The Network towards unity for health
VOLUME 26 | Number 02 | DECEMBER 2007
NEWSLETTER
Thank you Art, for eight years of inspirational leadership as Secretary General. The last few months we have kept our ear to the ground, listening to what the Network: TUFH membership thinks of Arthur Kaufman: you have stolen many hearts with your ‘warm and funny nature’ and your ‘great dance moves’, but you have also made a big impression as a leader who is ‘visionary’, ‘wise’, ‘a good listener’, ‘supportive’, ‘respectful’, ‘committed’, with ‘quick insight’, ‘good judgement’ and an ‘infectious optimism and passion for work’. Some of these words probably also rang in the judges’ heads when they awarded you the WONCA World Award for Excellence in Healthcare: The 5-Star Doctor 2007. This award has only been awarded once before, in 2004… to Jan de Maeseneer, our new Secretary General! A good sign for the future! So thank you Arthur Kaufman, and welcome Jan de Maeseneer! Marion Stijnen and Pauline Vluggen Editors
In the Newsletter we refer to The Network: Towards Unity for Health as The Network: TUFH.
In this issue, among others: “What Kind of a Conference Is This, I Mused?” 5 Healthcare for the Indian Elderly 10 A Network of Community Activities in Primary Care in Spain 12 The Greatest Challenge of Interprofessional Education 14 Community Care Bags 15
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contents 03 Foreword New Challenges for The Network: TUFH 04 The Network: TUFH in Action 04 Annual International Conference ‘South-South’ Collaboration: Association of African Health Institutions | Kampala Call | ‘What Kind of a Conference Is This, I Mused?’ | Listening, Planning and Evolving our Conferences | Winning Posters | The 2008 Conference 07 Book Review HIV, Health and Your Community: A Guide for Action 08 Position Paper The Ultimate Challenge? Higher Education for Adapting to Change and Participating in Managing Change 10 Improving Health 10 Care for the Elderly Healthcare for the Indian Elderly 11 Rural Health Enhancing Community-University Partnerships in a Rural State 12 Community Action A Network of Community Activities in Primary Care in Spain 13 International Health Professions Education 13 Interprofessional Education UK Centre for the Advancement of Interprofessional Education | The Greatest Challenge of Interprofessional Education 15 Social Accountability Community Care Bags 16 Yellow Papers Jimma University Experience in CBE 17 Problem-Based Learning and Community-Based Education PBL System Guide of Variables 17 International Diary 17 Diary 2008 18 An Interview with Arthur Kaufman: “Be Reflective, Sit, Listen” 19 Students’ Column 19 Student Interview The Big Five 20 Member and Organisational News 21 Messages from the Executive Committee New Members Executive Committee | New Co-Editor EfH | Moving On: Changes in Institutional Leadership 22 Introducing Members Igbinedion University, Nigeria | Advertising in the Network: TUFH Newsletter 22 Taskforces Taskforces Reporting | Taskforce Interprofessional Education: An Update 24 Represented at International Meetings/Conferences Partnerships Working Together 25 Re-Assessing Full Members “Teaching, Research and Services Are Oriented to the Community” 26 About our Members Members Helping Members | A Passion for… | Tribute to… | New Members
FOREWORD
New Challenges for The Network: TUFH Africa, during the same period, life expectancy rose by four months”.
Dr. Jan De Maeseneer
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References BOSSUYT, N., GADYENE, S., DEBOOSERE, P. & VAN OYEN, H. (2004). Socio-economic inequalities in health expectancy in Belgium. Public Health, 118, 310. DE MAESENEER, J., WILLEMS, S., DE SUTTER, A., VANDE GEUCHTE, I. & BILLINGS, M. (2007). Primary health care as a strategy for achieving equitable care: A literature review commissioned by the Health Systems Knowledge Network. www.primarycare.ugent.be
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How can The Network: TUFH address social determinants of health? I think there are three important challenges. The first is to increase the social accountability of our training programmes, so that for all the health workers we train, it becomes clear how important it is to address social determinants of health through intersectoral action. Secondly, it is clear that primary healthcare may be a strategy to achieve equitable care. So developing horizontal comprehensive primary healthcare in the communities is of the utmost importance (De Maeseneer et al., 2007). Thirdly, as the ‘Kampala Call’ (see page 4) made it clear, efforts for recruitment, education and retention in order to face the internal and external brain drain are major points. In this respect, there is increasing concern about the way vertical diseaseoriented programmes divert skilled health personnel from the local primary care system towards highly funded vertical projects. Combined with the international brain drain, this is a real threat for the
The many contributions at the Kampala Conference once more made it clear how committed all participants are to address social determinants of health and to improve access to quality healthcare. Participation in campaigns like Fifteen by 2015 enables The Network: TUFH to broaden the academic perspective towards focused action in partnership with other important stakeholders. Thanks to the efforts of all of you, together we can make a difference!
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This new mission-statement emphasizes the contribution of The Network: TUFH to equity in health. This is in line with the actual developments in the World Health Organization. On September 6th, 2007, the Commission on Social Determinants of Health launched its interim statement: Achieving health equity: from root causes to fair outcomes (www.who.int/social_ determinants/en). The interim statement illustrates in a very concrete way that there are still major inequalities between countries: “Consider three children: one African, one South-Asian and one European. At birth each one representing the country average has life expectancy of less than 50 years. The African and SouthAsian figures come from 1970, the European figure from 1901. Over the last century life expectancy for the European child increased by about 30 years, and is still rising. Between 1970 and 2000 the South-Asian life expectancy rose by 13 years, while for the child in Sub-Saharan
The analysis makes it clear that those huge differences are related to social determinants of health. And one of those social determinants is the healthcare system itself.
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In Kampala, after discussions in the General Council, the mission statement of The Network: TUFH was rephrased in the following way: “The Network: Towards Unity for Health is an international organisation of academic health professions institutions and organisations promoting equity in health through community-oriented education, research and service. It is a non-governmental organisation in official relationships with the World Health Organization”.
Differences are not only huge between countries but also within countries. Let’s look at my own country, Belgium. The healthy life expectancy at the age of 25 for men with higher education is 17 years more than for men with only primary school or less; at the age of 25, for a woman with only primary school or less, the healthy life expectancy is 24 years, whereas for a woman with higher education it is 49 years (Bossuyt et al., 2004).
future of healthcare in developing countries. Therefore, The Network: TUFH, together with the World Organisation of Family Physicians (WONCA: www.globalfamilydoctor.com), Global Health through Education, Training and Service (GHETS: www.ghets.org) and European Forum for Primary Care (EFPC: www.euprimarycare. org) launched the campaign Fifteen by 2015. The aim of this campaign is that, by 2015, 15% of the new vertical disease-oriented programmes funded by big donors like PEPFAR, Bill and Melinda Gates Foundation, Global Fund should be invested in strengthening local primary healthcare (www.15by2015.org).
Jan De Maeseneer | Secretary General Email: jan.demaeseneer@ugent.be 3
THE NETWORK: TUFH IN ACTION ANNUAL INTERNATIONAL CONFERENCE Every year The Network: TUFH organises an international scientific and networking conference. Here you find a retrospective of this year’s Conference (Kampala, Uganda, from 15 - 20 September), and a preview of the 2008 Conference in Chía/Bogota, Colombia).
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‘South-South’ Collaboration: Association of African Health Institutions The African region continues to be ravaged by the AIDS Pandemic in almost all the sub-Saharan African countries. Brain drain to rich affluent nations of the Western world continues to seriously affect these countries staffing levels in professions such as nurses, physicians, and biomedical scientists. Conflicts and wars in Sudan, Somalia, Chad and other pockets of the continent have also displaced settled communities into refugee camps. Regional Network At the Network: TUFH 2006 Conference in Belgium, the Association of African Health Institutions (AAHI) was founded. After the Conference, representatives from Eastern Africa (Sarah Kiguli, Makerere University), Western/Central Africa (Godwin Aja, Babcock University), Southern Africa (Bernard Groosjohan, Catholic University of Mozambique), and Simeon Mining (EC Member of The Network: TUFH) continued corresponding. A meeting was held in Kampala on 4 - 5 May 2007 to prepare a constitution and a grant proposal with the assistance of Global Health through Education, Training and Service (GHETS). The objectives were clustered in four main areas: • education - to facilitate the training of health workers and continuing professional development; • professional development – integrate knowledge from key health stakeholders across languages and countries; • research – develop partnership and linkages for African health institutions; • leadership training and development. From the meeting a concept paper was set up for a mini-workshop for the Network: TUFH Uganda Conference: Increasing 4
Health Workforce Training and Capacity in Low Resource Settings: Experience from the African Association of Health Institutions (AAHI).
from l. to r.: Sarah Kiguli, Simeon Mining, Bernard Groosjohan, and Godwin Aja Two full members (the College of Igbinedion University, Nigeria and Chainama College of Health Sciences, Zambia) and eight corresponding members are recruited. Challenges South–South collaboration should be encouraged and fostered in addition to the already existing North-South collaboration. Note that there are several challenges in the region: • it is a too huge and vast region to be effectively covered by one EC member, hence the start of AAHI and sub-regional team leaders; • language barriers and political set ups: English, French, Portuguese and Spanish makes it difficult to initiate partnership and linkages; • lack of IT infrastructures: making communication difficult between institutions.
Simeon Mining | Senior Lecturer, Moi University, Kenya Email: mining@mtrh.or.ke
Kampala Call The 2007 Conference of The Network: TUFH in Kampala, Uganda discussed Human Resources for Health: Recruitment, Education and Retention. Every country is confronted by two types of medical migration. There is an internal ‘brain drain’ away from generalism and primary care to specialisation, sub-specialisation and disease-oriented practice. In the developed world this is most noticed in an increasing crisis in numbers of family physicians and general practitioners. In the developing world it is most noticed in the ‘vertical’ disease-oriented programmes, attracting the majority of international donor funding, extracting health workers away from local primary care systems. This weakens healthcare provision at the district level, and ultimately leaves the primary care programme at being unsustainable. The crisis in the developed world in primary care doctors and nurses leads to the second brain drain of international medical migration from the developing to the developed world. The Network: TUFH Kampala Conference calls for different strategies to be implemented across all countries: The Network: TUFH supports the WONCA Singapore statement that calls for investment in training and support for family physicians at undergraduate, vocational training and continuing career path. The Network: TUFH appeals to all stakeholders to support Governments of countries in striving for a better solution to the health workforce crisis through improved working conditions, increased salaries, permanent education, safety and security, for all primary healthcare workers. The Network: TUFH - in co-operation with the World Organisation of Family Physicians (WONCA), Global Health through Education, Training and Service (GHETS) and European Forum for Primary Care (EFPC) - proposed that by 2015 15% of all new resources in vertical disease-oriented programmes should be invested in strengthening the local primary healthcare system.
“What Kind of a Conference Is This, I Mused?”
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The Network: TUFH Conference in Kampala, Uganda - the ‘Pearl of Africa’ was an unforgettable experience. An octopus network. A unique life experience.
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When I looked at the programme of the Conference, I found there was a dearth of the usual didactic lectures, seminar presentations, plenary sessions, panel discussions, etcetera. Then there were these ‘thematic poster sessions’ or whatever. Where were the legendary oral presentations? The PowerPoint presentations? What kind of a conference is this, I mused? Morning they say, shows the day. At the very first workshop session, we were asked “What are your expectations? What did you come to this session hoping to gain?”. This was new. What I came to gain? A lot! I want to become a Professor of Family Medicine! Period! “O.K. then, fair enough! We will help you”. Help me? So this was a conference to help people become whatever they wanted to become! Incredible! Not for the professors and the experts and the ‘gurus’; I am the centre of the conference! A participant-centred conference! Brilliant!
As the new Secretary General, Jan de Maeseneer has said in his acceptance speech, everybody at The Network: TUFH has a story to tell. And I add, somebody at The Network: TUFH will listen to your story, however long, however complicated, however strange. And somebody will help you make sure that your story eventually has a happy ending. A happy ending for the community which you serve. A happy ending for the institution where you work. A happy ending for the colleagues that you work with. A happy ending for the health of your community. And finally, a happy ending for you.
