to be totally taught through distance learning in Egypt and the Eastern Mediterranean Region, targeting mid to top career faculty and preparing them as potential leadership in Health Professions Education.
N U M B E R 0 1
Dr. Jan van Dalen and Dr. Wagdy Talaat, the directors of this programme, are quite satisfied with the high level of co-operation between their institutions as two pioneering, innovative schools since the establishment of The Network: TUFH.
N E W S L E T T E R | 2 5
For more information about this programme, please visit www.medfomscu.org or www.she.unimaas.nl (click Master of Health Professions Education, Joint Master Netherlands-Egypt).
V O L U M E
Although the skillslab is a modest unit, it contributes considerably to the process of renovating contents and teaching-learning methods, and it enhances the training quality, especially training practice skills. At present, we are confronted with practical challenges, such as: the large number of students; changing the attitude of staff from being teachers to facilitators of the students’ learning process (from teachercentred to student-centred approach); integrating skills training in the whole curriculum; maintenance of models; training and effective use of simulated patients; and evaluation of the effectiveness of skills training.
The Joint Master of Health Professions Education (JMHPE) between Maastricht and Suez Canal Universities has concluded its first round and celebrated the graduation of the 1st group of students on March 20, 2006. Attending the ceremony were representatives from the World Health Organization, Dutch Embassy in Cairo, and the Egyptian Ministry of Higher Education.
2 0 0 6
First, UMP HCMC developed a training programme comprising of 35 skills for 2nd, 3rd, 4th and 5th year students. Eight departments participated in the training. Many workshops and courses were organised to develop one skills training programme, in order to ensure the unity of contents and prevent training overlap. In conjunction with writing, teaching and learning materials, an active skills teaching and learning method was used (skillslab method) and applied for a small group of students (one facilitator per 10 students). This method encourages students to self-study and is increasingly accepted by training staff and students. In 2005, a pilot research project was conducted to study essential skills for gradu-
In 2004, the project Strengthening Medical Skills Training at Eight Medical Universities/ Faculties in Vietnam started with the support from Nuffic (Netherlands organisation for international cooperation in higher education). This project aims at strengthening medical skills training at eight medical universities/faculties in Vietnam. It will assist UMP HCMC in improving the current medical skills programme, and will help develop a common medical skills training programme in eight universities/faculties in Vietnam.
J U N E
However, in the current situation students have fewer opportunities to practice and improve skills at hospitals, while the quality of healthcare is directly related to the practical performance of health workers at all levels. Therefore, with full realisation of the importance of practical competence training and in order to create more opportunities for practicing, the University of Medicine and Pharmacy at HoChiMinh City (UMP HCMC) developed a skillslab unit in 2001, with the financial support from the Vietnamese Government and the World Bank. The skillslab was designed to enhance more practical skills training for all health professionals.
ates. A list of 100 required skills will be developed. Currently, 39 skills are being trained. In the future, the number of skills will be increased, emphasizing the importance of communication skills in the whole curriculum.
Nguyen Thi My Hanh | Skillslab, University of Medicine and Pharmacy at HoChiMinh City, Vietnam Email: myhanhyd_96@yahoo.com
19
INTERNATIONAL HEALTH PROFESSIONS EDUCATION MEDICAL EDUCATION
Best Evidence in Medical Education
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 5
J U N E
2 0 0 6
Since the early 90’s, the paradigm of Evidence-based Medicine (EBM) has rapidly influenced medical practice and training all over the world. Almost 10 years after the establishment of EBM, a similar paradigm in medical education evolved to move from Opinion-based Education to Evidence-based Education. In 1999 Best Evidence in Medical Education (BEME) was defined by the BEME Steering Group as “the implementation, by teachers in their practice, of methods and approaches to education based on the best evidence available” (Harden et al., 1999).
20
Aims and Concerns BEME aims to create a culture of using the Best Evidence in Medical Education, improving the evidence base by preparing and maintaining high quality systematic reviews, developing methods of searching which are user-friendly, disseminating best available evidence, and stimulating high quality research. It operates at two levels: to utilise existing evidence from world-wide research and literature on education and associated subjects; and to establish sound evidence where existing evidence is lacking or of a questionable, uncertain or weak nature. The emphasis in BEME is on the user, translating educational research into practice and educational decisions at the level of the teacher, learner (micro decisions) and educational institutions (macro decisions) (Jason, 2000). Concerns about BEME have been raised. Having the evidence of the effectiveness or ineffectiveness of a teaching or assessment method is not sufficient to make a positive significant change in the educational process or outcome. To enable BEME to have a significant impact on the education and training of health professionals, teachers should be educated and trained, and have their teaching capabilities developed. Faculty attitude: what is wrong with what we are doing? Should we change?
Steps Practising the BEME approach in education usually goes through the following steps: • define the educational question: it should be focused, consider the characteristics of the study population, educational context, educational intervention or correlation, and outcome measurements; • look for the evidence: databases are not well developed in medical education. In addition to what is available on MEDLINE, other databases like TIMELIT (Centre for Medical Education Dundee) are more specific to medical education, but not comprehensive. Systematic searching in medical education is particularly challenging given that the evidences are widely dispersed and very often poorly indexed; • evaluate the evidence: the process for deciding what is ‘best’ should be as objective and reproducible as possible. ‘Best’ is relevant to the educational situation and context; and • judge whether or not the results of the research are applicable to your educational context (based on the quality of the available evidence). Finding weak evidence is usually the trigger for initiating a primary research or a systematic review. Systematic Review Conducting a systematic review in medical education is one of the important activities of the BEME collaboration. Systematic reviews provide summaries of what we know and do not know. These reviews should be free from bias. The BEME systematic review is an overview of a clearly formulated question that uses explicit methods of systematically assembled, critically analysed and appropriately synthesised evidence relevant to the topic. The BEME search approach is inclusive and open to a wide range of evidence, including grey literature. International, multi-centric topic review groups are collaborating to develop systematic
review. Examples of some of the completed reviews are: Features and uses of highfidelity medical simulations that lead to effective learning: a BEME systematic review (Issenberg et al., 2005) and Predictive values of measurements obtained in medical schools and future performance in medical practice (Hamdy, 2005). Future Success The future success of BEME as an educational philosophy, approach and organisation will depend on: creating an ethos in educational institutions that evidence is better than hearsay or tradition; spreading the BEME culture through training; identifying and directing educational researches and systematic reviews to assess where the evidence is lacking or weak; and improving and developing databases of educational researches which are user-friendly and improving the methodology of systematic reviews in medical education. References CENTRE FOR MEDICAL EDUCATION DUNDEE: www.timelit.org HAMDY, H. (2005). Predictive values of measurements obtained in medical schools and future performance in medical practice. Accepted for Medical Teacher. HARDEN, R.M., GRANR, J., BUCKLEY, G. & HART, I.R. (1999). Best Evidence Medical Education. Medical Teacher, 21(6):553-562. ISSENBERG, S.B., McGAGHIE, W.C., PETRUSA, E.R., LEE GORDON, D. & SCALESE, R.J. (2005). Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Medical Teacher, 27(1):10.28. JASON, H. (2000). The importance - and limits - of Best Evidence Medical Education (editorial). Education for Health: Change in Learning & Practice, 13(1):9-14. Hossam Hamdy | Dean, College of Medicine & Medical Sciences, Arabian Gulf University, Bahrain Email: meddean@agu.edu.bh
PARTNERSHIPS
Health Services for Barceloneta AUPA is a Catalan acronym that stands for Actuem Units per la Salut, which means Acting Together for Health. This innovative project took place between 1994 and 2004 in Barcelona, Spain, and was a Towards Unity for Health (TUFH) award recipient in 1999.