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Little did I know that my earlier research proposal and request for funds on the International Classification on Primary Care - that was sent electronically to the President of the WONCA International Classification Committee (WICC), and was flashed around the globe by the President of the Committee - had attracted the attention of this strange Professor from Belgium, who himself was a high ranking member of the Classification Committee (I was later to discover!). For an obscure African Medical
Scientist, struggling to prove to his specialist academic colleagues at his College of Medicine that Family Medicine has something to contribute to the world of academic Medicine, the invitation was a break of a lifetime. Needed and timely help had come. It had come in the guise of a top official of a hitherto ‘unknown’ organisation: The Network: TUFH. The Pre-Conference Meeting of six days, that took place at the same venue as the Conference, more than confirmed that.
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“Then there were these ‘thematic poster sessions’ or whatever. Where were the legendary oral presentations?”
Dr. Olayinka Ayankogbe (at the front) during the Conference
There were enough materials at that Conference (the workshops, the excursions, the poster presentations, the cultural shows, etcetera) to allow all the 140 million Nigerians in the country to become Professors of Primary Care in seven days. The sheer enormity of health and medical information; the expertise in medicine, public health, nursing, sociology, psychology, with endless online resources (both academic and financial) and everything else in between, was just incredible. I should know. I have been involved in Family Medicine/Primary Care for the past 27 years.
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Participant Olayinka Ayankogbe concerning his experiences at the Network: TUFH Conference in Kampala, Uganda. Monday 4th December 2006. I opened my inbox and found an invitation from some Professor in Belgium, MD. PhD, asking me to collaborate in an International Consortium of Family Medicine University Departments in East and Southern Africa, led by a Promoter University in Europe, bidding for an EU contract. My first thought was that there had been some mistake. Some high powered international organisation had strayed unknowingly into my inbox. I was looking for the typical disclaimer stating “if this email has been mistakenly sent into your inbox, please disregard and delete”, but there was none. I looked at the mail again. It was addressed to me. My full names were spelt out. I was cautious. Had I won a lottery or something?!
See you in Colombia in 2008! Olayinka Ayankogbe | Senior Lecturer, College of Medicine, Institute of Child Health & Primary Care, University of Lagos, Nigeria Email: yinayanks@yahoo.com
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THE NETWORK: TUFH IN ACTION ANNUAL INTERNATIONAL CONFERENCE
Listening, Planning and Evolving our Conferences
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In the spirit of Stewart Mennin’s opening presentation in Kampala, the Network: TUFH Conference Evaluation Committee strives toward maintaining an environment of permanent learning through listening, planning and evolving our Conferences to best meet the needs of our participants. As the Chair of the Committee, I would like to personally thank the Committee Members and Conference attendees who took the time to contribute to the evaluation.
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Not many surprises were found in this year’s evaluation results. Participants felt the Conference was an unprecedented opportunity to share ideas in an honest, collegial and culturally respectful environment. Community site visits, overall Conference organisation and the interactive nature of the workshops were all emphasized as exceptionally beneficial to the learning experience. Conference catering was not well rated, along with a flood of complaints regarding the accommodations, but well deserved thanks to the Network: TUFH staff for running interference with the challenges the Hotel Africa presented! Rather than rambling on with the general points on the good and the bad which vary little from year to year, I will use this opportunity to discuss one result which presents a true learning opportunity. Posed with the statement “The Conference has given me new ideas for designing effective curricula and courses to educate and retain healthcare providers”, Conference attendees responded with mean score of 3.65 (5.0 being ‘agree completely’). This was the lowest score for any of the 34 evaluation questions posed. Given that this statement represents the crux of the Kampala Conference, we need to critically look at how and what is being presented at the Conference to assure participants those topics and ideas are truly translational. This is not an easy task given the breadth of cultures and situations repre-
sented at the Network: TUFH international Conferences, but working through the question of applicability is something best addressed at these ‘teachable moments’. The challenge to improving this result lies not with the Conference organisers, but primarily with workshop leaders, poster session facilitators and key note speakers. Consequently, participants must also do their part to use the time they have with course leaders to assure an understanding of topics that lends itself to applicability in their home countries.
Community site visits were emphasized as exceptionally beneficial to the learning experience
We will strive to improve this result in Colombia next year and look forward to a healthy, productive year until we come together again in September, 2008! Please go to www.the-networktufh.org/ conferences/previousconferences.asp for the evaluation report.
Joseph Ichter | Chair Conference Evaluation Committee Email: jichter@salud.unm.edu
Community site visits were emphasized as exceptionally beneficial to the learning experience
Moses Barasa (l) receives the Best Poster Award Winning Posters The following posters were awarded with a prize during the Network: TUFH Conference in Kampala, Uganda: • Best Poster Award: The Local Community: An Important Human Resource for Health, by Moses Barasa (student, Faculty of Health Sciences, Moi University, Kenya). • Poster Award: Kenyan Medical Officer Interns ‘Knowledge and Attitudes Towards Healthworkforce Emigration’ by Job Siekei Mogire (student, Faculty of Health Sciences, Moi University, Kenya). • Student Poster Award: Students Towards Unity For Health: Working Group Founded by the Medical Students, Ghent, by Chloë De Roo (student, Faculty of Medicine and Health Sciences, Ghent University, Belgium).
The 2008 Conference In the second half of September 2008 The Network: TUFH will organise its annual Conference in collaboration with the Facultad de Medicina, Universidad de La Sabana, Colombia. This Conference will be held in Chía-Bogota, Colombia, September 27October 2, 2008. The theme of the Conference is Adapting Health Services and Health Professions Education to Local Needs: Partnerships, Priorities, and Passions. After the Conference you can choose one of the following Post-Conference Excursions: • Healthcentre Aqua de Dios (October 3, 2008), • Valledupar - Sierra Nevada de Santa Marta (October 3 - 5, 2008). Available from early 2008: Conference site: www.the-networktufh.org/conference Preliminary programme: www.the-networktufh.org/conference/programme.asp Registration (Please note that the deadline for early registration is June 1, 2008.): www.the-networktufh.org/conference/registration.asp Abstract submission (for Thematic Poster Sessions): www.the-networktufh.org/conference/abstractchoice.asp Proposal submission (for Mini-workshops or Didactic Sessions): www.the-networktufh.org/conference/abstractchoice.asp
BOOK REVIEW
HIV, Health and Your Community: A Guide for Action Book Review of: HIV, Health and Your Community: A Guide for Action Authors: Reuben Granich and Jonathan Mermin ISBN: 0-942364-40-6, 238 pp.
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In writing this book the authors achieved their goal of creating a comprehensive and comprehensible reference text on HIV for outreach and healthcare workers in com-
References SIMONE, R. (Series Producer and Reporter) (2006, May 30 & 31). The Age of AIDS (Television broadcast). Part One and Two, Frontline. United States: Public Broadcasting Service.
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At times issues raised in the book may need to be expanded upon, and if this book is used as a text accompanied by a lecture, the lecture may help develop certain topics. In discussing mitigating HIV risk to healthcare workers in clinics, the authors did not address the concerns specific to midwives of HIV+ women, but did address avoiding contracting or spreading HIV in a
This book does particularly well in addressing HIV world-wide, and the authors have carefully tailored their examples and data to address issues on a global scale. The Appendix outlines current HIV medicines, other opportunistic infections, STIs, and their treatments, and would best be utilised by healthcare workers in particular, although it is of some use to other readers. This forth printing provides updated information on antiretroviral medicines and other treatments commonly given to HIV+ patients, though the authors are careful to caution that treatments change frequently over time and may not be available in all areas. Updated epidemiological data is also included.
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The scope of the book focuses on community-based outreach, diagnosis, care, treatment, education, counselling, and prevention; and covers these topics in a fairly thorough manner. The text is complemented by specific tables with descriptive titles and real world examples. Readers may find that these tables contain the most useful information in the book. The authors do a solid job covering the basics of HIV, as well as more advanced topics, such as issues specific to women and children; addressing needle use; stigma/myths; the connection between other STDs/tuberculosis/substance abuse and HIV; how poverty, war, cultural factors, and lack of education in third-world countries may necessitate specialised outreach efforts; the importance of using neutral language during counselling sessions; and considerations in seeking funding for community-based projects.
munities around the world. Counselling women who may be in relationships where patterns of violence, power and control are present, and the importance of developing a microbicide that would allow women to protect themselves independent of the cooperation of their partners are deserving of more direct attention, however (Simone, 2006). The text could be supplemented as needed, particularly in industrialised nations where information on HIV is more readily accessible but where more complex issues in doing outreach and counselling may emerge. The issue of men who have sex with men has historically polarised HIV outreach efforts (Simone, 2006). In the USA and Europe, where knowledge of HIV on the whole may be more sophisticated but where politics have often played a negative role in the dissemination of needed information, this book may not be as complete in addressing its intended audience. Although the authors do address the history, ‘misunderstandings’, stereotypes, and myths about HIV at points throughout the book, these points tend to get lost in the conversational style of the book and could be better addressed by delegating a full chapter on this subject.
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The authors’ stated intended audience is local health and community workers who have a desire to learn more about HIV. However, this book may be more widely applicable, such as students studying public health education and the educators teaching them, community volunteers, or members of the general public interested in learning more about HIV/AIDS.
more general sense, and needed information may be extrapolated from this advice (page 66). In the chapter entitled How to Support and Care for a Person with HIV, the authors could have included more detailed information on assessing suicide risk and intervening with patients who appear to be in imminent danger of harm to themselves or others, such as a lover (pages 112, 116, 124). However, on the whole the authors have done a nice job in attempting to broadly address their subjects in a straightforward manner.
This review has been published before in Education for Health, Volume 19, no. 3, 2006. Vanessa E. Ford | Howard Brown Health Centre, United States of America Email: vanessaeford@gmail.com
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THE NETWORK: TUFH IN ACTION POSITION PAPER The Network: TUFH Executive Committee decided to undertake the writing of a series of ‘Position Papers’ on issues that are closely related to the aims and objectives of our organisation. They must be seen as starting points for further discussion. You may contribute by submitting a letter to secretariat@network.unimaas.nl, by participating in sessions on these issues at Network: TUFH Conferences, or responding to the electronic versions of these Position Papers at the Network: TUFH’s website (www.the-networktufh.org/publications_resources/positionpapers.asp).
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The Ultimate Challenge? Higher Education for Adapting to Change and Participating in Managing Change We hope that you will consider the reasons for our suggestion that future graduates of all disciplines and professions, in every country should to be able to adapt themselves to change and to participate in the management of change - not only within their own discipline or profession, but also on behalf of society at large. The latter responsibility will call for interdisciplinary, interprofessional and international collaboration with Governments across the world. Which changes are likely to face the health professions during the life span of our graduates? E.g.: • The emergence of new diseases and a further increase in anti-microbial resistance. • Accelerated transmission of infectious diseases, due to air travel, tourism, adverse living conditions, and migration. • A growing pandemic of non-communicable disorders, largely due to inappropriate life styles - with consequent affect on earning power. • Growth in the number of elderly patients with a range of needs for healthcare. • Persistent unequal access to healthcare services with consequent economic and social disadvantages. We accept that these are but some examples of the changes that bear on the professional and personal lives of our colleagues. Which changes, not only local but dependent on global developments, are likely to 8
influence every one, not only the health professions, not only in one country but world-wide? Which changes should thus be regarded as of supra or pan-professional and international concern? E.g.: • The continuing economic burden of having to service large national financial debts, not infrequently aggravated by an imbalance in international commercial relationships (viz the disappointing outcome of the G 8 2006 Meeting). • Continuing growth in the number of the world’s population existing at or below subsistence level. • Unregulated use of technology exacerbating the overuse of irreplaceable raw material, related to geopolitical tension, e.g. for access to oil and also to water. What, then, ought to be the responsibility of the professions, including the caring professions in relation to such supra-professional problems? E.g.: • The essential research, as well as related mitigating and resolving interventions are primarily of an international, interdependent, long-term nature. • However, Governments might not wish to hazard popular support during their limited tenure without an assurance of major support from a segment of the community which can provide expert, long-term and non-political support. Such support for the necessary research, mitigation and remediation of the interrelated causes and consequences of our global problems would necessarily involve the full spectrum of disciplines
and professions, including agriculture, architecture, behavioural sciences, engineering, geography, health, law, sociology, veterinary sciences. • As the problems are so interdependent, the professions would need to be prepared to contribute collectively from their constantly growing experience and expertise towards the national and international exploration of the causes and consequences of the world’s major problems. • Just how realistic is it to expect all the professions to adopt such wide ranging commitments? We would propose that the professions would need to consider a major change which would enable them to extend their traditional responsibilities to include outward looking, proactive, interprofessional and intersectoral collaboration. Our proposition is, therefore, that the next generation of professionals should benefit from an education which is deliberately aimed to equip them with the requisite abilities and skills for adapting to change and for participating in the management of change which requires interprofessional collaboration. This extended role as collaborators in confronting the intricate problems of our planet would contribute significantly to a renaissance of the corporate reputation and standing of the professions. Why should the caring professions take the initiative? Human values were sadly ignored during the last century, and the prospect of
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You can read the unabridged version of this Position Paper at www.the-networktufh.org/ publications_resources/positionpapers.asp
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In 2001 the Secretary General and the Associate Secretary General signed A Proposal for an International Initiative by the Network: Community Partnerships for Health through Innovative Education, Service and Research: Adapting to Change and Participating in Managing Change - A Reform of Higher Professional Education.
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How might this ultimate challenge be approached? In order to explore this question, one of the authors (CE) undertook a limited Delphi consultation with some 100 senior educators from Medicine, Nursing, Occupational Therapy and Physiotherapy in France, Germany, The Netherlands, Portugal and Sweden. The consultation was arranged in two rounds. In the first round the participants were invited to suggest the abilities and skills which future graduates would need, in order to be able to adapt themselves to change and to participate in managing change on behalf of society and within their own profession. The respondents were also invited to suggest examples of educational interventions which would assist students to develop the related abilities or skills. The second round invited the participants to suggest amendments and to add further proposals in relation to the collated responses from the first round. They were then asked to suggest how the proposed educational interventions might be accommodated within their existing, or parallel curricula. Finally, the respondents were invited to consider reality by suggesting the conditions which would need to be satisfied, in order to ensure that so substantial a curricular change could be introduced and sustained successfully. This pilot consultation addressed three
further aspects in addition to the abilities and skill needed for adapting to, and participating in, managing change. Interprofessional and intersectoral collaboration will call for familiarity with the professional environments, the ways of thinking and the languages of the other professions, and similarly the motivation and reactions of politicians and their public service colleagues. International collaboration will require an informed sensitivity of the different cultures and their respective history that enrich our world. Lastly, there is the wide range of economic, environmental, geopolitical, sociological and other affects on the human condition which are the fundamental concern of this challenge. These will need to constitute the context in which the learning is to be grounded. The report of this Delphi Consultation may be accessed at www.caipe.org.uk/publications.html
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What, then, ought to be the responsibility of higher education? Could universities justify an ‘ivory tower’ image by isolating themselves from the stark realities that face our planet? Noblesse oblige - let privilege be matched by responsibility. This Position Paper suggests that the universities of the 21st century should accept the responsibility of ensuring that their graduates will be able to adapt to change and participate in the management of change - not only within their own profession, but also on behalf of society at large. The linking of societal responsibility with participating in the management of change will expect the universities and thus their graduates to accept supra-professional responsibilities for interprofessional and intersectorial collaboration. This is the ultimate challenge to the
universities. The Full Members of The Network accepted the implications of this proposition at the General Meeting of The Network at its biennial Conference in Mexico City in 1997. At the subsequent biennial Conference at Linköping a plenary presentation cited the Network’s acceptance of this challenge as one of three major programmes to be undertaken by The Network in the new century.
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significant change towards universal respect of human dignity and welfare is not promising at the beginning of the present century. Yet, what would be the quality of human existence in the absence of human values? Numerous examples could be cited to support the claim that the caring professions should be acknowledged as the guardians of human values. As long ago as 1847 Rudolf Vircho, the father of pathology, wrote in his report on the typhus epidemic in Upper Silesia “The improvement of medicine will eventually prolong life, but improvement of social conditions could even now achieve this result more rapidly and more successfully. The physician’s responsibility is to serve as the advocate for the poor”. The health professions will need to show the way to the other professions by also taking a global view, as well as a view focused on the individual exclusively. After all, what would be the value of caring for the individual, if life for all were to become too hazardous and eventually impossible for survival?
Charles Engel | Corresponding author on behalf of the writing group Email: charlesengel@lineone.net
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IMPROVING HEALTH CARE FOR THE ELDERLY
Healthcare for the Indian Elderly
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India defines 60 years as the age that people transition to the elderly segment of the population, as suggested by the United Nations in 1980 (WHO, 1987).
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The global population of persons aged 60 years and above is estimated at 600 million in the year 2000, expected to reach 1.4 billion in 2030, two-thirds of whom are living in the developing world (WHO et al.). In India, the number of persons 60 years and over is currently about 80 million. The proportion of population in India aged 60 years and above was 5.63% in 1961, 7.1% in 2001 and is expected to be 9.87% in 2021. This fact makes India a ‘greying’ nation, with the growth rate of the elderly segment being greater than the growth rate of the population as a whole. The reasons for this rise are twofold: a decline in fertility and a rise in life expectancy. The total fertility rate for India was around 6 in 1971 and is projected to reach 2.6 by 2021. The expectation of life at birth was 49.3 years in 1971, rose to 62.2 years in 1996, and is expected to reach 70.2 years by 2021 (Irudaya & Mohanachandran, 1998).The proportion of young persons will decrease in the future, as the ‘bulge’ in the age sex pyramid moves upward from the base, leading to a higher proportion of people in the older age groups. The problems faced by the Indian elderly include health, social and economic problems, which stem from the lack of an organised state sponsored healthcare and social security system as exists in many western societies. Added to this is the changing social fabric especially in urban India, where migration and change in value systems leads to isolation and loneliness in old age. Economic insecurity can lead to a renewed poverty; at the time it hurts most old age, especially for those elderly at high risk (WHO, 1974).
How do we care for the health of this large, growing and vulnerable group? Approximately 45% of the elderly are estimated to have chronic diseases and disabilities. The healthcare of elderly people is envisaged at the following levels: • Primary healthcare including primary medical care would be delivered at the point of first contact, with elements of community education and community participation in addition to simple health service delivery. Primary care is organised on the basis that the majority of elderly people live in their own homes or that of their relatives. Such primary care may be delivered by professionals ranging from general practitioners to nurses trained in the care of the elderly. While India has a network of state-run primary health centres in rural areas, and urban health centres in cities, the capability of these facilities to deal with the problems of older persons in the face of a growing burden of chronic disease is limited. • Specialised geriatric care should ideally be a referral service based at an institution which offers multidisciplinary services. Functions which the specialised care unit could serve include care of the acutely ill, training of the primary care team, rehabilitation and long term care, if the infrastructure and resources permit. Departments/units of geriatric medicine have been established at only two to three medical colleges out of more than 150 institutions in India. This discipline, which places emphasis on func-
tional assessment, holistic care and a personalised approach, has yet to make a mark on the Indian health professional. With the numbers of people above 60 years of age in India poised to double over the next 20 years and reach a staggering 135 million, the challenge for the health sector in this country is to make a meaningful health service available in some form to this growing and needy segment of the population. References IRUDAYA RAJAN, S. & MOHANACHANDRAN, P. (1998). Infant and Child Mortality Estimates. Economic and Political Weekly, volume XXXIII, no. 19. WHO Technical report series 779 (1987). Health of the Elderly - report of a WHO expert committee. WHO Technical report series 548 (1974). Planning and organisation of geriatric services - report of a WHO expert committee. WHO, MINISTRY OF HEALTH AND FAMILY WELFARE & ALL INDIA INSTITUTE OF MEDICAL SCIENCES. Health care of the elderly - A manual for trainers of physicians in Primary and Secondary Health Care Facilities. Arvind Kasthuri | Professor, Department of Community Health, St Johns Medical College, Bangalore, India Email: arvindk@gmail.com
RURAL HEALTH
Enhancing Community University Partnerships in a Rural State
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Effective Training Across Disciplines Unlike traditional post-graduate education, that is very lecture-based and discipline specific, our faculty consciously model a team approach that trains students to function well in an interprofessional process. Long car rides to rural areas and shared meals shape the team and cement bonds within the team. We had several unsuccessful attempts to link with community health providers. Failed
Getting Results Graduates of this community-focused training process tell us that their comfort level, confidence and competence in working with adults with intellectual disabilities in their home communities has soared. Many learners report that they are now willing to treat these clients in their communities and share their experience and expertise with colleagues; in the past, they would often avoid treating these patients. Clients do not need institutional care, prolonged hospitalization, or frequent trips to the University Hospital to get the same excellent care. These university-community partnerships in training and service have served as fertile ground to improve healthcare throughout the state for individuals with intellectual disabilities and complex medical, psychiatric and behavioural problems.
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Using Telecommunications It is always important to establish a face-toface, community-to-community relationship first, and then use telecommunication as a way to continue the conversation, consultation, or patient evaluation. It is easy to assume that the technology will solve all rural access problems, but often poor understanding of equipment capacity, technological failures, and lack of communication between sites lead to dashed hopes. Realistic expectations should be made clear from the beginning so problems that arise do not become overwhelming. The university should provide technical assistance and try to solve technical glitches so that solutions do not cost the community extra money.
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Building and Maintaining Partnerships Some strategies that consistently work: • Respond to a need that the community requests rather than offer something that the university wants. Community members consistently complain that university visitors are far too often searching for research subjects than answering needs. • Designate a university-based contact person who is accessible to community members, and who is committed to returning phone calls and emails. • Find out what is already successful and build on it, rather than giving presumed ‘expert advice’. Be sure that you function
as a consultant, rather than a judgmental visitor. • Offer and help facilitate access to special resources that the university has to offer.
Patient Success Enhances Partnerships Seeing patients in their own homes and work sites removes the added stress of having to drive for several hours to see the team at the university. Patients and families are welcoming and proud to show us their homes, hobbies, and successes. Care givers are happier and are able to enhance their abilities to care for their own patients.
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The programme is funded by the State of New Mexico and is based at the University of New Mexico Health Sciences Centre. We have 14 years of experience doing this work and over the years have been able to sort out what works and what does not work in our quest to develop sustainable partnerships between the university and the communities we visit.
The Transdisciplinary Evaluation and Support Clinic Team (from left to right: Patricia Beery, Susan Parke, Helene Silverblatt)
early educational attempts included newsletters to practicing clinicians that went unread and assigned student visits to patients’ homes without adequate faculty support. As students and residents graduate from UNM and establish their own practices, they feel comfortable caring for individuals with intellectual disabilities, and often serve as the local resource to other providers.
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We are a team of psychiatrists, family physicians, social workers and trainees from the University of New Mexico (UNM) who travel throughout the state of New Mexico, responding to requests for consultations from community residents and care providers to see individuals who have intellectual disabilities with complex medical, behavioural, and psychiatric problems. We treat these individuals in their own communities: at their homes, doctor’s offices, agencies, job sites, and day programmes. In the process, we provide training to learners from the university as well as community caregivers, physicians, and agency providers. Fundamentally, we model respectful interviewing and physical exams with patients who are often non-verbal and sometimes fairly agitated. Family members and extensive support teams are welcome to participate; they provide essential information and are often role models for us.