cal director decided to step down. The Government appointed a new director and it now appears the experiment of autonomous management in the Barceloneta is no longer. Barceloneta from the air
| V O L U M E 2 5
Despite these impressive results, tensions had been mounting between the clinical director and the municipal Government over autonomy issues. In the summer of 2004, a conflict arose between different factions within the community about how the centre should handle urgent care visits. Instead of allowing the PCT to resolve this problem on their own, the Government stepped in, violating the PCTâ&#x20AC;&#x2122;s privileged relationship with the community. The clini-
visits to the Emergency Room decreased by 20%.
0 1
The PCT worked extensively with the senior centre and the schools - doing regular educational programmes - and with the neighbourhood newspaper, where the PCT had a health advice column. The PCT contracted medical specialists from the nearby hospital to see patients together with the primary care doctors, to give lectures, and to do chart reviews. A programme was established with the geriatric hospital to identify fragile elderly people in the community and provide assistance for them.
Andreu Segura Benedicto and Frederick Miller / Director of Public Health and Health Services Research, Department of Health, Institute for Health Studies, Spain; General Practitioner, Division of Public Health, Institute for Health Studies, Spain Email: asegura@ies.scs.es; farm1777@yahoo.com
N U M B E R
Outcomes Despite the challenges that come with working in a low socio-economic status area, the quality ratings for the Barceloneta health centre were the highest in the city. With better follow-up care and diffusion of information within the community, visits to the Emergency Room decreased by 20%. Expenditures for prescriptions decreased over 20%. Patient visits with their physicians averaged 12 minutes for an urgent care visit and 24 minutes for a scheduled visit, compared with the city average of 6 minutes for all types of patient visits.
N E W S L E T T E R
Collaborations The PCT developed a trusting, working relationship with the community, starting with regular meetings with neighbourhood and commercial associations to explain the goals of the PCT, to work on common problems together, and to dispel fears regarding a private group taking over their health services. Examples of issues tackled together included how to handle frequent visitors to urgent care, or scheduling arrangements to make the centre more accessible.
2 0 0 6
One of the more innovative programmes involved the neighbourhood pharmacists. Hypertensive and diabetic patients could choose to have their regular check-ups done in their local pharmacy instead of coming in to the health centre. From this patient population, 50% chose to see the pharmacists, which resulted in significant cost savings for the centre. The results indicated equal outcomes for patients followed by either method.
J U N E
In 1994 a private group of physicians called the Barceloneta Primary Care Team (PCT) was contracted by the Government to provide health services for the Barceloneta, a poor neighbourhood near the port of Barcelona. While the Spanish health system is normally staffed and financed within the public sector, in the Barcelonese this private group was given autonomy to take public money and organise health for the population.
From the ashes of the old AUPA project, however, has arisen a new AUPA project promoting community health activities for the entire Autonomous Region. Sponsored by the Institute for Health Studies of the Catalan Autonomous Government, the AUPA project has joined together various institutions involved in educating primary care providers, and provides training, resources and opportunities for the exchanging experiences for health centres doing community projects in Catalonia.
21
STUDENTS’ COLUMN OUT OF THE SNO PEN
STUDENTS’ SPEAKERS CORNER
“I Will Be a Doctor For My People” SNO WEBLOG To stay more connected between annual meetings we have created a web log for communication between SNO members: snotufh.blogspot.com/
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 5
J U N E
2 0 0 6
With this new web log (‘blog’) we would like to encourage students to share news and interesting materials or just simply add comments to postings. The web log also contains useful links to interesting web pages. With this unique communication tool you can reach many students across the whole world.
22
Please note that in case you would like to contribute to the web log by adding postings, you need to sign up as a member of the SNO web log. To do so, please send an email to Raoul Bermejo (rabermejo@yahoo.com). Everybody can add comments, there is no need to sign up. SNO Reports Available The SNO December 2005 Report and the January 2006 Report (by the SNO Executive Committee) are now available at: www.thenetworktufh.org/about_us/headlinenews.asp These reports contain information on what the SNO has done the past months, and hopes to do in the upcoming months. In case you have any questions about these reports, or other SNO activities, please contact Ramullah Kasozi (rkasozi@med.mak.ac.ug). Ghent 2006: Extremely Student Friendly! The 2006 Conference in Ghent will be as student friendly as possible. There will be a pre-conference workshop focusing on the students’ role in the community (Practical Skills for Students and Young Health Professionals to Set Up Community Projects); and there are two student friendly parallel sessions (Humanities in Health Professions Curricula and Clinical and Social Relevance of Teaching Basic Sciences: Utopia or Opportunity?)
I just visited the remote mountain community of Batad, in Northern Luzon in the Philippines. It is an ancient farming village of about a thousand people. They plant rice on stonewalled terraces. There is a midwife in the village; she is charged with delivering primary healthcare. The last time they saw a doctor in the village clinic was more than 20 years ago. The nearest hospital is about two hours of hiking steep slopes, and another hour on a motorcycle or jeep. It costs about a month of rice consumption of a family to hire transport to the hospital for an emergency. Kathy just finished high school. Her mother is a teacher in the village school, her father is a wood carver. The family owns the inn where I stayed. They also own several patches of terraces in Batad. Their family of six is considered privileged in the village. Kathy wants to be a doctor. It would be good to have a doctor in the village, and she wants to help her village. But she has put her dream on hold for now. Their family cannot afford to send her to medical school. She has two other siblings who are in college, and it takes approximately nine years to become a doctor in the Philippines. The family has instead settled for her to enrol in a nursing course. It takes less time and there are plenty of opportunities abroad. She may then join the massive wave of migration of thousands of Filipino health workers, finding better paying jobs in the USA, Canada, Saudi Arabia, UK, and Japan. But Kathy has no plans to go abroad; she approaches me to find out about opportunities for her to realise her dream. She has much affinity with her land and her people. She wants to be a doctor for her people. Call it innocent, naïve idealism. But I find in her strength and hope. I just finished medical school at the University of the Philippines. Along with other new medical graduates, I am faced
Batad, the Philippines
She wants to be a doctor for her people. Call it innocent, naïve idealism. But I find in her strength and hope. with very difficult questions. Am I going to specialise or not? Where am I going for residency or specialty training? Am I going to take the US Medical Licensure Exam or not? Where do I imagine myself practicing medicine? Am I staying? Or am I leaving too? I visited Batad partly to evade all these questions. I only wanted to be lost in amazement as to how a people can adapt to such fierce conditions and develop one of the most complex and colourful cultures I know. I got there only to find that with the background of the emerald mosaic of ancient terraces, the same questions are still staring at me. I draw strength from people like Kathy. I am innocent. I am a naïve idealist. I will be a doctor for my people. Raoul Bermejo | Secretary General of SNO, Student, College of Medicine, University of the Philippines, the Philippines Email: rabermejo@yahoo.com
The Girl in the Blue Dress As I left medical school to head to my room at main campus yesterday, I noticed a girl (probably around 15 years old) walking aimlessly, in the middle of the road with no concern for the afternoon rush hour. On close examination, I realised that her lower lip was literally split into two, with body fluids spilling from the injury. Her face and arms had scrapes and she was covered in dirt. Based on her appearance, I assumed she must have been in a road traffic accident. She was barefooted and walked down the road in a long blue dress.
0 1 | V O L U M E 2 5
Ramullah Kasozi | Chairperson of SNO, Student, Faculty of Medicine, Makerere University, Uganda Email: rkasozi@med.mak.ac.ug
N U M B E R
I guess I just have to try to find some way in which I can be more proactive in helping out the less fortunate so that I do not fall victim to apathy. I would like to think that next time, when I see a girl in a blue dress, I can help her. Allah only knows!
N E W S L E T T E R
After I crossed the street, I could still see the girl walking through the traffic. Though
Who was this girl? Did she have a family? What had happened to her? How did she reach to such a state of mind that she did not care if she was walking through traffic? These questions kept going through my head as I left home, to the warm comforts of my room.
To defend my behaviour, I wanted to do something but I just did not know how! I do care about the homeless and sick and helping the poor; that is why I am in medicine! I do not want to think that apathy has got a hold on me. While living in Toronto, I was involved in many programmes and initiatives that sought to aid the poor. However, here in Kampala I have not encountered such programmes and initiatives that I can be a part of. There are just too many people on the streets and too many people who do not care about them.
2 0 0 6
Why did I not do anything? Was I being selfish? Proud? I am a medical student trying to become a doctor and therefore I should have had some sort of compassion for the girl to at least help her. But I did not! Maybe it is because I feared the possible transmission of blood-borne infections and therefore I did not want to touch her without any medical gear. Or, maybe it is because I have become so used to the sight of poverty that I have learned to numb myself when I see a disadvantaged person on the street.
Coming to Uganda has given me an inside look into poverty and the consequences it creates. One such consequence of poverty is apathy.
girl, and looking into her eyes, prompted me to re-evaluate myself and to determine whether or not apathy had entered my personality. There must have been close to 200 people in the busy intersection looking at the same girl in the blue dress. Yet no one showed any interest in helping out that girl. I should have done something, I am in medicine for goodness sake! Yet I did nothing except stare and look at the girl with sadness like everyone else.
J U N E
As she approached the side of the road I was on, her eyes met mine. In that moment, I was able to see the sadness and desperation in the girl’s eyes. It is like time stopped for just a moment to allow me to empathise with how poverty can affect one’s life. Through her eyes I could see the great cry for help. She was saying “help me, help me, take me out of my misery”, but no one was listening. Yet, for some reason, I could do nothing, nor say anything. I was in utter shock. It was like I was in some sort of immovable trance. I kept thinking to myself that I should be giving first aid to this girl, or at least assist her to seek medical attention, but my mouth could not open.
she was walking against traffic, and would literally walk towards a vehicle, no person or vehicle inquired about the state of this girl. Vehicles kept manoeuvring around her, so that they could avoid hitting her. Pedestrians continued to walk and seemed occupied with getting home to prepare for dinner. No one showed any interest in helping out that girl. It seemed as though no one even noticed this girl, except me!