Helene Silverblatt and Kerrie Seeger | MD, Health Sciences Centre, University of New Mexico, United States of America Email: hsilverblatt@salud.unm.edu 11
IMPROVING HEALTH COMMUNITY ACTION
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A Network of Community Activities in Primary Care in Spain
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The Spanish healthcare system has a number of elements that facilitate an orientation towards community health. The country is divided into Basic Health Zones, which are geographic areas with between 2,000 and 25,000 inhabitants. Each health zone has a health centre, staffed by a primary care team (PCT) of family physicians, paediatricians, mid-wives, nurses, social workers, front desk staff, and other ancillary personnel. Spanish law stipulates that these PCT´s are responsible for providing patient care as well as health promotion activities for the entire population living in the area. Home visits are a regular part of the weekly schedule for most doctors and nurses. Primary care physicians are specialists in family and community medicine; their training currently requires four years of residency training. There is also a substantial curriculum in community health in many of the nursing schools. In 1995 the Spanish Society of Family and Community Medicine started the Programme of Community Activities in Primary Care (El Programa de Actividades Comunitarias en Atención Primaria, or PACAP) to promote a community orientation in primary care in Spain. To advance this mission, PACAP has a number of continuing activities. There is an annual conference to exchange experiences, and the academic journal Comunidad containing in-depth descriptions of community health experiences in Spain and elsewhere, as well as articles on methodology, policy, evidence and other issues. Annual awards are given out to the best community health projects in Spain. A book of recommendations was published on how to begin a participatory community process from a healthcentre. PACAP has a website (www.pacap.net) where news and events are displayed, along with downloadable versions of the journal, summaries of prize winning projects and other links and resources in community health. In the centre of all of these activities is the Red de
Actividades Comunitarias (RAC): the network of community activities, which lies at the heart of PACAP´s mission. Currently, the RAC has over 341 activities in over 155 primary health centres all over Spain. These activities range from a series of presentations on healthy eating habits in the local school to a community development plan coordinating a comprehensive project on job insertion and local economic development for a city district of 400,000 people. The projects tend to use a mix of methodologies and often incorporate qualitative and participatory research methods. Collaboration between nurses, physicians and social workers in the PCT´s is quite normal, as are collaboration with the schools, social service professionals, the police, public health workers, pharmacists as well as with the local Governments. The participation of community members, and working with local citizen organisations is emphasized from the beginning and throughout all stages of many of the projects. The most common methodologies include CommunityOriented Primary Care (COPC), Group Education for Health, Community Development Plans, Community Correcting Processes, and a mix of methods. Many projects work with the media (newspapers, radio, television) as part of their interventions. Projects can be directed towards a specific sector of the populations, such as the elderly, or immigrants, or they can be directed towards the population as a whole. The list of the types of problems that are addressed is long, and includes such things as preventing traffic accidents, self care for care takers, group
A primary school community project on healthy habits resulted in these beautiful drawings education for diabetics or pregnant women, prevention of drug addition, alcoholism or tobacco dependence, memory loss, menopause, promoting physical exercise, healthy sexuality, violence prevention, relaxation and general self care. Some health centres have included process objectives and work hours in contracts for health professionals wanting to dedicate time to community activities. There is a growing debate within the RAC about including community activities in the formal Government listing of services delivered by all primary care centres. For the moment, however, most projects are propelled by motivated professionals who are convinced of the value of a community orientation and who are able to find funding, training and to forge agreements with the clinical directors and administrators to support their work to improve the health of their communities. Frederick Alan Miller | Scientific Secretary of PACAP, Spain Email: rmpacap@semfyc.es
INTERNATIONAL HEALTH PROFESSIONS EDUCATION INTERPROFESSIONAL EDUCATION
UK Centre for the Advancement of Interprofessional Education The UK Centre for the Advancement of Interprofessional Education (CAIPE) is a membership charity and a company limited by guarantee. It has had an informal link with The Network: TUFH since 2001. Professor Dawn Forman, one of CAIPE’s Vice Chairs, leads the Network: TUFH’s taskforce for Interprofessional Education (and is the newly elected European representative on the Network: TUFH’s Executive Committee).
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CAIPE is managed by a Board of elected trustees-directors and co-opted members who work voluntarily and virtually, sup-
An important new development is the UK Interprofessional Student Network (UKISN), supported by a partnership between CAIPE and the Centre for Excellence in Teaching and Learning, University of Central England. The inaugural meeting of the UKISN on November 21st will plan student-led initiatives that ensure students help to shape the development and delivery of interprofessional programmes. Students from The Network: TUFH are encouraged to par-
CAIPE contributes to the European Interprofessional Education Network project as a UK partner. More European member states joined as partners in this project in 2007. This expansion allows CAIPE members to enjoy even wider collaboration with international colleagues as they did through, for example, the recent conference on interprofessional education in Krakow, Poland. This year CAIPE has formally affiliated with the Canadian Interprofessional Health Collaborative and with InterEd, an international interprofessional education and practice organisation. CAIPE also recently announced links with the Institute of Technology, Tralee, to enable collaborative working on interprofessional initiatives in the Republic of Ireland. Through its members, CAIPE provides services and consultancy to organisations, educators and health and social care practitioners to assist and guide them in their provision of effective interprofessional education and collaborative care. It also has a vibrant programme of workshops (see www.caipe.org.uk). CAIPE maintains a major role in promoting learning together to work better together. We welcome applications from individuals and organisations to join us in these endeavours and look forward to continuing collaboration with likeminded colleagues.
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CAIPE is closely associated with the work which has established the evidence base for effective interprofessional education through systematic reviews. One of its aims is to promote good quality interprofessional education and to disseminate findings from relevant research and good practices. CAIPE provides a network of mutual support and interest that facilitates intellectual engagement with - and the development of - individual and organisational interprofessionalism. Present members include organisations and individuals across UK statutory, voluntary and independent sectors and we have a growing international membership.
On April 17/18 2008, CAIPE will mark its 21st anniversary with a two-day symposium. The programme is planned as an eclectic mix of perspectives on interprofessional education; designed to acknowledge the contribution of CAIPE to the past interprofessional agenda, the complexities of the present and to be a springboard for the future. Participants can expect to be challenged, informed, and to contribute their views in fine surroundings. There will be plenty of networking opportunities and, importantly, time for everyone to enjoy each other’s company. For more details or to book your place, send a message to admin@caipe.org.uk
ticipate in this meeting and to subsequently link with the UKISN. Another very recent development is the establishment of an interprofessional blog: to contribute go to http://interprofed.blogspot.com/
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CAIPE aims to promote and develop interprofessional education as a way of improving collaboration between practitioners and organisations, engaged in both statutory and non-statutory public services, and improving the quality of public services. CAIPE supports the integration of health and social care in local communities and enabling practitioners in the community, educational institutions and health and social care agencies to learn and work together, foster mutual respect, overcome barriers to collaboration and engender joint action. It promotes the involvement of service users, care givers and local communities as partners in the development and delivery of interprofessional education.
ported by an administrator. The organisation has a valuable web portal (www.caipe. org.uk) which keeps the interprofessional community of practice informed about relevant events, recent developments and useful publications. The CAIPE E-Bulletin is published four times a year and is a key means of letting people know what is happening in the world of interprofessional education and practice. One of CAIPE’s longest standing partners is the Journal of Interprofessional Care. Electronic access to this journal is a benefit of individual membership and print copies are included in corporate membership. This peer reviewed journal is the key international source of authoritative and scholarly papers on interprofessional matters.
Marilyn Hammick and Dawn Forman | Chair CAIPE; Vice Chair CAIPE Email: mhammick@gmail.com 13
INTERNATIONAL HEALTH PROFESSIONS EDUCATION INTERPROFESSIONAL EDUCATION
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The Greatest Challenge of Interprofessional Education
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Interprofessional education (IPE) occurs “when two or more professions learn with, from and about each other to improve collaboration and the quality of care” (CAIPE, 2002). The usual implications of this definition are often about curricula, teaching resources, learning methods and schedules. I submit that while these are important, they are not sufficient. Taken alone, they may miss what is profoundly human about professionals’ daily interactions: the lived experience of learning through adaptation to the daily challenges of an increasingly complex care delivery. In the midst of these challenges, professionals pursue universal human goals: to survive and fulfil their potential. They create their own ways of connecting formally and informally with colleagues, patients, and families; they define - implicitly or explicitly - their own goals depending on the situation at hand. Above all, they undergo, not only through formal conferences and teachings, but also through informal interactions with colleagues and circumstances, a learning process akin to what happens in a theatre troop or a jazz ensemble where each player harmonises their play according to what the others are playing. In the same way that jazz playing requires more than just instruments and musical skills, IPE requires more than just curricula and teaching resources. IPE is about living communities of professionals; it is about mutual dependencies among the participants in care delivery - professionals, patients and family members - and it is about how these participants can successfully face daily challenges to adjust care strategies according to the demands of patients’ illnesses and the resources to meet them (Soubhi, 2007). In this view, optimising the quality of care is about optimising the people who deliver it, their relationships, their valued roles and life course. Where then do we start?
Professional competence is a good start; competence subsumes a subtle balance between knowing and doing: knowing the right thing to do and doing it at the right time. What happens with multiple professionals and multiple ways of knowing and doing? How do we then nurture the collective competence that makes care delivery truly interprofessional? I believe that we need to balance what professionals know and what professionals do. We need to balance cognitive aspects of practice represented in the integration of what professionals know, and pragmatic aspects of practice including collaboration among professionals and the organisational support from senior leaders that facilitates and sustains what professionals learn and do (Rege Colet, 2002; Soubhi et al, forthcoming). The pragmatic structure of practice - what professionals do - becomes the basis for knowledge integration and includes shared leadership, enhanced communication, coordination, cohesion, trust, mutual engagement, and openness to experimentation. It also includes not only technical skills for care delivery, but also a complex mix of factors involved in social decisionmaking: selfishness, reciprocity, equity, fairness, and a host of emotional factors that experimental economics and neuroscience now recognise as key components in social decision-making (Wenger, 1998; Soubhi, 2007; Sanfey, 2007). IPE is then better seen as a living and evolving whole. Work processes that release the energy, human imagination, and mutual engagement among professionals are more likely to bring about a harmonious balance between what professionals know and do collectively. Such a balance is one between head and heart, technical skills and insightful compassion, system design and ethical dimensions of professional practice (Epstein, 1999).
Ultimately, the greatest challenge for IPE to improve the quality of care may be to add life and meaning into professionals’ everyday working. And perhaps the ultimate key to success in IPE is in what Donabedian once suggested: to leverage into professional practice one of the deepest of human emotions, love (Chapman, 2006). Like many of the assertions in this commentary, this one is also falsifiable, so the proof may be just one experiment away. References CAIPE: UK Center for Advancement of Interprofessional Education (2002). www.caipe.org.uk CHAPMAN, E. (2006). The secret of quality. Journal of Sacred Work. http://journalofsacredwork.typepad.com/ journal_of_sacred_work/2006/10/the_ secret_of_q.html (last accessed: 29/10/07) EPSTEIN, R.M. (1999). Mindful practice. Journal of the American Medical Association, 282(9), 833-839. REGE COLET, N. (2002). Enseignement universitaire et interdisciplinarité. Un cadre pour analyser, agir et évaluer. 1ère édition. Bruxelles: De Boeck & Larcier s.a. SANFEY, A.G. (2007). Social DecisionMaking: Insights from Game Theory and Neuroscience. Science, 318, 598-602. SOUBHI, H. (2007). Toward An Ecosystemic Approach to Chronic Care Design and Practice in Primary Care. Annals of Family Medicine, 5, 263-269. SOUBHI, H., REGE COLET, N., LEBEL, P., LEFEBVRE, H. & POISSANT, L. (forthcoming). Interprofessional Process in Communities of Practice. WENGER, E. (1998). Communities of practice: Learning, Meaning, and Identity. New York: Cambridge University Press. Hassan Soubhi | University of Sherbrooke; Canadian Interprofessional Health Collaborative, Canada Email: hassan.soubhi@usherbrooke.ca
SEXUAL
SOCIAL ACCOUNTABILITY
Community Care Bags After a member from the Family Medicine Interest Group (FMIG) at the University of New Mexico, School of Medicine (UNM SOM) heard an inspirational talk given at the American Academy of Family Physician’s national convention, the idea of creating Care Bags for the homeless community in Albuquerque was born. Shortly after, FMIG students turned this idea into a reality. Since the creation of the Community Care Bags Project, 275 bags have been distributed.
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Project evaluations were emailed to those who distributed the bags throughout the community. We asked questions regarding the number of bags handed out, the location in which they were distributed, the reaction they received from the recipient and any feedback they had regarding the project. The reactions and comments from recipients have been varied. Evaluations indicated that some recipients of the Care Bags began drinking the water or eating the snacks right away, other recipients smiled and said “God Bless You”, while others who were offered a bag said they only wanted
We have big dreams for continuing this project. We currently have a campus distribution day and shelter breakfast handout day set for each fall and spring semester. In the future we would like to use sturdier bags to include additional items such as bus tokens, white socks, sunscreen and band aids. Monetarily we plan to sustain the project with further community business and personal donations while simultaneously applying for grant funding. Although this is a small project compared to the problem of homelessness in our community, we believe that it encourages future doctors to become involved at the community level, which will undoubtedly help raise generations of physicians who are both aware and sensitive to the problem of homelessness in New Mexico.