Coming to Uganda has given me an inside look into poverty and the consequences it creates. One such consequence of poverty is apathy. The experience of seeing that 23
INTERNATIONAL DIARY
Diary 2006 6 - 8 September, 2006, Aberdeen, UK International Conference on Patient Safety in Undergraduate and Postgraduate Education: Have We got it Right? Organised by the Association for Study of Medical Education (ASME) in collaboration with NHS Education for Scotland. Further information: fax: 44-131-2259444; email: jenniferb@ asme.org.uk; Internet: www.asme.org.uk
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 5
J U N E
2 0 0 6
Annual International Conference of The Network: Towards Unity for Health September 9 - 14 2006, Ghent, Belgium International Conference on Improving Social Accountability in Education, Research and Service Delivery. Organised by The Network: TUFH and Ghent University, Faculty of Medicine and Health Sciences. Post-Conference Visit to one of the PBL Founders 14 - 16 September, 2006, Maastricht, the Netherlands Organised by The Network: TUFH and Faculty of Medicine, Maastricht University Further information: Network: TUFH Office, P.O. Box 616, 6200 MD Maastricht, the Netherlands; tel: 31-43-3881524; fax: 3143-3885639; email: secretariat@network. unimaas.nl; Internet: www.the-networktufh. org/conference/
11 - 13 September, 2006, Adelaide, Australia ISEqH 4th International Conference: Creating Healthy Societies through Inclusion and Equity. Organised by International Society for Equity in Health (ISEqH). Further information: fax: 1-416-9463147; email: iseqh. info@utoronto.ca; Internet: www.iseqh.org/ temp_conf2006.htm 8 - 10 October, 2006, Brisbane, Australia 3rd International Forum on Disability Management. Organised by CONROD, Universi-
24
ty of Queensland, Queensland, Australia. Further information: fax: 61-7-33464603; email: ifdm2006@somc.uq.edu.au; Internet: www.ifdm.com.au 14 - 16 October, 2006, Portland OR, USA 6th International Service-learning Research Conference - Passion to Objectivity: International and Cross-disciplinary Perspectives on Service-learning Research. Organised by Portland State University, Portland OR, United States of America. Further information: email: slrsrch@pdx.edu; Internet: www.upa.pdx.edu/slresearch06 22 - 24 October, 2006, Montreal, Canada International Conference on Violence Against Women: Diversifying Social Responses. Organised by Interdisciplinary Research Center on Family Violence and Violence Against Women (CRI-VIFF). Further information: Internet: www.criviff.qc.ca/ colloque/appel_ang.asp 23 October - 3 November, 2006, Maastricht, the Netherlands Focused Courses on student assessment, e-learning, educational research, curriculum design, tutor training, methodology and statistics, skills training, and (post-graduate) clinical training. Organised by School of Health Professions Education, Faculty of Medicine, Maastricht University, Maastricht, the Netherlands. Further information: School of Health Professions Education, P.O. Box 616, 6200 MD Maastricht, the Netherlands; tel: 31-43-3881524; fax: 31-433885639; email: she@oifdg.unimaas.nl; Internet: www.she.unimaas.nl 27 October - 1 November, 2006, Seattle WA, USA AAMC annual meeting. Organised by Association of American Medical Colleges (AAMC). Further information: Internet: www.aamc.org/meetings
28 - 31 October, 2006, Singapore Regional Conference on Cost-effective Healthcare. Organised by Singapore General Hospital Postgraduate Medical Institute, Singapore. Further information: fax: 65-62260356; email: cehealth@sgh.com.sg; Internet: www.cehealth2006.com 1 - 4 November, 2006, Bangkok, Thailand 9th Asia Oceania Congress of Sexology. Organised by Consortium of Thai Training Institutes for STDs and AIDS (COTTISA). Further information: COTTISA, c/o Bangkok Hospital, 189 Sathorn Road, Bangkok 10120, Thailand; fax; 66-2-2863013; email: verapol.c@psu.ac.th; Internet: www.cottisa. org 4 - 8 November, 2006, Boston MA, USA APHA annual meeting. Organised by American Public Health Association (APHA). Further information: Internet: www.apha.org/ meetings/ 23 - 24 November, 2006, Maastricht, the Netherlands Visitors Workshop: A Primer on the Maastricht Approach to Medical Education. Organised by the School of Health Professions Education, Faculty of Medicine, Maastricht University, Maastricht, the Netherlands. Further information: School of Health Professions Education, P.O. Box 616, 6200 MD Maastricht, the Netherlands; tel: 31-43-388 1524; fax: 31-43-3885639; email: she@oifdg. unimaas.nl; Internet: www.she.unimaas.nl 23 - 27 December, 2006, Ismailia, Egypt 8th International workshop on Human Resource Development in Health Management and Leadership. Organised by Faculty of Medicine, Suez Canal University, Ismailia, Egypt. Further information: fax: 2-64-320 9448; email: crdmed@ismailia.ie-eg.com
Diary 2007 10 - 14 March, 2007, Ismailia, Egypt 21st International Workshop on Community-based Education Incorporating Problembased Learning - Innovative Approaches. Organised by Faculty of Medicine, Suez Canal University, Ismailia, Egypt. Further information: fax: 2-64-3209448; email: crdmed@ismailia.ie-eg.com
3 - 7 November, 2007, Washington DC, USA APHA annual meeting. Organised by American Public Health Association (APHA). Further information: Internet: www.apha.org/ meetings/
International Conference on Human Resources for Health: Recruitment, Education and Retention. Organised by The Network: TUFH and Faculty of Medicine, Makerere University. Post-Conference Visit to Mbarara Faculty of Medicine 21 September, 2006, Mbarara, Uganda Further information: Network: TUFH Office, PO Box 616, 6200 MD Maastricht, the Netherlands; tel: 31-43-3881524; fax: 3143-3885639; email: secretariat@network. unimaas.nl; Internet: www.the-networktufh.org/conferences/index.asp
0 1 |
It is possible to add events to this International Diary from behind your computer. Information inserted in our website database (www.the-networktufh.org) will be automatically included in the International Diary of our journal Education for Health, and in the Network: TUFH Newsletter.
N U M B E R V O L U M E 2 5
Uganda: the perfect place to see for what reason we have the 2007 Conference!
29 - 30 November, 2007, Maastricht, the Netherlands Visitors Workshop: A Primer on the Maastricht Approach to Medical Education. Organised by School of Health Professions Education, Faculty of Medicine, Maastricht University, Maastricht, the Netherlands. Further information: School of Health Professions Education, P.O. Box 616, 6200 MD Maastricht, the Netherlands; tel: 31-43-388 1524; fax: 31-43-3885639; email: she@oifdg. unimaas.nl; Internet: www.she.unimaas.nl
N E W S L E T T E R
22 - 27 July, 2007, Windsor, UK International course on Developing Leaders in Healthcare Education (Residential Course). Organised by the Association for the Study of Medical Education (ASME). Further information: fax: 44-131-2259444; email: jenniferb@asme.org.uk; Internet: www.asme.org.uk
Annual International Conference of The Network: Towards Unity for Health September 15 - 20 2007, Kampala, Uganda
2 0 0 6
11 - 26 June, 2007, Maastricht, the Netherlands Summer Course: Expanding Horizons in Problem-based Learning in Medicine, Health and Behavioural Sciences. Organised by School of Health Professions Education, Faculty of Medicine, Maastricht University, Maastricht, the Netherlands. Further information: School of Health Professions Education, P.O. Box 616, 6200 MD Maastricht, the Netherlands; tel: 31-43-3881524; fax: 31-43-3885639; email: she@oifdg.unimaas. nl; Internet: www.she.unimaas.nl
2 - 7 November, 2007, Washington DC, USA AAMC annual meeting. Organised by Association of American Medical Colleges (AAMC). Further information: Internet: www.aamc.org/meetings
J U N E
15 - 16 March, 2007, Maastricht, the Netherlands Visitors Workshop: A Primer on the Maastricht Approach to Medical Education. Organised by School of Health Professions Education, Faculty of Medicine, Maastricht University, Maastricht, the Netherlands. Further information: School of Health Professions Education, P.O. Box 616, 6200 MD Maastricht, the Netherlands; tel: 31-43-388 1524; fax: 31-43-3885639; email: she@oifdg. unimaas.nl; Internet: www.she.unimaas.nl
24 - 28 July, 2007, Singapore 18th Wonca World Conference: Human Genomics and its Impact on Family Physicians. Further information: fax: 65-6222-0204; email: rccfps@pacific.net.sg
25
Member and organisational News Messages from the executive committee To learn more about the personal beliefs, motivation and goals of our EC Members, we have invited Mohamed Moukhyer (EC Member of The Network: TUFH since 2005) and Rogayah Ja’afar (Chairperson of The Network: TUFH since 2005) to share their thoughts with us.
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 5
J U N E
2 0 0 6
EC Intelligence
26
Mohamed Moukhyer Mohamed Moukhyer qualified as a medical doctor in 1981. He worked as a medical practitioner in Sudan, Yemen, Scotland and Libya, then joined Ahfad University as a teaching assistant in 1992. In 1996 he obtained a Master Degree in Public Health from Maastricht University. After returning from the Netherlands, he par ticipated in the development of the Ahfad Centre for Reproductive Dr. Mohamed Moukhyer Health in collaboration with UNFPA in Sudan. In 2005 he obtained his PhD degree from Maastricht University in the field of Adolescent Health and Health Promotion. At present he is Assistant Professor in Adolescents Health and Health Promotion and Vice Dean for Academic Affairs at the School of Medicine, Ahfad University for Women, Sudan. “I think co-operation between countries and regions is very important. This co-operation enhances the chance for global participation towards the achievement of our goals, and it unites the qualified professionals from the entire world with all the diversifications in cultures and beliefs. The Eastern Mediterranean region is the link between eastern and western cultures. Countries in this region are similar in their cultural and social structure, and they contain highly qualified people, although the local circumstances highly affect the abilities of the population of these countries. We have to think beyond borders, be willing to work outside everybody’s home country, and keep an open mind. This approach will enable us to gain more experiences and abili-
ties, which in turn will be beneficial for our own countries. I also think we should focus more on practical issues (researches, projects, etcetera), beside our annual Conferences. We need people who dare to care and who are not afraid to stick their necks out to make a difference, starting with health professionals and health workers. But we must also involve students of different specialisations and graduates; they are the future leaders for change and the corner stones for development of the future Network: TUFH.” Rogayah Ja’afar Rogayah Ja’afar is Professor and Head of the Department of Medical Education at the School of Medical Sciences at Universiti Sains Malaysia (USM). She also previously served as Acting Deputy Dean of Academic and Student Development at USM. She received her Bachelor of Medicine and Surgery (MBBCh) from the University of Cairo, Egypt and her Masters in Health Personnel Education (MHPEd) from the University of New South Wales, Sydney, Australia; and holds Post Graduate Certification as a Health Partner Fellow from the University of Illinois, Chicago, USA. Ja’afar teaches Communication Skills and Women and Health in the undergraduate, graduate, and postgraduate Community Medicine programs at the School of Medical Sciences, USM. “As I rejoin The Network: TUFH EC, I cannot help but ponder on the various innovations and efforts within the Network: TUFH Dr. Rogayah Ja’afar fraternity that could make a difference to the rest of the world. We have dwelled a lot during our con-
ferences, meetings and publications on the concepts of partnership development and star alliance, the 5-star doctor, as well as showcasing new initiatives on women’s health, health of the elderly, interprofessional education, and integrating public health and medicine. These concepts and principles are familiar and have often been adopted within the Network: TUFH membership. However, a basic question that keeps coming back to me is whether we have been able to propagate these concepts and principles to a wider audience globally? A more fundamental question would be whether we have influenced and created an impact beyond The Network: TUFH that we can be equally proud of? The answer to the questions above is a definite YES, at least judging from my own personal experience and observations recently. My current involvement with a demonstration project of The Network: TUFH, as well as attendance in two separate events in Bangladesh and the Philippines point to a positive influence of Network: TUFH efforts in forging smart partnerships and alliances beyond its membership. They were opportunities to learn, compare notes, and share ideas and experiences; and also to promote and share the Network: TUFH and GHETS agenda. And I am sure that there are other examples of smart partnerships being propagated and extended by The Network: TUFH. I do know that colleagues such as Basanti Majumdar, Vic Neufeld, Art Kaufman, Portia Marcelo, Michael Gnilo, Raoul Bermejo and Charles Boelen have more interesting partnership stories to tell. Ultimately, I believe that the global community will gain when The Network: TUFH builds and encourages strategic alliances with more like-minded partners, particular in the developing world.”
TASKFORCES MEMBERS INTRODUCING
Ziauddin
Medical University
A tutorial group meeting at Ziauddin Medical University
0 1 | V O L U M E 2 5
We are conscious of the fact that we still have to achieve a lot, specifically in the areas of vertical integration, multidisciplinary education and assessment. The key element hampering our progress is the rigid rules on holding subject-based examination. More freedom from the accreditation body, coupled with a positive and continuous support from the faculty, are key elements for introducing further innovations.
N U M B E R
Programme Characteristics • A system-based model in the first two years, followed by integration within the three subjects of the 3rd year (Pharmacology, Forensic Medicine, Pathology). • Parallel modules of Biostatistics, Epidemiology, Survey Methodology. • Integration of social issues, such as women’s issues, according to modules relevance. • Introduction of problem-based learning phase-wise, that is initially in the first two years, followed by the 3rd and recently the 4th year. • Reduction in the quantum of lectures.
Sustaining the Model After ten years, the biggest challenge program sustainability. The strategy employed is to widen the core through faculty development, sustaining the ‘like-minded faculty’, and where possible to employ ‘likeminded faculty’ including our medical graduates. On the other hand, to share our model and experiences at different national and international forums, as well as publish more in indexed journals.
N E W S L E T T E R
The task of developing an innovative model was overwhelming. The challenges before the planners were what to implement, who will do it, where to do it, and how to do it. The first exercise undertaken was defining the competencies of graduates. The consensus was to prepare graduates with adequate knowledge and skills required of a physician (at undergraduate level) who could function effectively at individual, family, and community level. In addition, graduates would develop selflearning skills to cope with the exponential growth of knowledge and sophisticated technology.