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Our first set of 275 bags included a bottle of water, granola bar, fruit snacks, peanut butter crackers, shampoo, conditioner, lotion, soap, toothbrush, toothpaste, condoms, and an AHCH resource list of shelters, food and job services. The 225 bags, along with an Albuquerque homeless fact information sheet, were given to students, staff and faculty of the UNM SOM during two campus distribution days. Those who took bags were asked to keep them in their car to hand out to individuals they saw asking for help while driving around the city. The other 50 bags were handed out by medical students at a local homeless shelter where they served breakfast and distributed bags to the clients.
money and did not take the bags. Overall, the evaluations showed UNM SOM personnel feel proactive and positive about reaching out to their community. Since the majority of the feedback from recipients and local shelters has been positive, we have decided to continue the Care Bags project.
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A community evaluation to determine the bag contents included talking to staff and clients from area shelters and soup kitchens, as well as speaking with Albuquerque Healthcare for the Homeless (AHCH) patients. To fill the bags, we received $2,235 (retail value) in product donations from New Mexico businesses and $544.66 in monetary donations from the UNM SOM campus community via various fundraising events, e.g.student bake sales. Since each of the Care Bag items were purchased in bulk or donated by the manufacturer, we were able
to take advantage of the much lower wholesale prices, which has made this project fiscally achievable thus far.
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The UNM SOM FMIG envisions the Community Care Bags project to be an ongoing, year-round service designed to benefit those in need in Albuquerque and its surrounding areas. By creating Care Bags, which contain various non-perishable goods, toiletries and resource information, FMIG hopes to achieve four major goals: to provide information and goods to those in need in the Albuquerque area, to educate the UNM SOM community about the Albuquerque homeless population, to encourage medical students to reach out to the community in which they study, and to create interactions between our UNM SOM campus and the community we serve to better understand their needs. By providing information regarding available resources in Albuquerque and basic hygiene products, we hope these Care Bags show those in need that we are concerned about them, their health and their livelihood.
Care bag assembly
Andrea Jo King and Erin Corriveau | Medical students, School of Medicine, University of New Mexico, United States of America Email: aking@salud.unm.edu
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INTERNATIONAL HEALTH PROFESSIONS EDUCATION 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 one of such yellow papers.
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Jimma University Experience in CBE
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Historically, universities were centres of academics employing clever people of society. The universities attracted the cream of society and boosted their image. The traditional universities saw the general public as the silent recipient of ideas. In most cases, these universities confined themselves to more theoretical activities, which isolated them from the real world of the larger society. This approach of university education was challenged by progressive elements of society. Society is increasingly demanding that educational institutions should be socially accountable. Another serious question, which is also being raised by society, is: do university graduates have the competency and the commitment to improve the lives of their people? These questions have created the obligation to direct education, research and service towards addressing the priority development needs of community. In response to such demand, sensitised educational institutions have been attempting to reform their educational approach and introduce innovative curricula with varying degree of success. Innovative Curriculum Since its inception, the Jimma Institute of Health Sciences, Ethopia adopted an innovative curriculum and started its health training by integrating education, research and service. The innovative curriculum is comprised of: • Community-based training programme: beginning in year 1 students go to the community in a group and are attached for at least four weeks every academic year and engage themselves in developmental needs of the community; • Developmental team training programme:
senior students in different fields of study are deployed for two months and engage themselves in developmental work; • Student research programme: all degree programme students are required to do an independent research work. The objectives of Community-based Education (CBE) at Jimma University are: to make students understand the comprehensiveness of the healthcare delivery system with a special emphasis on primary healthcare (PHC) and realise the need for a holistic approach; to test their knowledge acquired through theoretical learning and apply to practical skills; to acquire abilities like leadership, management, teamwork and communication with the community and be able to apply them to PHC services; to help them understand the performance of health personnel in a health team; to work in a team, enabling them to prepare for their future professional life. In addition, the innovation of opinions, analysis and synthesis of information would improve students’ perception of real life conditions and facilitate their adaptation to the conditions of their future professional life. Impact and Achievements A study was conducted to evaluate the effect of CBE on districts in which CBE was working. It was found that immunisation coverage was significantly higher in CBE districts compared to non-CBE districts (P<0.001). Among the key optimal breastfeeding practices of mothers it was observed that mothers in CBE districts continue breastfeeding during bouts of diarrhoea attack compared to non-CBE districts (P<0.001) (OR=2.63,95% CI: 2.0,3.39). Similarly appropriate time of initi-
ation of complimentary feeding, use of safe delivery services, ORS use, contraceptive prevalence and environmental conditions (measured by latrine availability, per capita water consumption and solid waste disposal) were found to be significantly higher in CBE districts. Many public latrines and other facilities were constructed with the students’ activities. Moreover, the contributions of student researches were also published on national and international journals (Alemayehu et al., 2004). In addition, job assessment of Jimma University medical students showed higher community-oriented outlook and practices (Asefa et al., 2000). It was witnessed that they developed social responsibility and community-oriented actions in their actual practices. CBE appears not to be without problems; there was a lack of joint planning with the Governmental administrative bodies. And stakeholders, especially the community, had little opportunity to participate in the monitoring and evaluation of the CBE programme. The experiences and achievements of Jimma University on CBE are encouraging and exemplary to other national and international institutions. References ALEMAYEHU, E., BELACHEW, T., AMBELU, A. & TEGEGN, A. (2004). Impact assessment of community-based education programme supported by Irish AID, Jimma University, Southwest Ethiopia (unpublished). ASEFA, M., AYELE, F., TESHOME, M. & HAILE, G. (2000). Assessing the impact of an innovative curriculum on medical graduates: The Jimma Experience, Ethiopia. Ethiopian Journal of Health Development, 14:253-267. JIMMA UNIVERSITY (2004). Communitybased education Jimma University guideline revised. January 2004, Jimma. Kebede Deribe Kassaye and Sofonias Getachew | MPH candidate; Lecturer and Head CBE Central Office | Jimma University, Ethiopia Email: kebededeka@yahoo.com
PROBLEM-BASED LEARNING AND COMMUNITY-BASED EDUCATION
PBL System Guide of Variables Important Variables has been produced by a group of distinguished academic practitioners under the leadership of Charles Engel.
This resource is available from the CEEBL website: www.manchester.ac.uk/ceebl/resources/ resourcepacks/pblsystemapproach_v1.pdf
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2 - 5 June, 2008, Sweden International Conference - All Together Better Health IV: Development and Progress in Interprofessional Education and Practice. Organised by International Association for Interprofessional Education and Collaborative Practice, Karolinksa Institutet, Stockholm, Sweden and Linköping University, Linköping,
16 - 27 June, 2008, 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 Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. Further information: School of Health Professions Education, P.O. Box 616, 6200 MD Maastricht, the Netherlands; tel: 31-43-3885611; fax: 31-43-3885639; email: she@oifdg.unimaas.nl; Internet: www.she. unimaas.nl
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12 - 13 April, 2008, New Haven CT, USA Unite for Sight Fifth Annual International Health Conference: Building Global Health for Today and Tomorrow. Organised by Unite for Sight and Yale University, New Haven, CT, United States of America. Further information: Internet: http://uniteforsight.org/ conference/2008
Sweden. Further information: Internet: www. alltogether.se
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3 - 4 April, 2008, Maastricht, the Netherlands Visitors Workshop: A Primer on the Maastricht Approach to Medical Education. Organised by School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. Further information: School of Health Professions Education, P.O. Box 616, 6200 MD Maastricht, the Netherlands; tel:
31-43-3885626; fax: 31-43-3885639; email: she@oifdg.unimaas.nl; Internet: www.she. unimaas.nl
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Diary 2008 9 - 13 March, 2008, Ismailia, Egypt 22nd International Workshop on Communitybased 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; Internet: http:// crdmed.tripod.com
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This guide aims to describe the most important variables which may have a significant affect on the success or failure of PBL in medical, dental or veterinary medical education. The guide may be of particular interest to those who are developing a new curriculum, those who are revising their curriculum and those who are researching the application of PBL not merely as one method of teaching among many other methods and not just in a traditional curriculum. The guide focuses on the variables which need to be considered in a coherent educational system, based on the principles of PBL.
Among the 13 variables are the goals of the curriculum, how the curriculum should help students in their learning, how the curriculum should be implemented, selection of students, induction and help for students and academics, formative and summative assessment, perception of a cumulative, integrated, contextual, active learning curriculum by non-clinical academics, how such colleagues might be assisted, monitoring and evaluation of the curriculum, and what needs to be considered in introducing and maintaining an innovative curriculum.
D E C E M B E R
The Centre for Excellence in Enquiry-Based Learning (CEEBL) is one of the 74 Centres for Excellence in Teaching and Learning set up in 2005 by the Higher Education Funding Council for England “to reward excellent teaching practice and to invest in that practice further in order to increase and deepen its impact across a wider teaching and learning community”. A significant aspect of CEEBL’s contribution to the goal of increasing and deepening the impact of excellent teaching practice is its funding of projects which reflect the theory and practice of forms of Enquiry-Based Learning. Problem-Based Learning (PBL) is one of those forms. With the assistance of CEEBL funding, the guide A Whole System Approach to Problem-Based Learning in Dental, Medical and Veterinary Sciences; A Guide to
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INTERNATIONAL DIARY
“Be Reflective, Sit, Listen” Annual International Conference of The Network: Towards Unity for Health 27 September - 2 October, 2008, Chía-Bogotá, Colombia
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International Conference on Adapting Health Services and Health Professions Education to Local Needs: Partnerships, Priorities and Passions. Organised by The Network: TUFH and Facultad de Medicina, Universidad de La Sabana Post-Conference Excursions: October 3, 2008: Health Centre Aqua de Dios October 3-5, 2008: Valledupar-Sierra Nevada de Santa Marta Further information: Network: TUFH Office, P.O. Box 616, 6200 MD Maastricht, the Netherlands; tel: 31-43-3885638; fax: 3143-3885639; email: secretariat@network. unimaas.nl; Internet: www.the-networktufh. org/conference 25 - 29 October, San Diego CA, USA APHA annual meeting. Organised by American Public Health Association (APHA). Further information: email: comments@ apha.org; Internet: www.apha.org/meetings 31 October - 5 November, 2008, San Antonio TX, USA AAMC annual meeting. Organised by Association of American Medical Colleges (AAMC). Further information: Internet: www.aamc.org/meetings 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 the Network: TUFH Newsletter.
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An interview with the past Secretary General Arthur Kaufman. This interview was conducted by Gerard Majoor during the Network: TUFH Conference in Uganda. What was your most memorable moment as a Secretary General? What comes to mind most quickly is dancing with the students by the canal in Ghent. I taught them some fancy dance steps. Next, I saw something that was almost magical: they organised themselves into this theatrical team, elaborated on the steps, and danced down the bank in ways that I had never seen. It was everything to me: thrilling, unplanned, studentled, a skill that I could share. It was teachers and students on an equal social plain, which I believe is the best environment for learning. What is your most memorable Network Conference? There are two. My first one, because I was so new; I was bedazzled. And then there was the Conference in Ismailia, Egypt. There was a lot of tension; fundamentalist Muslim students were protesting outside against the Israeli visitors, and I was guarded by soldiers with automatic weapons. During one of the celebrations I sat next to a man who once during the war had been lobbing shells at Ismailia. That pictures what The Network is to me: you can be friends with people whom your Government considers enemies. What was the best lesson learned from your period as Secretary General? To be a learner and listener. When I started as Secretary General, I wanted to bring in my skills and experiences that I had gathered at my university in New Mexico. I wanted to put my stamp on something. But after a while I learned that it was better to listen to and learn from other people’s ideas and experiences. I realised that I can contribute a lot by trying to reconfigure what I learned from The Network: TUFH in my own institution, and seeing how others could adapt as well. This attitude of listening and learning is particularly necessary in an
Dr. Arthur Kaufman receiving his Honorary Membership plate
international environment, such as the Executive Committee (EC). For example: how do you normally run meetings? I saw participation in a meeting as being verbal. Totally cultural, I realised, when I had people who were extremely quiet during the meeting, but doing great things outside the meeting. I learned to be a little bit quieter and listen to what people are actually doing. What do you consider to be your best achievement as Secretary General? Probably making a calmer, friendlier, welcoming environment. Before, there was a lot of tension within the EC. I tried to deal with interpersonal crises, keep things moving. I have also been an advocate of new ways to connect with other organisations. We are a very strong organisation ourselves; when we make partners, we get stronger, we never get weaker. I think partnering is going to be one of our strengths in the future. Do you have any advice to give to Jan de Maeseneer? I think Jan is a doer. He likes to have lots of plates spinning in the air at the same time. He distributes things to be done. And I think he has strong ideas, and a vision for The Network: TUFH based on these ideas. What I have learned - that I would urge him to do is to be reflective, sit, listen. Try not to convince other people of what you think, but frame and summarize what they think. That to me is a successful Secretary General. This organisation grows by reflecting the wisdom of the students and faculty, and the influx of all the people around it. Famous last words as Secretary General? I think we formed such a good partnership. When you look at our group, we are very complementary in our strengths. And that is the strength of The Network: TUFH; we should keep that alive.