2 0 0 6
Turning Point The turning point in the University history was the appointment of Professor N. A. Jafarey as the University’s Vice Chancellor in 1996. He is a dynamic and visionary leader, trained as a pathologist and researcher and well known for his radical views on education. He led the University with passion, commitment and risk. He is the architect of the many programmes initiated, including community-university
partnership, integrated curriculum, faculty development, and more for creating an environment for lifelong learning skills.
J U N E
In 1995, Ziauddin Medical University - a full member of The Network: TUFH - was created in the private sector through the legislative Ordinance of the Sind Provincial Assembly. Within ten years (1996-2005), its University Medical College (UMC) stands as an indigenous and innovative model in Pakistan, which is embedded in traditional medical education. The direction of the UMC since its inception is towards producing competent family physicians that are able to identify themselves as part of the healthcare system. The model reflects adequate community orientation, integrated teaching, and the utilisation of problem solving and self-learning approaches. The curriculum content was designed to reflect national priority health problems. It stresses the needs of the country and the profession. It is led and developed by a small group of Pakistani professionals, taking into consideration limited resources, growing needs, and challenges of knowledge and technology.
• Emphasis on community-based education. • Emphasis on producing critical thinkers and lifelong learners. Skills for practicing evidence-based medicine are inculcated through organised academic activities for critical appraisal of scientific literature. • Continuous assessment/feedback and remedial; the backbone of the system. • In contrast to the typical numerical/ alphabetical grading system, introduction of ‘Satisfactory/Unsatisfactory’. • An independent Examination Department supported by computer technology. • Faculty development.
Nighat Huda | Professor of Medical Education, Department of Medical Education & Examination, Ziauddin Medical University, Pakistan Email: nighathuda@zmu.edu.pk 27
Member and organisational News REPRESENTED AT INTERNATIONAL MEETINGS/CONFERENCES
Impact of Global Issues on Women and Children
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 5
J U N E
2 0 0 6
Members of the Women and Health taskforce gathered in front of the conference banner in Dhaka. Pictured, from left to right: Nighat Huda, Rogayah Ja’afar, Bridget Canniff Fellini, Shakuntala Chhabra, and Mohamed Moukhyer Dhaka, Bangladesh, February 2006 In February, the Network: TUFH Women and Health taskforce sent five representatives to the Third International Conference on the Impact of Global Issues on Women and Children, held in Dhaka, Bangladesh. The group - including members from India, Malaysia, Pakistan, Sudan and USA - were invited to present a workshop on our community-based model for promoting women-friendly healthcare around the world. Support for this activity was provided by Global Health through Education, Training and Service (GHETS), a programme development partner of The Network: TUFH that has worked closely with the taskforce since 2002. The conference was a unique opportunity to share the taskforce’s work with a new audience of women’s advocates from nearly 40 countries, including doctors, nurses, educators, researchers, journalists and lawyers. Taskforce members and colleagues were thrilled to have this opportunity to share ideas, resources and inspiration for improving women’s health, especially in developing countries. The taskforce members attending the conference were Nighat Huda (taskforce Chair, Pakistan), Rogayah Ja’afar (Malaysia), Mohamed Moukhyer (Sudan), Shakuntala Chhabra (India), and Bridget Canniff (Direc28
tor of International Programmes at GHETS, USA). Together, they led an afternoon workshop that highlighted the critical intersection between gender, health and other socioeconomic factors. During the workshop they encouraged participants to share observations on gender and health from their own experiences, and they discussed strategies to promote more gender-sensitive healthcare throughout the world, including use of the Women and Health Learning Package developed by the taskforce. Nighat Huda, Mohamed Moukhyer and Shakuntala Chhabra also spoke about current community-based women’s health education projects in Pakistan, Sudan and India, which they are implementing with support from the taskforce and GHETS. The workshop attracted 20 enthusiastic attendees from seven countries, providing an exciting opportunity for the taskforce to expand awareness and build global support for programmes that promote better health for women and their families, as well as for the work of The Network: TUFH. Bridget Canniff Fellini | Director of International Programmes at GHETS, United States of America Email: bridget@ghets.org
The Network: TUFH is being represented at meetings/conferences all over the world: • Taipei Healthy Cities Leaders Roundtable & International Healthy Cities Conference, October 2005, Taiwan. Represented by Gerard Majoor. • 117th Session of the WHO Executive Board, January 2006, Switzerland. Represented by Pertti Kekki and Gerard Majoor. • 3rd International Conference on the Impact of Global Issues on Women and Children, February 2006, Bangladesh. Represented by Nighat Huda, Rogayah Ja’afar, Mohamed Moukhyer, Shakuntala Chhabra, Bridget Canniff. • 9th International Seminar on Primary Health Care, March 2006, Cuba. Represented by Fernando Mora. • Roundtable Discussion with the Philippines Association of Medical Colleges, April 2006, the Philippines. Represented by Rogayah Ja’afar. • 3rd All Together Better Health, InterEd, April 2006, United Kingdom. Represented by Gerard Majoor. • 59th World Health Assembly, May 2006, Switzerland. Represented by Pertti Kekki.
Education for Health Indexed in SIIC We are happy to announce that, as of Volume 18, 2005, The Network: TUFH journal Education for Health is indexed in SIIC’s indexing and reviewing services. SIIC is the abbreviation of Sociedad Iberoamericana de Información Científica. SIIC publishes in Spanish and Portuguese, scientific information on medicine and healthcare. SIIC´s homepage is placed among those of greater impact and prestige among physicians, healthcare professionals and institutions of Latin America, Spain and Portugal. Please, access www.siicsalud.com/main/ ingresoa.htm to read SIIC´s Institutional Statement and field of endevour.
2 nd Global Health Course/ Roundtable Discussion PAMC Manila, the Philippines, April 2006 In April 2006 I was invited by the Medical College of the University of the Philippines to their 2nd Global Health Course and a roundtable discussion with the Philippines Association of Medical Colleges (PAMC).