STUDENTS’ COLUMN STUDENT INTERVIEW How do students from all over the world perceive the educational programme at their Faculty, or the educational system in their country? How do they see the future, for their nation and for themselves? And what changes would they make, if they had the chance? We wanted to know. Therefore every Newsletter December edition we ask a student five questions.
The Big Five This interview was conducted with Jairo Alexander Hernández Pinzón, medical student at the Facultad de Medicina, Universidad de La Sabana, Colombia.
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Do you ever get in touch with the community? Yes. As a matter of fact, La Sabana University has many community programmes. Currently I am involved in an outreach and tutoring programme with displaced people in Colombia. It is a project of the Department of Social Projection of our Medical School. We help more than 1,000 families who are displaced because of the violence in some rural areas in Colombia.
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What part of your study was the most educational to you (e.g. internship, research or being ill yourself)? Performing research, undoubtedly. The generation of new knowledge is a necessary challenge, not only for the healthcare professional, but for professionals in all areas. It not only demands that you get a great mastery of the research topic; it also requires that you learn by solving problems.
I would try to change the subjective assessments of students’ academic performances during hospital practice experiences. Also, I would ask attention for the fact that clinical practice places have become places where students only serve as assistants (filing paperwork, collecting paraclinical information, etcetera). This approach to learning destroys the goals of academic clinical practice. Another thing that affects the human resource for health in Colombia is the excessively high cost of postgraduate programmes; I would like to find a solution for this problem.
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INTERESTING INTERNET SITES The Network: TUFH Interactive - Recommended Internet sites www.the-networktufh.org/publications_ resources/interactive.asp Teaching for Learning: Learning for Health: Quick Reference Guides for Planning, Implementing and Assessing Learning Experiences www.the-networktufh.org/publications_ resources/furtherreading.asp Migration, Globalisation and Poverty www.migrationdrc.org/news/reports/ mobility/index.html World Health Statistics www.who.int/whosis/en Institute: Health and Life Sciences; Policies and Guidelines www.intute.ac.uk/healthandlifesciences/ policy
What is your opinion about innovative educational formats like problem-based learning (or the educational format that your own Faculty uses)? It is often difficult to transmit new knowledge through old educational methods like regular didactic classes, so it is critical to use innovative educational formats such as problem-based learning in order to optimise the learning processes. In addition, effective learning does not only depend on the teacher. Also important is the student’s attitude. Teachers can encourage, guide and inspire, but it is the students who must want to learn rather than be taught.
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Jairo Alexander Hernández Pinzón
Why did you choose to study Medicine? I always thought that all professions have been created in order to help other people; the medical profession embodies this goal the most. I also had the influence of my mother, a great Colombian doctor who made it easier for me to decide to study medicine.
What would you change if you were Dean of your Faculty? Or on a national level if you were Minister of Education in your country? I think that I still need a few years of study to answer these questions. There are many things to change and there are many problems to solve. To be the Dean of a medical school or a Health or Education Minister in a country is not an easy thing; I need to understand the background of the problems and gain more academic preparation in order to get better solutions.
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Member and organisational News
New Members Executive Committee At the General Meeting in Uganda (September 16 and 20, 2007) five new Executive Committee (EC) Members were elected: • F or the African region: Sarah Kiguli (Faculty of Medicine, Makerere University, Uganda) • For the Latin American region: Francisco Lamus Lemus (Facultad de Medicina, Universidad de La Sabana, Colombia) • For the North American region: Denise Donovan (Faculty of Medicine and Health Sciences, University of Sherbrooke, Canada) • For the European region: Dawn Forman (Individual Member, Sheffield UK) • For the Asian region: Bishan Swarup Garg (Dr. Sushila Nayar School of Public Health, Faculty of Medicine, Mahatma Gandhi Institute of Medical Sciences, India) From September 2007 on, Prof. Jan de Maeseneer will be the new Secretary General of The Network: TUFH. Prof. De Maeseneer will succeed Prof. Kaufman (University of New Mexico, USA).
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Messages from the executive committee
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Jan De Maeseneer graduated as a Medical Doctor in 1977 at Ghent University (Belgium). Since 1978, he has been working part-time as a general practitioner in the community healthcentre Botermarkt in Ledeberg, a deprived area in the city of Ghent. Since 1981, he has been working as a part-time assistant at the Department of Family Medicine and Primary Health Care at Ghent University. He chairs the (Medical) Educational Committee at the Faculty of Medicine and Health Sciences (since 1997) in charge of a fundamental reform of the undergraduate curriculum (from a discipline based towards an integrated patient-based approach). In 2006 he became a member of the Executive Committee of The Network: TUFH. In September 2006, he was involved in the organisation of the Network: TUFH Conference in Ghent: Improving social accountability in education, research and service delivery.
New Co-Editor EfH During our Network: TUFH conference in Kampala, Uganda, Donald Pathman, MD, MPH was officially appointed as new CoEditor of Education for Health. He is sharing the editorship with Michael Glasser, PhD, who has been the journal’s Co-Editor for a period of 2 years already. Don Pathman is succeeding Margaret Gadon. Dr. Pathman is Professor in the Department of Family Medicine at the University of North Carolina at Chapel Hill (USA), and Co-Director of the Programme on Health Professions and Primary Care at the Cecil G. Sheps Center for Health Services Research. Don Pathman has numerous peer-reviewed publications, has served as principal and lead investigator on projects addressing such issues as health workforce, access to care, and physician retention, and has served as editorial board member for several journals, such as The American Board of Family Practice, The Journal of Rural Health, Annals of Family Medicine, and Family Medicine.
Signing of the contract (from left to right) Don Pathman and Michael Glasser
Don Pathman has been a practicing family physician for over 20 years and still sees patients at a UNC-affiliated hospital in rural Chatham County, North Carolina. As with previous Co-Editors his appointment will initially be for 3 years. The appointment may be renewed for a further period of up to three years. Don, welcome aboard the journal!
Moving On: Changes in Institutional Leadership De La Salle University, Cavite, PhilipThe Secretariat received information about pines has been replaced by Dr. Joseline changes in leadership with the following Ferrolino, vparpa@hsc.dlsu.edu.ph Network: TUFH members. We have listed the names of the former and new (Vice-) • Dr. Sul Chong-Koo, College of Medicine, ChungNam National University Daejeon Deans/Directors for you: Metropolitan City, Republic of Korea • Dr. Geraldo Brasileiro Filho, Faculty of has been replaced by Dr. Jung-Un Lee, Medicine, Federal University of Minas medean@cnu.ac.kr Gerais, Belo Horizonte, Brazil has been replaced by Dr. Francisco José Penna, diretor@medicina.ufmg.br • Dr. Solomon Mogus, Jimma University, Jimma, Ethiopia has been replaced by Dr. Kaba Urgessa, solomonbly@yahoo.com • Dr. Romeo Ariniego, College of Medicine,
INTRODUCING TASKFORCES MEMBERS
Igbinedion University Nigeria
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Discount Repeat advertisements in the Newsletter: 15% (minimum of two advertisements, all reservations must be made in one go).
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Felix Omoragbon and Tayo Awofeko / Student network, Igbinedion University Email: felixomor@yahoo.com
■ advertisers from industrialized countries ● advertisers from developing countries
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The first set of medical doctors from IU graduated in July 2007. They were the first medical graduates from any private university in the country. In all, Igbinedion University is prepared to meet the intellectual needs of an advancing globe, even as far as healthcare delivery is concerned.
Prices for one advertisement Advertisements are printed in black-andwhite (Prices excl. bank commission): Size (in mm) advertisement (based on A-4) Full page (w180 x h250) ■ US$ 500 | ● US$ 350 1/ page horizontal (w180 x h199) 2 ■ US$ 350 | ● US$ 225 1/ page horizontal (w180 x h80) 3 or island (w118 x h125) ■ US$ 225 | ● US$ 150 1/ page horizontal (w118 x h62,5) 6 or vertical (w56 x h125) ■ US$ 150 | ● US$ 100
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• to tackle the problem of acute shortage of medical personnel in Nigeria, Africa and the world at large; • to fill the gap created by brain drain of medical personnel in Nigeria; • to encourage medical research in order to solve some nagging medical problems that afflict millions of people locally and globally; • to provide an opportunity for university education to the thousands of qualified students, who due to limited spaces cannot gain admission into public universities; • to offer qualitative medical education both at graduate and postgraduate levels in order to produce efficient and highly skillful doctors dedicated to the primary healthcare delivery, and to the teaching of medical sciences; • to produce doctors who will uphold the highest ethical standard of the profession.
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Igbinedion University (IU), the first private university in Nigeria, was established on the 12th of May, 1999. It is the only university with Medicine as one of the founding colleges. On the 25th of September, 1999 the School of Basic Medical Sciences was established within the College of Health Sciences (one of the six founding colleges). The college started with 54 students and eight staff members. The College of Health Sciences currently consists of the School of Basic Medical Sciences, the School of Clinical Medicine, the School of Pharmacy, and the School of Nursing. Its mission is to educate and train an appropriate number of competent medical doctors, pharmacists, and other health personnel to meet the growing health delivery requirements locally and internationally. The medical curriculum normally spans six academic years. The first academic session is the pre-medical stage and this is based in the College of Natural and Applied Sciences. The second and third sessions constitute the preclinical stage, where basic medical sciences are taught. Academic sessions four, five and six constitute the clinical years based in the School of Clinical Medicine. The objectives of the college are: • to organise and offer courses of instructions leading to degree, diplomas, certificates and others in medical studies; • to arrange and organise conferences, seminars, studies in the interest of public erudition;
The Network: TUFH offers advertising opportunities in this Newsletter. The Newsletter is sent to approximately 1.000 addresses worldwide twice a year (in June and December) and is available through the Network: TUFH website.
D E C E M B E R
Alayeluwa Oba Okunade Sijuwade Olubuse II College of Health Sciences, Igbinedion University
Advertising in the Network: TUFH Newsletter With around 250 institutional and individual members and a database of more than 8000 contact addresses around the world, The Network: TUFH offers a unique opportunity to reach individuals and institutions in health professions education, health services and health policy development.
Deadlines for submission • For publication in the June edition of the Newsletter, please send your submission before the end of April • For publication in the December edition of the Newsletter, please send your submission before the end of October
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Member and organisational News TASKFORCES
Taskforces Reporting
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Network: TUFH taskforces report to the Executive Committee on an annual basis. Below you will find some of the focus points of these reports. Taskforce Women and Health This taskforce now includes more than 20 members from over a dozen countries, including a core group of active members from Egypt, India, Iran, Kenya, Malaysia, Mexico, Pakistan, South Africa, Sudan and Uganda. 2007 activities update: • Completion of the first round of mini grants aimed at community dissemination of the Women and Health Learning Package (WHLP). • Four mini grants were awarded to Sarah Kiguli, Rogayah Ja’afar Todd Maja and Godwin Aja (see also page 4). • 17 highly-qualified fellows were chosen to receive travel support to the 2007 Network: TUFH Conference in Kampala to promote their participation in the annual taskforce meetings. • Subcommittees were created: Evaluation Committee, Promotional Committee, and Research Committee. • Dissemination of the WHLP and the taskforce model. • Rogayah Ja’afar spoke at a roundtable discussion of the Philippines Association of Medical Colleges regarding health professions education, training and services. Rogayah Ja’afar spoke at several sessions of the 2007 3rd UP Global Health Course regarding women’s health and other key issues in health professions education. • The taskforce organised a number of activities at the 2007 Network: TUFH Conference: pre-conference meeting, taskforce meeting, film event, mini workshop. Taskforce Skills Training Skills training is on the agenda of many schools of health professionals (especially 22
for doctors, nurses, midwives), all over the world. Exchange of materials, exchange of ideas and of experiences is very much needed. A taskforce, creating a format for such an exchange, chairing the problems and possible solutions for setting up skills training programmes/skills labs could be a big help. During the Network: TUFH Conference in Ho Chi Minh City the Maastricht skills lab, where this new training method was started in the seventies, was asked to initiate this taskforce. Taskforce Integrating Medicine and Public Health The 2006 Conference in Ghent was a new opportunity to exchange knowledge and experiences related to Integrating Medicine (clinical individual care) and Public Health, with participants from different countries. Diverse activities were organised and their content, attendees and suggestions made, are described in detail in the document prepared by the taskforce and distributed to all members of The Network: TUFH through the website. Activities taskforce: • Suggested to work in the integration of a Hospital Care and University education (in the field of Mother and Child Health) in one region in Angola. A draft document was prepared and is now under discussion before presenting it to the Health Authorities in Angola. • Education on integration. • Analysis of the experience of the AUPA network in Spain. • Development and maintenance of the taskforce blogs. • Sessions at 2007 Network: TUFH Conference: brown bag session, mini workshop, affiliated session, thematic poster session. Taskforce Interprofessional Education The taskforce Interprofessional Education (IPE) has developed a Position Paper and
poster. These together with the closer working relationships between the taskforces and other IPE organisations, have been the main activities this year. During the 2007 Network: TUFH Conference the IPE taskforce also held a mini workshop: Promoting Interprofessional Capability for Collaborative Practice. Educational Possibilities and Cultural Understandings. See also page 23 for more information on the IPE taskforce.
Taskforce Elderly Care • Members of the taskforce were encouraged to participate in preparation of the Position Paper on Interprofessional Education. • At the 2006 Conference taskforce members attended the mini workshop E-Learning and Interprofessional Education for Collaborative Patient-Centred Practice. E-learning about care of older persons was one of the topics covered. • The taskforce’s Position Paper Community-based Education for Older Persons was summarised in the June 2007 Newsletter. • The Network: TUFH Conference in Kampala provided opportunities for connecting with other taskforces in a brown bag session on The Role of the Taskforces in The Network: TUFH and a mini workshop entitled Integration of Health Professions Education and Delivery of Health Care in Developing and Developed Countries - The Role of the Network: TUFH ‘s Taskforces.
Taskforce Interprofessional Education: An Update
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Objectives of the taskforce: • collect baseline data about existing interprofessional activities; • promote work on more specific research questions related to IPE; • develop and maintain a current communication link e.g. listserve; • meet as a taskforce between Network: TUFH meetings where possible;
New Executive Committee Member At this years Conference Dawn was successfully elected as the European representative to The Network: TUFH. So in addition to the list of activities planned for the IPE taskforce, Dawn will be seeking to take forward initiatives for the European representatives.
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Mission and Objectives From the new IPE Position Paper: Mission of the taskforce: to enhance the quality of interprofessional education, learning and practice by drawing together experience(s) from the international context.
• explore the use of teleconference or SKYPE to maintain and expand the taskforce; • further develop the Network: TUFH webpage in relation to IPE (links, organisations, publications, etcetera); • maintain the Position Paper on IPE through reviews and updates via IPE taskforce member and network member feedback; • enable collaborative ventures with other Network: TUFH taskforces and with other IPE and IPLD interested organisations, e.g. joint meetings and conferences; • promote interprofessional learning and practice based on the needs of service users and carers; • form an interprofessional subgroup focusing on community-based practice (a natural area for interprofessional collaboration in both education and practice). Encouraging those involved in community-based rehabilitation education and practice could potentially draw greater involvement in The Network: TUFH on the part of individuals from a diverse set of health professions, and could be the focus of interprofessional scholarship and projects.
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• suggest a key note presentation on International Development in IPE for the next taskforce meeting; • seek agreement from each IPE organisation to collaborate in an affiliated agreement and ensure communication on research, education and practice is possible between IPE organisations; • work with other taskforces of The Network: TUFH to share agendas and take forward joint developments; • enhance the website presence of the IPE taskforce and thereby aid communication between meetings; • have co-chairs of the IPE taskforce in order to share the workload and stimulate creative developments - Dawn Forman and Betsy VanLeit (New Mexico); • continue to contribute to the production of the WHO definitions for IPE.
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Position Paper and Mini Workshop A new Position Paper on Interprofessional Education (IPE) was accepted at this year’s Conference in Uganda and is available on the website. The IPE taskforce will be ensuring the objectives set out in the Position Paper are met and are keen to ensure more members get involved. During the Conference Dawn Forman (Chair of the taskforce), Jill Thistlethwaite Marion Jones presented an interprofessional workshop; it was attended by 19 delegates with 11 different countries represented. The delegates gave very positive reviews to the workshop, and during this session (and later taskforce meetings) the following objectives for the year to come were agreed:
During the Uganda Conference the IPE taskforce held a mini workshop
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The necessity for collaboration between health and social care professions and health and welfare/social care agencies arises from the multiple needs of specific groups of service users, the variety of required service responses to these and the need for effective information exchange and discussion with regards to care planning and delivery. The term ‘interprofessional’ is used to denote a team, training ward or student group which contains representation from a number of professions each learning with, from and about each other in order to address the needs of the individuals and specific groups of service users or communities with which they are working. The IPE taskforce focuses on international research, education, learning and practice which facilitates this communication.The IPE taskforce has so far adopted the definition provided by CAIPE as follows: interprofessional education occurs when one or more professions learn with, from and about each other to improve collaboration and the quality of care. It is of interest to note there is a group now working with the WHO and reviewing definitions commonly used with interprofessional working (2007).
For more information - and to get involved - please contact: Dawn Forman, Chair of the IPE taskforce: dawn.forman@btinternet.com 23
Member and organisational News REPRESENTED AT INTERNATIONAL MEETINGS/CONFERENCES The Network: TUFH is being represented at meetings and conferences all over the world. Here is a report of one of our representatives.
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Partnerships Working Together Global Health Council Annual Meeting, Washington DC, May-June 2007 The Global Health Council (GHC) describes itself as ‘the world’s largest membership alliance dedicated to saving lives by improving health throughout the world’. Its membership is comprised of healthcare professionals and organisations that include NGOs, foundations, corporations, Government agencies and academic institutions that work to ensure global health for all. GHC’s mission is “to ensure that all who strive for improvement and equity in health have the information and the resources they need to succeed”. The GHC meeting takes place annually in Washington DC, USA. The attendees were from throughout the world, although the bulk of those from outside of the USA were affiliated with a specific project that was being presented. Over 100 organisations exhibited and offered an opportunity to learn more about the work of some of the NGOs with which I was unfamiliar and which are very interested in partnerships. There was representation from all of the US schools of Public Health that offer an international track, some of which now offer multidisciplinary global health programmes with a medical school component. The theme of this year’s meeting was Partnerships Working Together, and the majority of the sessions were focused on some element of this theme. The sessions were classified as skill building, round table, or concurrent panel. There were also plenary sessions and didactic policy sessions. The topics for most of the sessions involved improving health services; improving performance, increasing health equity, increasing health system capacity or health workforce 24
capacity through partnerships. There were also disease specific and public health domain specific sessions, as well as one on information systems. Partnerships were presented that were based on funding source, target population, disease and geographic region. Much attention was focused on the role of the private sector in developing countries as providers of healthcare services. There were also several presentations on the use of social marketing to improve healthcare access at the community level. I found this meeting very useful in terms of expanding my knowledge of how to document the process of partnering and to assess the outcomes of partnerships between the various sectors of the private and public health and medical systems. There were many opportunities to share information with other attendees and with presenters. I saw numerous opportunities for collaborations with local health professional schools that could be used to model physician/public health collaborations and opportunities for service learning projects in developing countries for students and trainees from more developed ones. Areas of opportunity for The Network: TUFH to expand its involvement were also evident; specifically in healthcare in disasters, refugee health, and health and human rights. Over 200 Network: TUFH and Education for Health brochures were distributed, as well as about 100 Network: TUFH Conference flyers. There seemed to be significant interest as these brochures were picked up very quickly. I did speak with a number of attendees about both the journal and the organisation. In the future I think it would be worthwhile for The Network: TUFH to have a larger presence at the GHC, as it could lead to increased membership - particularly from
The Network: TUFH is being represented at meetings and conferences all over the world: • Global Health Council Annual Meeting, May-June 2007, USA. Represented by Margaret Gadon. • 18th Wonca World Conference, July 2007, Singapore. Represented by Ian Cameron.
the global public health domain - and possibly lead to some expanded opportunities for Network: TUFH partnerships. Margaret Gadon | Programme Director Health Disparities, Department of Medicine and Public Health, American Medical Association, United States of America Email: margaret.gadon@ama-assn.org
Areas of opportunity for The Network: TUFH to expand its involvement were evident; specifically in healthcare in disasters, refugee health, and health and human rights.
RE-ASSESSING FULL MEMBERS Since 1998 Full Member Institutions (FM) are being re-assessed on a regular basis. As part of this re-assessment procedure FM perform a self-evaluation report. The following Full Membership categories are defined: Bronze (successful re-assessment for the first time), Silver (successful re-assessment for the second time), and Gold (successful re-assessment for the third time). In this section you find a summary of a self-evaluation report of an FM that has recently been awarded continuation of its Full Membership; they now are a Silver Full Member. Read more about them in the Network: TUFH Hall of Fame (www.the-networktufh.org).
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• Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia. Silver Full Member
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There are national and international links between the FOM/SCU and other institutions in the field of research and medical education. For example: the Academy of
Other activities include conducting a self study in 2005; establishing the Joint Master of Health Profession Education between Maastricht and FOM/SCU; internal publications as school booklets; editing and reviewing of different national and international publications.
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There is collaboration with the Ministry of Health to use their training sites, help their staff for continuous medical education, and share in delivery of health services to people.
• Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Canada. Silver Full Member
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The problem-based approach adopted at FOM/SCU facilitates the choice of focusing on specific priority health problems. The undergraduate curriculum is dynamic and responsive to changes in the health map.
Teaching, research and services delivered in different departments are oriented to the community. Advancement in medical education is also supported by many projects that are successfully run in the Faculty. The CRD is also contributing to this mission. It offers training opportunities to external faculty in different fields, for example curriculum development, quality assurance, student assessment, et cetera.
It is with pleasure that we would like to inform you that the following Full Members have been awarded (a continuation of their) Full Membership, Up to 2012.
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To address priority health problems of the community, the FOM/SCU established specific regulations in post-graduate research. A research committee within the Faculty has been delegated the authority to review, modify and approve research proposals.
Somaya Hosny and Hassan Al Shatoury | Vice Dean for Education, Director of the CRD; Lecturer of Neurosurgery, Co-Director of CRD | Faculty of Medicine, Suez Canal University, Egypt Email: crdmed@ismailia.ic-eg.com
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The community-based activities represent 35 to 40% of total curriculum hours. Activities are conducted in different settings, including primary healthcare centres, district and city hospitals, university hospitals, occupational clinics, geriatric homes and school clinics besides family visits at the five-governorate Suez Canal area.
The Centre for Research and Development in medical education (CRD) was re-designated many times as a WHO collaborating centre; the last period was from 2005-2009. The CRD conducts two annual international workshops to support community-based education and problem-based learning, and to support development in human resources, management and leadership.
Community field work
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Scientific Research and Technology, the Network of Arabian Universities, National Institute of Health, Komouto University, Maryland University, Maastricht University and others.