N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 5
In my own briefing, I touched on the organisational frameworks of both The Network: TUFH and GHETS, and shared experiences
Business aside, I had an opportunity to tour downtown old Manila on foot with Michael Gnilo as the tour guide to hear and see the Spanish influence on this cityâ&#x20AC;&#x2122;s architecture and way of life. Mike is an extraordinary student leader with an equally extraordinary story to tell about his family and educational background. Two major outcomes of my Manila visit are: the strong interest and intent voiced by member representatives of the PAMC to join The Network: TUFH (both the President as the Executive Director of the PAMC promised to promote The Network: TUFH and GHETS at their next meeting in January 2007, and explore the best option for Network: TUFH membership); and a promise by medical students to resubmit a second proposal on the Global Health Course as a Western Pacific SNO driven yearly activity for possible funding by The Network: TUFH/GHETS, with Portia Marcelo agreeing to supervise this effort.
2 0 0 6
I was very impressed with the global health course objectives, structure and content as documented and presented by Portia Marcelo during the roundtable discussion. It was a five-day course on global health issues using plenary discussions, workshops and mentoring sessions. It was intended primarily for students of medicine, nursing, dentistry, and other allied health professions to deepen their understanding of health, thus preparing them to become more effective future health professionals. The objectives and framework are very similar to the ones adopted by The Network: TUFH in its activities and demonstration projects. Feedback from the student representatives who attended the roundtable meeting was also very positive.
I had the privilege during my visit and at the roundtable discussion to meet SNO members from the Philippines i.e. Raoul Bermejo, Michael Gnilo and Katrina Estacio, who formed the active team of student organisers of the Global Health Course, and who were very involved and committed to its philosophy, course structure and content. To me, this course is a solid indication of how members of our SNO can create a difference in their own regions and countries. We will need to groom this exciting group of people to take up the future leadership of The Network: TUFH!
To me, this course is a solid indication of how SNO members can create a difference in their own regions and countries. We will need to groom this exciting group of people to take up the future leadership of The Network: TUFH!
J U N E
The invitation came from Portia Marcelo, the Chairperson of the 2nd Global Health Course, whom I had met for the first time during the Network: TUFH Conference in Vietnam in 2005. Unfortunately, I could not get away early enough to attend the Global Health Course, but I was able to make it for the roundtable discussion. There I briefed the Deans of the Medical Colleges about the work of The Network: TUFH and GHETS in helping to develop international partnerships in health professional education, training and services. And I took the opportunity to invite more medical colleges in the Philippines to join The Network: TUFH.
of a number of international partnership projects such as the University Partnership Programme and the Women and Health taskforce, which successfully unites individuals and schools from across the world to make a difference in the quality of life of women and communities globally.
Rogayah Jaâ&#x20AC;&#x2122;afar | Chairperson of The Network: TUFH, Malaysia Email: rogayah@kb.usm.my 29
Member and organisational News TASKFORCES
2 0 0 6
In the report, the Education Working Group of the taskforce recommended
the Clinical Prevention and Population Health Curriculum Framework (recently published in Am J Prev Med. 2004 Dec;27:471-6) to be used for discussions in developed and developing countries, adapting the materials to their own needs and priorities. The four basic components recommended for public health education within medical education are: evidence base for practice; clinical preventive services and health promotion; health systems and health policy; and community aspects of practice. • Following the work done in Vietnam, and the very useful discussions and recommendations in the five sessions of the Conference, it was decided to organise the future work of the taskforce around the two main dimensions related to integration: education on integration; and practice of integration.
The purpose of these two groups is to discuss and elaborate on the process conducive to implementation of integration, both in education and in practice. • In preparation for the forthcoming Conference of The Network: TUFH in Belgium, the taskforce is engaged in organising the following activities: a thematic poster session; a mini-workshop; a brown bag session; and a taskforce meeting. The specific topics and the structure of each activity are currently under discussion by members of the taskforce and will be soon announced through the website. Jaime Gofin | Chairman taskforce Integrating Medicine and Public Health Email: jaime@md.huji.ac.il
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 5
• A report made prior to the Vietnam Conference, compiling the work done by three sub groups of TF, has been submitted to the Executive Committee of The Network: TUFH (soon available on the website). It is proposed that the recommendations will be considered as part of the Network TUFH’s policy regarding integration.
J U N E
Integrating Medicine and Public Health: Update During the last Network: TUFH Conference held in Vietnam, the taskforce on Integrating Medicine and Public Health organised five sessions which were well attended (see details on the website). Following these activities the taskforce engaged in:
NEW CHAIR Interprofessional education: New Chair Betsy Vanleit has passed the baton of Chair of the taskforce Interprofessional Education (IPE) to Dawn Forman. Betsy has accepted a one-year appointment in Cambodia, to work in community-based health. She will be working for Handicap International, which is based in Brussels, but does a lot of work in Asia and Africa. We hope that through Betsy, The Network: TUFH and Handicap International - which employs many health professionals in community settings - can establish a relationship. Dr. Dawn Foreman
30
Dawn Forman is Director of Faculty, School of Education, Health and Sciences at the University of Derby in the UK. Dawn has been very active in the IPE taskforce, and she has attended a number of Network: TUFH conferences the past years. We would like to congratulate Betsy with her new and exciting appointment, and thank her for reviving the taskforce during her leadership - and we are looking forward to a bright future under the leadership of Dawn. Women and Health: New Chair The Women and Health taskforce would like to announce a transition in its leadership. After serving as taskforce Chair since 2003, Rogayah Ja’afar was elected as Chair of The Network: TUFH in November 2005, and has therefore decided to step down from her leadership role in the Women and Health taskforce. Rogayah will continue to be an active member of the taskforce and help guide its work in the future.
Rogayah will be succeeded by Nighat Huda - a long time Network: TUFH member and co-founder of the taskforce in 1991 - who was elected as taskforce Chair in January 2006. Nighat is currently the Controller of Examinations in the Department of Examinations at Ziauddin Medical University, a department she established to plan and implement assessment of both undergraduate and postgraduate education on scientific principles. Thank you Rogayah, for your inspiring, lively and visionary leadership of the taskforce over the past several years; and welcome Nighat into your new and exciting role. Ms. Nighat Huda
ABOUT OUR MEMBERS
“A Wonderful Initiative!”
NEW MEMBERS
Dear Women and Health Taskforce, I just wanted to take this opportunity to thank all those who were involved in creating the Women and Health Learning Package (WHLP).
Full Members • Faculdade de Ciências Médicinas, Universidade Estadual de Pernambuco, Recife Pernambuco, Brazil; • College of Medicine, ChungNam National University, Daejeon Metropolitan City, Republic of Korea; • Medicare Health Professionals College, Machsu School of Clinical Officers, Kampala, Uganda; • Medical School, American University of the Caribbean, Sint Maarten, Netherlands Antilles.
Fortunately, at the Faculty of Medicine at Makerere University (Uganda) two resources materials have been implemented into our PBL curriculum via tutorial problems. The materials that we are currently reading for our tutorial problems are: Adolescent Health and Violence Against Women.
N E W S L E T T E R N U M B E R 0 1 |
Sincerely yours, Ramullah Kasozi
2 5
Moving on: Changes in Institutional Leadership The Secretariat received information about changes in leadership with the following Network: TUFH members. We have listed the names of the former and new (Vice-) Deans/ Directors for you: • Dr. Wilfried Diener, Facultad de Medicina, Universidad de la Frontera, Temuco, Chile has been replaced by Dr. Eduardo Hebel Weiss; • Dr. Damtew W/Mariam, Jimma University, Jimma, Ethiopia has been replaced by Dr. Solomon Mogus; • Dr. Rivka Carmi, Faculty of Health Sciences, Ben-Gurion University of the Negev, BeerSheva, Israel has been replaced by Dr. Shaul Sofer; • Dr. Arnuparp Lekhakula, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand has been replaced by Dr. Mayuree Vasinanukorn.
V O L U M E
Position Paper News The Position Paper Community-based Care for Older Persons is now available: www.the-networktufh.org/publications_ resources/positionpapers.asp (corresponding author on behalf of the writing group: Larry Chambers). The Network: TUFH Position Papers must be seen as starting points for further discussion. We would very much appreciate to receive your comments on this new Position Paper. Your reaction can be sent to secretariat@network.unimaas.nl
2 0 0 6
Just a recommendation: to better enhance future modules (especially material that has potential to be implemented into a school’s curriculum and/or learning process), it would be nice if the authors created study questions at the end of the document which promote the student to seek knowledge, think in another perspective, and appreciate other views of the same topic. Other than that, WHLP is a wonderful initiative and I look forward to future modules!
Individual Members • Dr. Jaime Gofin, School of Public Health and Community Medicine, HadassahHebrew University, Jerusalem, Israel; • Dr. Vibhore Prasad, Oxfordshire Deanery, The Horton Hospital, Wakefield, West Yorkshire, United Kingdom; • Dr. Iona Black, Chemistry Department, Yale University, New Haven, CT, United States of America; • Dr. Fadil Oenzil, Faculty of Medicine, Andalas University, Padang, Sumatera Barat, Indonesia;
J U N E
As a student, I have appreciated the information provided in the WHLP and how well it has been incorporated into my learning experience. Both of the above resources give a nice overview of the topic at hand, and motivate the reader to go seek more information about the topic.
• Dr. Gad Ndaruhutse Ruzaaza, Mbarara University, Mbarara, Uganda.
31
Member and organisational News
The Network towards unity for health
ABOUT OUR MEMBERS
Interesting Internet Sites The Network: TUFH Interactive - Recommended Internet sites www.the-networktufh.org/publications_resources/interactive.asp Our health and theirs: Forced migration, othering, and public health www.sciencedirect.com The New World of Global Health www.sciencemag.org February 2006 Bulletin of WHO www.who.int/bulletin/volumes/84/2/en/ Applying Public Health Principles to the HIV Epidemic http://content.nejm.org/cgi/content/full/353/22/2397?query=TOC The Public Health Observatory Handbook of Health Inequalities Measurement www.sepho.org.uk/extras/rch_handbook.aspx Directory of International Grants and Fellowships in the Health Sciences: Grant Opportunities and Fellowship Opportunities www.fic.nih.gov/news/DirectoryGrants.html www.fic.nih.gov/news/DirectoryFellowships.html Global Forum for Health. No Development without Research, 2005 www.globalforumhealth.org December 2005 Bulletin of WHO www.who.int/bulletin/volumes/83/12/en/ WHO website for health Services managers www.who.int/management
Editors: Marion Stijnen and Pauline Vluggen Language editor: Sandra McCollum The Network: Towards Unity for Health Publications P.O. Box 616 6200 MD Maastricht The Netherlands Tel: 31-43-3885633, Fax: 31-43-3885639 Email: secretariat@network.unimaas.nl www.the-networktufh.org
Lay-out: Graphic Design Agency Emilio Perez Print: Drukkerij Gijsemberg
N E W S L E T T E R
N U M B E R
0 1
|
V O L U M E
2 5
J U N E
2 0 0 6
Newsletter Volume 25 | no. 1 | June 2006 ISSN 1571-9308
Tribute to… * Shakuntala Chhabra (Head of the Department of Obstetrics & Gynaecology, Kasturba Hospital Sevagram, India) was awarded by FIGO (International Federation of Gynaecology and Obstetrics) the Distinguished Community Service Award for Emergency Obstetric Care. Chhabra and her department have been able to bring down the maternal mortality in their rural community. They also work on social aspects of obstetrics, such as care for unwed mothers with advanced unwanted pregnancy. The aim of the award is to honour individuals actually providing emergency obstetric care in an underserved population, particularly rural areas, or directly administering facilities providing such services.
32
* Charles Engel (Centre for Higher Education Studies, University of London / Honorary Member of The Network: TUFH) has been appointed Royal Academy of Engineering Visiting Professor in Engineering Design for Sustainable Development, in the Faculty of Engineering and Physical Sciences at the University of Manchester, UK. The remit to develop a pilot module towards an eventual strand within the Faculty’s curricula relates closely to his continuing interest in the development of an interdisciplinary course for adapting to change and for participating in the management of change on behalf of society at large. Engel’s chapter The Ultimate Challenge: Is it Sustainable? with Bland Tomkinson is due to be published in The Realities of Change: Interventions to Promote Learning and Teaching in Higher Education (L. Hunt, A. Bromage & B. Tomkinson (Eds). London: Routledge. July, 2006).
* On April 28, 2006 Gerard Majoor (Medical Education Institute, Faculty of Medicine, Maastricht University/Past Chairman of The Network: TUFH) was awarded the Royal title of Officier in de Orde van Oranje Nassau (Officer in the Order of Orange Nassau; Orange Nassau being the family name of the Dutch Royals). He got this award mainly for his dedication in developing PBL in medical education, in the Netherlands and abroad. For countries in Africa, Asia and Latin America, his approach to medical education can be seen as a plea for more attention for health problems of the underprivileged. In his acceptance speech, Majoor said that he shares this award with all the people that have worked with him in innovative medical education over the years, especially his colleagues in developing countries.