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The updated mission statement of the Faculty of Medicine, Suez Canal University (FOM/SCU) is “to create an educational system aiming at graduating a competent physician able to meet satisfactorily the individual and community health needs, not only at the local level but also at the international level”. Carrying the responsibility to support innovations in medical education, the FOM/SCU established a Department of Medical Education in 2001. FOM/ SCU was the first one in this field in Egypt and the Middle East. The department offers a Master and Doctorate degree in Health Professions Education.
• School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. Silver Full Member
• College of Medicine at Rockford, University of Illinois, Rockford IL, United States of America. Silver Full Member 25
Member andPROFESSIONS organisational News INTERNATIONAL HEALTH EDUCATION ABOUT OUR MEMBERS Problem-based leArning and community-based education Occasionally the Network: TUFH Alert is being used for members (or Network: TUFH relations) who ask for help from the Network: TUFH membership. Here we give you the results from these ‘quests’. Erica Bell requested information on design and development of rural and remote competencies for doctors, nurses, and pharmacists, as well as other health.
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Rural and remote medical, nursing, and allied health competencies are a live issue around the world, and many educators are vitally interested in learning about best practice for developing them. Well-designed competencies can help meet the goal of preparing willing and able practitioners for these underserved communities.
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An Australian project has collected publiclyavailable statements of rural and remote competencies, and investigated best practice in the development of such competencies. Of course, rural and remote health practice can mean very different things in different countries. This project was less about the content of the competencies than best practice in methods for developing them.
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Many Network: TUFH members provided directions to publicly available competencies for this project. As their responses also often asked for suggestions for resources, I thought I would pass on some of the key ones for this Newsletter, as a way of saying thank you. At the international level, the WONCA website offers policy and definitional statements on rural medicine at www.globalfamilydoctor. com/aboutWonca/working_groups/rural_ training/wonca-ruralpractice.asp?refurl=wg The most well developed model of rural and remote curriculum is by the Australian Council for Rural and Remote Education; it is now accredited by the Australian Medical Council. This document is called the Primary Curriculum for Rural and Remote Medicine (Edition 3) and is available electronically on www. acrrm.org.au/main.asp?NodeID=29291 Their website at www.acrrm.org.au also offers a fund of resources for educators in this area.
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The Royal Australian College for General Practitioners has also developed some postgraduate curriculum documents, which can be obtained by contacting them directly (see www.racgp.org.au). The Society of Rural Physicians of Canada and the College of Family Physicians of Canada have published position and other papers (available at www.srpc.ca and then going to their electronic library), which are helpful reading for rural and remote educators. Network: TUFH members might also like to look at publications from the CanMEDS project which was about enhancing specialist training in rural settings through adapting specialist competency frameworks developed by the Royal College of Physicians and Surgeons of Canada to non-urban medical education. I would recommend: ROURKE, J., FRANK, J.R. (2005). Implementing the CanMEDS physician roles in rural specialist education: the multi-speciality community training network. Rural and Remote Health 5 (online);406. Available at www.rrh.org.au/articles/showarticlenew. asp?ArticleID=406 For those wanting to build practical skills in developing competencies I would recommend: PRIDEAUX, D. (2003). ABC of learning and teaching in medicine: Curriculum design. British Medical Journal, 326, 268-270. Available at www.bmj.com/cgi/search?ful ltext=prideaux&x=14&y=7 NEWBLE, D., STARK, P., BAX, N., et al. (2005). Developing an outcome-focussed core curriculum. Medical Education;39(7):680-687. www.blackwell-synergy.com/loi/MED
Dr. Erica Bell
MASH, B., COUPER, I. & Hugo, J. (2006). Building consensus on clinical procedural skills for South African family medicine training using the Delphi technique. South African Family Practice; 48 (10). Available at www.safpj.co.za/index.php/safpj/article/ viewPDFInterstitial/602/622 However, there are very few papers available on the specific issues of developing rural and remote competencies in medical curricula. An earlier paper by me and my colleagues offers an overview of some rural health education curriculum design issues: BELL, E., MACCARRICK, G., PARKER, L. & ALLEN, R. (2005). ‘Lost in translation’?: Developing assessment criteria that value rural practice. Rural and Remote Health, 5 (online) 420. Available at http://rrh.deakin.edu. au/articles/subviewnew.asp?ArticleID=420 The papers forthcoming from the now completed Australian competencies project aim to meet needs for better theorisation of, and practical directions for, developing rural and remote competencies. I will write again to let Network: TUFH members know when and where they are available. My experience working on this project has shown me that many rural and remote health educators are eager to examine international models, and what multidisciplinary competencies research has to offer, while keeping their gazes firmly fixed on the needs of their own communities. Getting that balance right is what the art of developing good competencies is all about. Erica Bell | Academic Research Leader and Research Fellow, University Department of Rural Health, University of Tasmania, Australia Email: erica.bell@utas.edu.au
INTERNATIONAL HEALTH PROFESSIONS EDUCATION Problem-based leArning and community-based education
A Passion for... ‘Make the most of today. Get interested in something. Shake yourself awake. Develop a hobby. Let the winds of enthusiasm sweep through you. Live today with gusto!’ Dale Carnegie, American lecturer/author, 18881955
‘He was to enjoy the soup, I got my shell...’
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Wherever I am on the globe I cannot resist looking around for snails. For instance, I knew that Ghana harbours the Giant African Snail (Achatina achatina), the largest land snail in the world. Last year kind colleagues accompanied me in Accra to a roadside vendor of living individuals of this species. The snails are sold there because Ghanaians use the animal to cook a great soup. I selected and bought one with a snail height of 15 cm, posing here with me on the photo. A minute after the picture was taken, and to my horror, the vendor pulled the living (!) snail from its shell. He was to enjoy the soup, I got my shell...
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What yields the excitement that turned this hobby into a passion? Let me give you an example. On comparison of our 1987 data with those published in the early 1950’s, one snail species of just three mm and at that time quite common on Saint Peter’s Mountain seemed to have disappeared from the hill in the 1980’s. We ascribed this phenomenon to desiccation of the hill, due to its proceeding excavation by a local cement industry. Later we undertook to test this hypothesis by an attempt to recover this species from a non-excavated twin hill close to Saint Peter’s Mountain, where it had also been found in the 1950’s. The result of this study was quite unexpected. This time we found three shells of the ‘lost species’ at one locality on Saint Peter’s Mountain, but we
failed to recover any from the twin hill. We published the data but could not provide any satisfactory explanation for this puzzle. However, just two years later I learned from an article in my local newspaper that hydrologists had shown that a canal dug in Belgium in the 1930’s and cutting through both hills to be responsible for a greatly reduced humidity of both hills. Eureka! And a good reason to write another paper, now providing an acceptable explanation for our earlier observations.
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sort of drudgery. Since 1985 Bert and I published ten papers on the snail fauna of Saint Peter’s Mountain and its surroundings. With Bert’s son Jelle and his friend Arjen (both Biology students) we are currently redoing the 1987 inventory, which has already yielded two species not found on the hill before. I have also linked up with a few other malacologists in my region and in 2010 we expect to publish a Distribution atlas of snails and slugs in the Dutch province of Limburg.
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When in 1983 I had obtained my PhD and BtA (‘Been to America’) degrees I commenced looking at land snails on Saint Peter’s Mountain, a limestone hill of 110 m close to my house, and a habitat unique to the Netherlands. Most of the 40-odd snail species found there are smaller than five mm and it takes special techniques to collect them. My explorations were boosted by meeting someone with the same interest: Dr. Bert Lever, a peer biologist and at that time librarian at my university. By combining our individual data we could publish in 1987 an inventory of the snail fauna of Saint Peter’s Mountain, which gained importance by comparison with data from similar studies performed since the 19th century by other ‘malacologists’ (i.e. experts on molluscs). Actually, the fact that papers on natural history may be appreciated much longer than those on topical medical biology has certainly contributed to my dedication to this
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The passion of Gerard Majoor, Associate Secretary General of The Network: TUFH: I have a passion for land snails. Not the collection of as many species as possible, but to try to understand their ecology: why certain species live in certain habitats, and others not, and for what reasons. My love for nature in general was aroused by my grandfather and my parents, who took me as a young boy for long walks in the dunes lining the Dutch coast. This acquired interest later made me choose Biology for my academic studies. However, to secure a living, I did my Master’s in Medical Biology rather than in Ecology and I eventually specialised in Immunology.
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Tribute to… * At the three-annual world conference for family doctors organised by the World Organisation of Family Doctors (WONCA) in Singapore, Arthur Kaufman - the present Secretary General of The Network: TUFH - was awarded the WONCA World Award for Excellence in Healthcare: The 5-Star Doctor 2007. Dr. Kaufman is the second doctor to be given this prestigious award; the first awardee was Jan de Maeseneer, Dr. Kaufman’s successor to the function of Secretary General of The Network: TUFH. We are most proud to have the 5-Star Doctor 2004 ánd 2007 in our midst! A 5-Star Doctor should fulfill at least five essential functions: (s)he is a care provider, decision maker, health advisor, community leader, and team member. (S)he has had significant impact on healthy care of individuals and community at the level of regional or global development, and demonstrated a community perspective and networked for the development of innovative services. The 5-Star Doctor has an interest in disadvantaged areas and demonstrated support of colleagues in international settings while maintaining academic leadership. Dr. Kaufman is considered to be an excellent role model that represents all the above mentioned features. The citation praised especially his scholarly and international leadership; in the award ceremony laudation, Chris van Weel (President of Wonca) also highlighted Dr. Kaufman’s care for the community and his qualities as a team player and communicator. The Network: TUFH congratulates Arthur Kaufman with this honourable distinction. * At the Annual Conference of the American Public Health Association (APHA), held in November 2007, Jaime Gofin (School of Public Health and Community Medicine, Hadassah-Hebrew University, Jerusalem) received the 2007 Gordon Wyon Award of 28
the Community Based Primary Health Care. The award is intended to reward outstanding achievement in community-oriented public health epidemiology and practice. John Gordon and John Wyon were pioneers in this field, so encouraging and recognising others in this field is one important way of honoring their memory. The evaluation criteria for this award include: the candidate must have had a central role in an outstanding achievement in community-oriented public health and practice; the candidate must have demonstrated creativity in expanding the concepts pertinent to the practice of community-oriented public health with an international focus; and the candidate must have membership in APHA or one of its affiliates (either a State affiliate or a national public health association that is a member of the World Federation of Public Health Associations). * On the 25th of Agust the Catholic University of Mozambique (UCM) celebrated the graduation of 198 students in Beira, Sofala, Mozambique. It concerned the Medical Faculty, the Faculty of Economics & Management, and the Centre for Distance Education. Because of several reasons this was a special event: • The founding of the UCM in 1996 is a direct result of the 1993 peace agreement of Rome, which ended a long and devastating civil war in Mozambique. The main objective of the UCM is helping to develop higher education in Central and Northern Mozambique. • For the first time in history the UCM will graduate Medical Doctors, Bachelors in different areas after following a distance education programme, and Masters in Bussiness Administration. • In Mozambique there are only 600 medical doctors (of which 300 Mozambican) for a total population of 17 million. The UCM starts to contribute to aument this number significantly in the coming years. • Most graduates used Problem-based Leaning (PBL) as their educational approach. PBL is an new and innovative methodology in the African setting.
The Network towards unity for health Newsletter Volume 26 | no. 2 | December 2007 ISSN 1571-9308 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
New Members Full Members • Northern Ontario School of Medicine, Sudbury, •C anada
Individual Members • Mr. Marwan Kastelany, Faculty of Medicine, Mulawarman University, Samarinda, Indonesia • Mr. Ronald Omenge Obwoge, Faculty of Medicine, Egerton University, Egerton, Nakuru, Kenya • Dr. Rosebella Ogutu Onyango, School of Public Health and Community Development, Maseno University, Maseno, Nyanza, Kenya • Dr. Kaleemullah Thahim, Dow University of Health Sciences, Karachi, Pakistan • Dr. Mohamed S. El-Tawil, Weill Cornell Medical College Qatar, Hamad Medical Corperation, Doha, Qatar • Mr. Shai Elliot Nkoana, Faculty of Health Sciences, University of Venda, Thohoyandou, Republic of South Africa • Dr. Dawn Forman, Dawn Forman Consultancy, Sheffield, United Kingdom